期刊
AMERICAN JOURNAL OF KIDNEY DISEASES
卷 65, 期 3, 页码 412-424出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2014.09.016
关键词
Chronic kidney disease (CKD); healthy lifestyle; lifestyle modification; physical activity; body mass index (BMI); diet; smoking; modifiable risk factor; CKD progression; renal disease trajectory; mortality; cardiovascular events
资金
- S National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902]
- Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award (CTSA) [UL1TR000003]
- ohns Hopkins University [UL1 TR-000424]
- University of Maryland [M01 RR-16500]
- Clinical and Translational Science Collaborative of Cleveland [UL1TR000439]
- Michigan Institute for Clinical and Health Research [UL1TR000433]
- University of Illinois at Chicago CTSA [UL1RR029879]
- Tulane University Translational Research in Hypertension and Renal Biology [P30GM103337]
- Kaiser Permanente NIH/National Center for Research Resources University of California San Francisco-Clinical & Translational Science Institute [UL1 RR-024131]
- NIDDK [1K23DK094829-01, K24DK092290]
Background: In general populations, healthy lifestyle is associated with fewer adverse outcomes. We estimated the degree to which adherence to a healthy lifestyle decreases the risk of renal and cardiovascular events among adults with chronic kidney disease (CKD). Study Design: Prospective cohort. Setting & Participants: 3,006 adults enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. Predictors: 4 lifestyle factors (regular physical activity, body mass index [BMI] of 20-<25 kg/m(2), nonsmoking, and healthy diet), individually and in combination. Outcomes: CKD progression (50% decrease in estimated glomerular filtration rate or end- stage renal disease), atherosclerotic events (myocardial infarction, stroke, or peripheral arterial disease), and all-cause mortality. Measurements: Multivariable-adjusted Cox proportional hazards. Results: During a median follow-up of 4 years, we observed 726 CKD progression events, 355 atherosclerotic events, and 437 deaths. BMI $25 kg/m(2) and nonsmoking were associated with reduced risk of CKD progression (HRs of 0.75 [95% CI, 0.58-0.97] and 0.61 [95% CI, 0.45-0.82] for BMIs of 25 to <30 and $30 kg/m(2), respectively, versus 20 to <25 kg/m(2); HR for nonsmoking of 0.68 [95% CI, 0.55-0.84] compared to the current smoker reference group) and reduced risk of atherosclerotic events (HRs of 0.67 [95% CI, 0.46-0.96] for BMI of 25-<30 vs 20-<25 kg/m(2) and 0.55 [95% CI, 0.40-0.75] vs current smoker). Factors associated with reduced all-cause mortality were regular physical activity (HR, 0.64 [95% CI, 0.52-0.79] vs inactive), BMI $30 kg/m(2) (HR, 0.64 [95% CI, 0.43-0.96] vs 20-<25 kg/m(2)), and nonsmoking (HR, 0.45 [95% CI, 0.340.60] vs current smoker). BMI, 20 kg/m(2) was associated with increased all-cause mortality risk (HR, 2.11 [95% CI, 1.13-3.93] vs 20-<25 kg/m(2)). Adherence to all 4 lifestyle factors was associated with a 68% lower risk of all-cause mortality compared to adherence to no lifestyle factors (HR, 0.32; 95% CI, 0.11-0.89). Limitations: Lifestyle factors were measured only once. Conclusions: Regular physical activity, nonsmoking, and BMI $25 kg/m(2) were associated with lower risk of adverse outcomes in this cohort of individuals with CKD. (C) 2015 by the National Kidney Foundation, Inc.
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