title: Dietary restriction and exercise for diabetic patients with chronic kidney disease: a systematic review.
abstract: BACKGROUND
  Obesity and sedentary lifestyle are major health problems and key features to develop cardiovascular disease. Data on the effects of lifestyle interventions in diabetics with chronic kidney disease (CKD) have been conflicting.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Diabetes patients with CKD stage 3 to 5. SEARCH STRATEGY AND SOURCES: Medline, Embase and Central were searched to identify papers.
  
  
  METHODS
  Effect of a negative energy balance on hard outcomes in diabetics with CKD.
  
  
  RESULTS
  Death, cardiovascular events, glycaemic control, kidney function, metabolic parameters and body composition.
  
  
  RESULTS
  We retained 11 studies. There are insufficient data to evaluate the effect on mortality to promote negative energy balance. None of the studies reported a difference in incidence of Major Adverse Cardiovascular Events. Reduction of energy intake does not alter creatinine clearance but significantly reduces proteinuria (mean difference from -0.66 to -1.77 g/24 h). Interventions with combined exercise and diet resulted in a slower decline of eGFR (-9.2 vs. -20.7 mL/min over two year observation; p<0.001). Aerobic and resistance exercise reduced HbA1c (-0.51 (-0.87 to -0.14); p = 0.007 and -0.38 (-0.72 to -0.22); p = 0.038, respectively). Exercise interventions improve the overall functional status and quality of life in this subgroup. Aerobic exercise reduces BMI (-0.74% (-1.29 to -0.18); p = 0.009) and body weight (-2.2 kg (-3.9 to -0.6); p = 0.008). Resistance exercise reduces trunk fat mass (-0,7±0,1 vs. +0,8 kg ±0,1 kg; p = 0,001-0,005). In none of the studies did the intervention cause an increase in adverse events.
  
  
  CONCLUSIONS
  All studies used a different intervention type and mixed patient groups.
  
  
  CONCLUSIONS
  There is insufficient evidence to evaluate the effect of negative energy balance interventions on mortality in diabetic patients with advanced CKD. Overall, these interventions have beneficial effects on glycaemic control, BMI and body composition, functional status and quality of life, and no harmful effects were observed.
authors.affiliation: Department of Endocrinology, Ghent University Hospital, Ghent, Belgium; European Renal Best Practice (ERBP), Ghent University Hospital, Ghent, Belgium.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Van Huffel
authors.affiliation: The Richard Bright Kidney Unit, Southmead Hospital, Bristol, United Kingdom.
authors.forename: Charles R V
authors.initials: CR
authors.lastname: Tomson
authors.affiliation: Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Johannes
authors.initials: J
authors.lastname: Ruige
authors.affiliation: European Renal Best Practice (ERBP), Ghent University Hospital, Ghent, Belgium; Nephrology Department, "Dr. C.I. Parhon" University Hospital, University of Medicine and Pharmacy "Gr. T. Popa," Iasi, Romania.
authors.forename: Ionut
authors.initials: I
authors.lastname: Nistor
authors.affiliation: European Renal Best Practice (ERBP), Ghent University Hospital, Ghent, Belgium; Renal Division, Ghent University Hospital, Ghent, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
authors.affiliation: European Renal Best Practice (ERBP), Ghent University Hospital, Ghent, Belgium; CNR-Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Bolignano
mesh_terms: D002986:Clinical Trials as Topic; D048909:Diabetes Complications / Q000178:diet therapy* / Q000503:physiopathology*; D003927:Diet, Diabetic; D015444:Exercise; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*