Associations of physical activity and sedentary time with diabetic kidney disease among adults with diabetes: a multicenter population-based study

Background: Increased physical activity and reduced sedentary time are associated with lower risks of diabetes. However, their association with diabetic kidney disease (DKD) is unclear. This study aimed to assess this issue in the Chinese adults with diabetes. Methods: This multicenter, cross-sectional study included adults with diabetes from 40 hospitals across 26 diverse Chinese cities. Leisure-time physical activity (LTPA), housework physical activity (HPA), occupational physical activity (OPA), and sedentary time were assessed using a validated questionnaire. DKD was defined according to the NKF-K/DOQI guidelines. Associations between activity domains and DKD were examined using multivariable logistic regression, with subgroup, interaction, and sensitivity analyses to assess robustness. Results: A total of 4,979 patients with diabetes were included. After multivariable adjustment, those meeting the guideline-recommended amount of LTPA had lower odds of DKD (OR 0.79, 95% CI 0.68-0.91 for aerobic exercise; OR 0.69, 95% CI 0.50-0.96 for resistance exercise) compared with those not meeting recommendations. However, heavier HPA and larger OPA were associated with higher odds of DKD (OR 1.51 and 1.66, respectively). Moreover, longer daily sedentary time was associated with increased odds of DKD only in women (OR 2.10), but not in men. Further stratified analysis suggested that the association between LTPA and lower odds of DKD may be modified by HPA, OPA, or sedentary time. Conclusions: Among Chinese adults with diabetes, LTPA was associated with lower odds of DKD, whereas higher occupational and household physical activity showed positive associations, underscoring the differences in domain-specific physical activity in DKD prevention.