Association of different domains of physical activity with diabetic kidney disease: a population-based study

Abstract

Background: The aim of this cross-sectional study was to elucidate the associations between various domains of physical activity, such as occupation-related (OPA), transportation-related (TPA), leisure-time (LTPA) and overall physical activity (PA), and diabetic kidney disease.

Methods: Our study encompassed 2,633 participants, drawn from the cross-sectional surveys of the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018, and employed survey-weighted logistic regression, generalized linear regression, and restricted cubic spline (RCS) analyses to ascertain the relationship between different domains of physical activity and diabetic kidney disease.

Results: After controlling for all confounders, multivariate logistic regression analyses revealed a lack of correlation between the various domains of physical activity and the prevalence of diabetic kidney disease. Multiple generalized linear regression analyses showed that durations of PA (β = 0.05, 95% CI, 0.01-0.09, P = 0.012) and TPA (β = 0.32, 95% CI, 0.10-0.55, P = 0.006) were positively associated with eGFR levels; and LTPA durations were inversely associated with UACR levels (β = -5.97, 95% CI, -10.50 - -1.44, P = 0.011). The RCS curves demonstrated a nonlinear relationship between PA, OPA, and eGFR, as well as a nonlinear correlation between PA and ACR. Subgroup and sensitivity analyses largely aligned with the outcomes of the multivariate generalized linear regression, underscoring the robustness of our findings.

Conclusion: Our population-based study explored the association between different domains of physical activity and diabetic kidney disease. Contrary to our expectations, we found no significant association between the duration of physical activity across all domains and the prevalence of diabetic nephropathy. Nonetheless, renal function markers, including eGFR and UACR, exhibited significant correlations with the duration of total physical activity (TPA) and leisure-time physical activity (LTPA), respectively, among diabetic patients. Interestingly, our findings suggest that diabetic patients engage in physical activity to preserve renal function, ensuring moderate exercise durations not exceeding 35 hours per week.

Keywords: National health and nutrition examination survey (NHANES); diabetes; diabetic kidney disease; domain-specific physical activity; kidney function.

Figure 1

Flow diagram of the included survey participants.

Figure 2

The relationship between physical activity and DKD. Multivariable model 1 was adjusted for age and sex; Multivariable model 2 was adjusted for age, sex, Race/ethnicity, Marital status, Education, PIR, Smoking and BMI. Multivariable model 3 was adjusted for age, sex, Race/ethnicity, Marital status, Education, PIR, Smoking, BMI, Hypertension, Heart, Cancer, Stroke and Liver. OPA, occupation-related physical activity; TPA, transportation-related physical activity; LTPA, leisure-time physical activity; PA, total physical activity.

Figure 3

Multivariate linear regression analysis of physical activity in relation to kidney biomarkers. Multivariable model 1 was adjusted for age and sex; Multivariable model 2 was adjusted for age, sex, Race/ethnicity, Marital status, Education, PIR, Smoking and BMI. Multivariable model 3 was adjusted for age, sex, Race/ethnicity, Marital status, Education, PIR, Smoking, BMI, Hypertension, Heart, Cancer, Stroke and Liver. OPA, occupation-related physical activity; TPA, transportation-related physical activity; LTPA, leisure-time physical activity; PA, total physical activity; eGFR, estimated Glomerular Filtration Rate; ACR, Albumin/Urine Creatinine Ratio.

Figure 4

Non-linear association between physical activity and kidney biomarkers by the restricted cubic spline model. OPA, occupation-related physical activity; TPA, transportation-related physical activity; LTPA, leisure-time physical activity; PA, total physical activity; eGFR, estimated Glomerular Filtration Rate; ACR, Albumin/Urine Creatinine Ratio.