Dietary patterns and physical activity in relation to renal and metabolic outcomes among older adults with type 2 diabetes and chronic kidney disease: a systematic review

Abstract

Introduction Lifestyle modification is increasingly recognized as a critical component in the management of chronic kidney disease (CKD), particularly among elderly individuals with type 2 diabetes, a population at high risk of disease progression and comorbidities. While pharmacological treatment remains central, growing evidence highlights the role of dietary patterns and physical activity in potentially influencing renal and metabolic outcomes. However, the extent and consistency of these effects remain unclear, particularly in older diabetic populations. This systematic review aimed to synthesize evidence from both intervention and observational studies examining dietary patterns, dietary interventions, physical activity, and related lifestyle exposures associated with renal and metabolic outcomes in older adults with type 2 diabetes and chronic kidney disease. Methods A comprehensive literature search was conducted across PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library. A total of 31 eligible studies were included in the final analysis. Results Healthier dietary patterns—particularly Mediterranean, plant-based, low-sodium, and moderated protein approaches—were generally associated with favorable renal and metabolic outcomes, although the certainty of evidence varied across themes. Sodium restriction reduced blood pressure and albuminuria, while moderated protein intake was associated with favorable renal outcomes when nutritional status was carefully monitored. Physical activity interventions improved glycemic control, blood pressure, and functional capacity, with possible indirect benefits for renal function. Evidence regarding antioxidant supplementation and very low-carbohydrate diets remains limited and inconclusive. Conclusion Dietary patterns and physical activity are associated with renal and metabolic outcomes among elderly individuals with type 2 diabetes. These findings suggest that nutrition-focused lifestyle interventions may be considered supportive components of routine care, although stronger evidence is required. However, further large-scale, high-quality, and long-term studies are needed to establish definitive recommendations and develop tailored intervention strategies for this high-risk population. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251087535, identifier PROSPERO (CRD420251087535).