Authors’ Reply: More Research is Still Needed to Support the Real-World Generalizability of the Benefits of Lifestyle Interventions for Chronic Kidney Disease

• lifestyle
• randomized controlled trials
• exercise

We thank the authors for their interest in our recent publication¹ and agree in premise that further research is required to aid the generalizability of our findings, especially among populations that were not the focus of the study.² We agree with the authors that evaluating the effects of lifestyle interventions on hard endpoints, such as cardiovascular and all-cause mortality, are important to move the field forward. However, this was not within the scope of this study and would require larger sample sizes and longer follow-up. There is robust evidence that demonstrates the strength of cardiorespiratory fitness as a surrogate endpoint for cardiovascular and all-cause mortality.³ But we agree this is an important area for further investigation in people with kidney disease, as are studies that include the objective evaluation of physical activity levels. As noted by the authors, there is indeed potential bias in the use of recall to measure physical activity, yet this approach is still commonly used.⁴ Future studies should incorporate objective measures of habitual physical activity, which is more feasible given the contemporary widespread use of trackers⁵ and access to accelerometers to determine the effects of intervention and relationship between this behavior and outcomes in patients with CKD.

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