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Benefits of a 12-week lifestyle modification program including diet and combined aerobic and resistance exercise on albuminuria in diabetic and non-diabetic Japanese populations

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Abstract

Background

Albuminuria is a biomarker for chronic kidney disease and an independent predictor of cardiovascular and all-cause mortality. A recent meta-analysis concluded that these risks increase with urinary albumin concentration, even when below the microalbuminuria threshold. Thus, minimizing urinary albumin may be a valuable therapeutic goal regardless of disease status.

Methods

We investigated the benefits and safety of a 12-week lifestyle modification program including diet and combined aerobic and resistance exercise for reducing albuminuria in 295 normoalbuminuric or microalbuminuric Japanese adults, including 30 with type 2 diabetes mellitus (T2DM), 104 with metabolic syndrome (MS), and 145 with hypertension (HT).

Results

In the study population, the urinary albumin:creatinine ratio (UACR) was reduced significantly (ΔUACR −3.8 ± 16.8 mg/g, P < 0.001) with no change in estimated glomerular filtration rate (eGFR) (ΔeGFR −0.4 ± 7.4 mL/min/1.73 m2, P = 0.343). The reduction in UACR was associated with decreased fasting plasma glucose (P < 0.05). The UACR was also reduced in the T2DM, MS, and HT groups with no change in eGFR. Reduced UACR was associated with decreased fasting plasma glucose in the MS group and decreased systolic blood pressure in the HT group. The UACR was also reduced in 46 subjects using renin–angiotensin system inhibitors with no change in eGFR.

Conclusions

Our 12-week lifestyle modification program reduced UACR, maintained eGFR, and improved multiple fitness findings in Japanese subjects including T2DM, MS, and HT patients.

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References

  1. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–266.

  2. Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med. 1984;310:356–60.

    Article  CAS  PubMed  Google Scholar 

  3. Locatelli F, Pozzoni P, Del Vecchio L. Renal manifestations in the metabolic syndrome. J Am Soc Nephrol. 2006;17:S81–5.

    Article  PubMed  Google Scholar 

  4. Parving HH, Mogensen CE, Jensen HA, Evrin PE. Increased urinary albumin-excretion rate in benign essential hypertension. Lancet. 1974;1:1190–2.

    Article  CAS  PubMed  Google Scholar 

  5. Hillege HL, Fidler V, Diercks GF, van Gilst WH, de Zeeuw D, van Veldhuisen DJ, Gans RO, Janssen WM, Grobbee DE, de Jong PE. Prevention of renal and vascular end stage disease (PREVEND) study group. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation. 2002;106:1777–82.

    Article  CAS  PubMed  Google Scholar 

  6. Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J, Gansevoort RT. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375:2073–81.

    Article  Google Scholar 

  7. Palmer BF. Proteinuria as a therapeutic target in patients with chronic kidney disease. Am J Nephrol. 2007;27:287–93.

    Article  PubMed  Google Scholar 

  8. Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, Fowler S, Diabetes Prevention Program Research Group. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005;142:611–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.

    Article  CAS  PubMed  Google Scholar 

  10. Church TS, Blair SN, Cocreham S, Johannsen N, Johnson W, Kramer K, Mikus CR, Myers V, Nauta M, Rodarte RQ, Sparks L, Thompson A, Earnest CP. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2010;304:2253–62.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Davidson LE, Hudson R, Kilpatrick K, Kuk JL, McMillan K, Janiszewski PM, Lee S, Lam M, Ross R. Effects of exercise modality on insulin resistance and functional limitation in older adults: a randomized controlled trial. Arch Intern Med. 2009;169:122–31.

    Article  PubMed  Google Scholar 

  12. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–52.

    Article  PubMed  Google Scholar 

  13. James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obes Res. 2001;9:228S–33S.

    Article  PubMed  Google Scholar 

  14. Whitworth JA. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21:1983–92.

    Article  PubMed  Google Scholar 

  15. Cubeddu LX, Alfieri AB, Hoffmann IS. Lowering the threshold for defining microalbuminuria: effects of a lifestyle-metformin intervention in obese “normoalbuminuric” non-diabetic subjects. Am J Hypertens. 2008;21:105–10.

    Article  CAS  PubMed  Google Scholar 

  16. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A. Collaborators developing the Japanese equation for estimated GFR. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.

    Article  CAS  PubMed  Google Scholar 

  17. Ibsen H, Olsen MH, Wachtell K, Borch-Johnsen K, Lindholm LH, Mogensen CE, Dahlöf B, Devereux RB, de Faire U, Fyhrquist F, Julius S, Kjeldsen SE, Lederballe-Pedersen O, Nieminen MS, Omvik P, Oparil S, Wan Y. Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertension study. Hypertension. 2005;45:198–202.

    Article  CAS  PubMed  Google Scholar 

  18. Araki S, Haneda M, Koya D, Hidaka H, Sugimoto T, Isono M, Isshiki K, Chin-Kanasaki M, Uzu T, Kashiwagi A. Reduction in microalbuminuria as an integrated indicator for renal and cardiovascular risk reduction in patients with type 2 diabetes. Diabetes. 2007;56:1727–30.

    Article  CAS  PubMed  Google Scholar 

  19. Babazono T, Nyumura I, Toya K, Hayashi T, Ohta M, Suzuki K, Kiuchi Y, Iwamoto Y. Higher levels of urinary albumin excretion within the normal range predict faster decline in glomerular filtration rate in diabetic patients. Diabetes Care. 2009;32:1518–20.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Gaede P, Tarnow L, Vedel P, Parving HH, Pedersen O. Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes and microalbuminuria. Nephrol Dial Transplant. 2004;19:2784–8.

    Article  PubMed  Google Scholar 

  21. MacIsaac RJ, Ekinci EI, Jerums G. Progressive diabetic nephropathy. How useful is microalbuminuria?: contra. Kidney Int. 2014;86:50–7.

    Article  PubMed  Google Scholar 

  22. Hao Z, Konta T, Takasaki S, Abiko H, Ishikawa M, Takahashi T, Ikeda A, Ichikawa K, Kawata S, Kato T, Kubota I. The association between microalbuminuria and metabolic syndrome in the general population in Japan: the Takahata study. Intern Med. 2007;46:341–6.

    Article  PubMed  Google Scholar 

  23. Tanaka S, Takase H, Dohi Y, Kimura G. The prevalence and characteristics of microalbuminuria in the general population: a cross-sectional study. BMC Res Notes. 2013;6:256.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Wang X, Armando I, Upadhyay K, Pascua A, Jose PA. The regulation of proximal tubular salt transport in hypertension: an update. Curr Opin Nephrol Hypertens. 2009;18:412–20.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Lewis EJ, Lewis JB. Treatment of diabetic nephropathy with angiotensin II receptor antagonist. Clin Exp Nephrol. 2003;1:1–8.

    Article  Google Scholar 

  26. Spanos G, Kalaitzidis R, Karasavvidou D, Pappas K, Siamopoulos KC. Efficacy of aliskiren and valsartan in hypertensive patients with albuminuria: a randomized parallel-group study. J Renin Angiotensin Aldosterone Syst. 2013;14:315–21.

    Article  CAS  PubMed  Google Scholar 

  27. Bellinghieri G, Savica V, Santoro D. Renal alterations during exercise. J Ren Nutr. 2008;1:158–64.

    Article  Google Scholar 

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Acknowledgments

We thank Dr. Masao Hashiba for expert advice, and Miwa Mitome and Kimie Ishizumi for technical assistance.

Conflict of interest

The authors have declared that no conflict of interest exists.

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Authors and Affiliations

  1. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Keiko Yamamoto-Kabasawa, Yusuke Yata & Ichiei Narita

  2. Department of Clinical Nutrition Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Michihiro Hosojima

  3. Niigata Institute for Health and Sports Medicine, 67-12 Seigoro, Chuo-ku, Niigata, Niigata, 950-0933, Japan

    Mariko Saito, Noriko Tanaka & Masaaki Arakawa

  4. Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Junta Tanaka

  5. Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture, 471 Ebigase, Higashi-ku, Niigata, Niigata, 950-8680, Japan

    Naohito Tanabe

  6. Department of Applied Molecular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Akihiko Saito

Authors
  1. Keiko Yamamoto-Kabasawa
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  2. Michihiro Hosojima
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  3. Yusuke Yata
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  4. Mariko Saito
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  5. Noriko Tanaka
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  6. Junta Tanaka
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  7. Naohito Tanabe
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  8. Ichiei Narita
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  9. Masaaki Arakawa
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  10. Akihiko Saito
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Corresponding author

Correspondence to Akihiko Saito.

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Yamamoto-Kabasawa, K., Hosojima, M., Yata, Y. et al. Benefits of a 12-week lifestyle modification program including diet and combined aerobic and resistance exercise on albuminuria in diabetic and non-diabetic Japanese populations. Clin Exp Nephrol 19, 1079–1089 (2015). https://doi.org/10.1007/s10157-015-1103-5

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  • DOI: https://doi.org/10.1007/s10157-015-1103-5

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