Within and post-trial effects of an intensive lifestyle intervention on kidney disease in adults with overweight or obesity and type 2 diabetes mellitus: a secondary analysis of the Look AHEAD clinical trial
Primary result · Incidence of eGFR <45 mL/min/1.73 m²Result — go to the resultHazard ratio 0.80 95% CI 0.66–0.98Authors' conclusion
ILI reduced kidney disease progression during and following the active intervention in persons aged ≥60 years. ILI should be considered for reducing kidney disease incidence in older persons with type 2 diabetes.
Study context
- Population
- Adults aged 45–76 years with T2D and overweight/obesity
- Participants
- 2,570 vs 2,575
- Comparison
- Intensive lifestyle intervention vs diabetes support and education
- Intensive lifestyle intervention (ILI)n = 2,570
- Diabetes support and education (DSE)n = 2,575reference
- Primary endpoint
- Kidney disease (trial's secondary outcome): decline in eGFR to <45 mL/min/1.73 m² or need for kidney replacement therapy (KRT: dialysis or kidney transplant)
- Follow-up
- During intervention and post-intervention (median 15.6 years overall)
Methodological detailspost-intervention follow-up, prespecified subgroup analyses
- Post-intervention follow-up
- Prespecified subgroup analyses
Primary result
Incidence of eGFR <45 mL/min/1.73 m² · during the intervention
Hazard ratio
0.80
95% CI 0.66–0.98
As reported in the abstract
Secondary outcomes
| Outcome | HR (CI) | |
|---|---|---|
| eGFR <45 mL/min/1.73 m² · post-intervention | 1.03 (0.86–1.23) | |
| eGFR <45 mL/min/1.73 m² · overall | 0.92 (0.80–1.04) | |
| 0.512Hazard ratio (log scale) |
KRT (dialysis or kidney transplant)
- No significant treatment group differences in KRT
Age × treatment interaction · total follow-up
- Interaction for estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m²
- P = 0.001
- Interaction for KRT
- P = 0.01
- Prespecified subgroup analyses
Participants aged >60 years at baseline (n=2205) · during intervention and overall
- Benefit in eGFR <45 mL/min/1.73 m², HR
- 0.75 (0.62 to 0.90) (95% CI)
- Benefit in KRT, HR
- 0.62 (0.43 to 0.91) (95% CI)
- Prespecified subgroup analyses
Absolute treatment effects, participants aged >60 years · during and post-intervention
cases/100 person-years
- ILI reduced rate of eGFR <45 mL/min/1.73 m², during intervention
- 0.46
- ILI reduced rate of eGFR <45 mL/min/1.73 m², post-intervention
- 0.76
- ILI reduced KRT, during intervention
- 0.15
- ILI reduced KRT, post-intervention
- 0.21
- Absolute effects greater post-intervention
Younger participants · post-intervention
- No post-intervention benefits in younger participants
Original publication
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