Background: Obesity and sedentary lifestyle are major health problems and key features to develop cardiovascular disease. Data on the effects of lifestyle interventions in diabetics with chronic kidney disease (CKD) have been conflicting. Study Design: Systematic review. Population: Diabetes patients with CKD stage 3 to 5. Search Strategy and Sources: Medline, Embase and Central were searched to identify papers. Intervention: Effect of a negative energy balance on hard outcomes in diabetics with CKD. Outcomes: Death, cardiovascular events, glycaemic control, kidney function, metabolic parameters and body composition. Results: We retained 11 studies. There are insufficient data to evaluate the effect on mortality to promote negative energy balance. None of the studies reported a difference in incidence of Major Adverse Cardiovascular Events. Reduction of energy intake does not alter creatinine clearance but significantly reduces proteinuria (mean difference from -0.66 to -1.77 g/24 h). Interventions with combined exercise and diet resulted in a slower decline of eGFR (-9.2 vs. -20.7 mL/min over two year observation; p