More Research is Still Needed To Support The Real-world Generalizability of The Benefits of Lifestyle Interventions for CKD

• chronic kidney disease
• randomized controlled trials
• lifestyle

We read with interest a randomized controlled trial by Beetham et al., published in the latest issue of JASN as part of the LANDMARK III trial.¹ The results demonstrated the beneficial effects of a 3-year lifestyle intervention on physical activity, cardiorespiratory fitness, and neuromuscular fitness in patients with stage 3–4 CKD. It also highlights the importance of multidisciplinary research for such a population.

However, some aspects need to be considered when interpreting the study results. First, only 160 patients who were screened received the randomization sequence, of which 79 participated in the lifestyle intervention, and restrictions of the included patients (patients with nondialysis CKD) and the higher rate of dropouts limit the generalizability of the results in the real world. Second, unlike previous studies of similar interventions,^2,3 the study lacked hard endpoints, such as mortality, and restricted the cost-effectiveness findings. Finally, although the questionnaire was validated, the assessment of physical activity levels through self-report could lead to recall bias and thus overestimate actual activity.

Undeniably, Beetham et al. presented this study with an extremely rigorous study design that provides further insight into the disease management of patients with CKD.

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