title: Physical activity is associated with decreased incidence of chronic kidney disease in type 2 diabetes patients: a retrospective cohort study in Taiwan.
abstract: OBJECTIVE
  To assess the effect of physical activity in patients with type 2 diabetes mellitus on prevention of diabetes with chronic kidney disease.
  
  
  METHODS
  This is a cohort study on stratified selected subjects in Taiwan from 2004/01/01 to 2005/12/31. Demographic data, lifestyle factors and clinical characteristics were analyzed for an association with the occurrence of chronic kidney disease. Applicable analysis weights, Stata 11.0, were applied to adjust the design variables for clustering and stratification.
  
  
  RESULTS
  During the two year study period, the univariate Cox proportional hazards model showed significant associations of age, physical activity, and the Charlson comorbidity index (CCI) with chronic kidney disease. Physical activity had a beneficial effect in diabetic subjects with chronic kidney disease (HR: 0.31, p<0.01). Older age and a CCI greater than 2 were both harmful in diabetic subjects with chronic kidney disease (1.06 and 3.44, respectively). The results of a multivariate Cox proportional hazards evaluation model were similar to those of a univariate evaluation model, except that CCI was not significantly different. Moreover, medications for hypertension of diabetic subjects created an increased risk of chronic kidney disease (HR: 5.85 and 3.74, respectively), indicating that the presence of hypertension is a strong risk factor for the progression of chronic kidney disease.
  
  
  CONCLUSIONS
  In this study, physical activity was not only a healthful lifestyle factor but also a treatment to decrease incidence of chronic kidney disease in diabetic patients.
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Nutrition, Chung Shan Medical University, Taichung, Taiwan; Department of Nutrition, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Hsing-Chun
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Division of Basic Medical Science, Hungkuang University, Taichung, Taiwan.
authors.forename: Chiung-Huei
authors.initials: CH
authors.lastname: Peng
authors.affiliation: The School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Jeng-Yuan
authors.initials: JY
authors.lastname: Chiou
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. Electronic address: cshy049@gmail.com.
authors.forename: Chien-Ning
authors.initials: CN
authors.lastname: Huang
mesh_terms: D000368:Aged; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D065840:Protective Factors; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
keywords: Chronic kidney disease; Cohort study; Physical activity; Stratification