Lifestyle Intervention In CKD

Prior treatment

• currently receiving or needing dialysis; having received or needing a kidney transplant
• planned weight loss surgery in 1 year
• a score of 27 or higher on the BP medication adherence scale
• illicit drug abuse
• gastric bypass surgery within the last 2 years

Other illness

• cardiac condition that would preclude participation in aerobic exercise training, including severe ischemic heart disease (CCS Class 3 or 4 angina or evidence of ischemia at \<85% heart rate reserve on screening treadmill testing), severe heart failure (NYHA Class 3 or 4), high grade arrhythmias, severe valvular heart disease
• severe asthma or chronic obstructive lung disease
• musculoskeletal or neurologic conditions that would preclude participation in aerobic exercise training
• a major psychiatric disorder
• a life-limiting comorbid medical condition, such as cancer.

Other

• acute kidney injury at time of screening
• average SBP ≥ 180 mm Hg or DBP ≥ 110 mm Hg at screening
• Exaggerated systolic response during ETT (e.g., SBP \>210 mmHg in men or \>190 mmHg in women)
• underweight (BMI \<18.5 kg/m2)
• current alcohol consumption \>14 drinks/week for men and \>7 drinks/week for women
• pregnant or planned pregnancy within 1 year
• physical limitation, gait instability, or need for continuous weight-bearing support that, in the opinion of study staff, would prevent safe completion of exercise treadmill testing

• Black race; ≥18 years old
• history of hypertension
• SBP ≥120 or DBP ≥80 mm Hg average of three measurements at screening visit (per KDIGO recommended SBP target of \<120 mm Hg)48
• Stable anti-hypertensive medication regimen (i.e., no medication changes 4 weeks prior to enrollment);
• eGFR of 15-44 ml/min/1.73m2 at screening visit
• agreeable to randomization to either of the 2 study arms