Exercise intensity and the risk of end-stage renal disease in diabetes: A nationwide population-based study.

Abstract

Background: Exercise plays a key role in managing chronic conditions such as diabetes mellitus (DM), a major contributor to end-stage renal disease (ESRD), a serious public health issue.

Aim: To investigate the relationship between exercise intensity, DM duration, and ESRD incidence.

Methods: This retrospective cohort study analyzed data from 2495031 individuals with DM who underwent the Korean National Health Screening between 2015 and 2016, with follow-up through 2022. The Cox proportional hazards model was adjusted for confounders, including age, sex, income, smoking, and baseline comorbidities.

Results: Longer DM duration was associated with a significantly higher risk of ESRD, with durations ≥ 10 years showing the highest risk [hazard ratio (HR): 2.624, 95% confidence interval (CI): 2.486-2.770]. Increased exercise intensity reduced the risk of developing ESRD across all diabetes duration groups, with the highest exercise category (≥ 1500 metabolic equivalents of task-min/week) demonstrating a protective effect compared to that of no exercise (HR: 0.837, 95%CI: 0.791-0.886). Exercise benefits were more pronounced in patients without hypertension, non-smokers, and those with lower alcohol consumption. Additionally, ESRD risk reduction was significant among patients with a body mass index ≥ 25 and those without proteinuria or chronic kidney disease.

Conclusion: Longer diabetes duration is associated with increased ESRD risk, while high-intensity exercise may mitigate this risk. These findings suggest promoting exercise is important for managing diabetes to reduce renal complications.