Lifestyle Medicine Research and Implementation in Chronic Kidney Disease

The focus of this chapter is on the evidence-based landscape describing the impact of two of the most important lifestyle components—healthy eating and physical activity—on chronic kidney disease (CKD) in adults in the stable outpatient setting. The interaction between cardiovascular disease (CVD) and kidney disease is increasingly recognized, particularly with the cardiovascular kidney metabolic health description. Healthy weight is a key element of Life’s Essential 8 because overweight and obesity are at the core of cardiovascular kidney metabolic syndrome. Dysfunctional fat characteristic of visceral or central overweight and obesity are associated with multiple pathologic processes mediated by pro-inflammatory macrophages; adipokines; oxidative stress; insulin resistance; endothelial dysfunction; and in turn, a vicious cycle of T2D, hypertension, dyslipidemia, CVD, and kidney disease. The existing evidence base strongly supports the impact of healthy eating and physically active living on chronic disease prevention, including CKD risk factors, CKD incidence, and CKD progression. Thus, lifestyles that promote cardiovascular health will also universally promote kidney health, with some caveats regarding CKD complications such as hyperkalemia and hyperphosphatemia. Nevertheless, there are still significant research gaps that need to be closed in order to optimize the implementation of lifestyle interventions in the CKD population.