Revista de nefrología y terapéutica

Exercise in Diabetic Kidney Disease: Protective Effects and Molecular Mechanisms

Abstract

Berbert Terk

Diabetic kidney disease represents a significant complication of diabetes mellitus, contributing to the escalating global burden of end-stage renal disease. Exercise has emerged as a crucial non-pharmacological intervention for managing DKD, offering protective effects against its development and progression. This article reviews the epidemiological evidence supporting the benefits of exercise in DKD and elucidates the underlying molecular mechanisms involved. Epidemiological studies consistently demonstrate an inverse relationship between physical activity levels and DKD risk, with regular exercise associated with improvements in renal function, reduction in albuminuria, and attenuation of renal fibrosis. At the molecular level, exercise exerts multifaceted effects on key pathophysiological pathways implicated in DKD. These include enhancing insulin sensitivity, promoting glucose uptake, reducing systemic inflammation and oxidative stress, modulating the renin-angiotensinaldosterone system and endothelin pathways, and inducing adaptations in skeletal muscle metabolism. Furthermore, exercise activates antiinflammatory and antioxidant responses within the kidney, mitigating renal inflammation, oxidative stress, and fibrosis. Understanding the molecular mechanisms by which exercise confers renal protection in DKD is essential for optimizing therapeutic strategies and promoting early intervention to delay disease progression. Therefore, integrating exercise into comprehensive management plans for individuals with diabetes may offer significant benefits in preserving renal structure and function, ultimately improving clinical outcomes and reducing the burden of DKD.