Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2025; 16(7): 108344
Published online Jul 15, 2025. doi: 10.4239/wjd.v16.i7.108344
Exercise intensity and the risk of end-stage renal disease in diabetes: A nationwide population-based study
Eun Hui Bae, Sang Yup Lim, Bong-Seong Kim, Kyung-Do Han, Sang Heon Suh, Hong Sang Choi, Chang Seong Kim, Seong Kwon Ma, Soo Wan Kim
Eun Hui Bae, Sang Heon Suh, Hong Sang Choi, Chang Seong Kim, Seong Kwon Ma, Soo Wan Kim, Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, South Korea
Sang Yup Lim, Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, South Korea
Bong-Seong Kim, Kyung-Do Han, Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, South Korea
Co-first authors: Eun Hui Bae and Sang Yup Lim.
Co-corresponding authors: Kyung-Do Han and Soo Wan Kim.
Author contributions: Bae EH, Han KD and Kim SW conceived and designed the study; Bae EH and Lim SY participated in drafting the manuscript and provided revision and final editing. All authors analyzed the data, and reviewed the manuscript. All authors contributed to the article and approved the submitted the manuscript. Bae EH and Lim SY contributed equally to this work as co-first authors. Prof. Han KD was primarily responsible for the study’s conception, design, and data extraction, serving as the technical lead throughout the project. Prof. Kim SW secured the research funding, oversaw the study’s overall progress, and coordinated communications among all contributors. Both authors played essential and complementary roles. Prof. Han KD focusing on scientific execution and data integrity, and Prof. Kim SW ensuring project feasibility, direction, and interdisciplinary collaboration. Given their shared leadership and equal responsibility in the development and completion of the study, co-corresponding authorship accurately reflects their respective contributions and is fully justified for transparency and acknowledgment of their roles.
Supported by National Research Foundation of Korea (NRF) grant funded by the Korean Government (MSIT), No. RS-2023-00217317; Chonnam National University Grant, No. 2024-0444-01; and Chonnam National University Hospital Institute for Biomedical Science, No. BCRI24032.
Institutional review board statement: The study was approved by the Institutional Review Board of Chonnam National University Hospital (CNUH-EXP-2023-183).
Informed consent statement: The review board waived the need for written informed consent because the data were anonymous and de-identified. The institutional review board of the Korean Centers for Disease Control approved the KNHANES.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data underlying this article will be shared on reasonable request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Soo Wan Kim, MD, PhD, Professor, Department of Internal Medicine, Chonnam National University Medical School, Jebongro 42, Gwangju 61469, South Korea. skimw@chonnam.ac.kr
Received: April 13, 2025
Revised: May 19, 2025
Accepted: June 23, 2025
Published online: July 15, 2025
Processing time: 95 Days and 5.3 Hours
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.

Keywords: Exercise; Diabetes mellitus; End-stage renal disease; Chronic kidney disease; Intensity; Duration

Core Tip: This large-scale nationwide cohort study explored the association between exercise intensity and the risk of end-stage renal disease (ESRD) in patients with diabetes. The findings indicate that high-intensity physical activity (≥ 1500 metabolic equivalents of task-min/week) significantly reduced ESRD risk, particularly in those with diabetes for over 10 years. Subgroup analyses revealed the greatest benefit in patients without hypertension, non-smokers, and those with higher body mass index. These findings highlight the potential of targeted exercise interventions to delay renal complications in diabetes management.