More Research is Still Needed To Support The Real-world Generalizability of The Benefits of Lifestyle Interventions for CKD : Journal of the American Society of Nephrology

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Letter to the Editor

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

Huang, Liuyan; Zhang, Fan

Author Information
JASN 33(5):p 1045, May 2022. | DOI: 10.1681/ASN.2022020172
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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.


All authors have nothing to disclose.



Published online ahead of print. Publication date available at

See related reply, “Authors' Reply: More Research is Still Needed to Support the Real-World Generalizability of the Benefits of Lifestyle Interventions for Chronic Kidney Disease, ” on pages , and original article, “Effect of a 3-Year Lifestyle Intervention in Patients with Chronic Kidney Disease: A Randomized Clinical Trial,” in Vol. 33, Iss. 2, on pages .

Author Contributions

CRediT Taxonomy L. Huang was responsible for conceptualization, and reviewed and edited the manuscript; and F. Zhang was responsible for formal analysis and investigation, and wrote the original draft.


1. Beetham KS, Krishnasamy R, Stanton T, Sacre JW, Douglas B, Isbel NM, et al.: Effect of a 3-year lifestyle intervention in patients with chronic kidney disease: A randomized clinical trial. J Am Soc Nephrol 33: 431–441, 2022
2. Chen YR, Yang Y, Wang SC, Chiu PF, Chou WY, Lin CY, et al.: Effectiveness of multidisciplinary care for chronic kidney disease in Taiwan: A 3-year prospective cohort study. Nephrol Dial Transplant 28: 671–682, 2013
3. Chen PM, Lai TS, Chen PY, Lai CF, Yang SY, Wu V, et al.: Multidisciplinary care program for advanced chronic kidney disease: Reduces renal replacement and medical costs. Am J Med 128: 68–76, 2015

chronic kidney disease; randomized controlled trials; lifestyle

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