TY - JOUR
T1 - Healthy lifestyle and risk of kidney disease progression, atherosclerotic events, and death in CKD
T2 - Findings from the Chronic Renal Insufficiency Cohort (CRIC) study
AU - Ricardo, Ana C.
AU - Anderson, Cheryl A.
AU - Yang, Wei
AU - Zhang, Xiaoming
AU - Fischer, Michael J.
AU - Dember, Laura M.
AU - Fink, Jeffrey C.
AU - Frydrych, Anne
AU - Jensvold, Nancy G.
AU - Lustigova, Eva
AU - Nessel, Lisa C.
AU - Porter, Anna C.
AU - Rahman, Mahboob
AU - Wright Nunes, Julie A.
AU - Daviglus, Martha L.
AU - Lash, James P.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - 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 20-2, 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/m2 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 2, respectively, versus 20 to 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 25-2 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/m2 (HR, 0.64 [95% CI, 0.43-0.96] vs 20-2), and nonsmoking (HR, 0.45 [95% CI, 0.34-0.60] vs current smoker). BMI <20 kg/m2 was associated with increased all-cause mortality risk (HR, 2.11 [95% CI, 1.13-3.93] vs 20-2). 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/m2 were associated with lower risk of adverse outcomes in this cohort of individuals with CKD.
AB - 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 20-2, 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/m2 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 2, respectively, versus 20 to 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 25-2 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/m2 (HR, 0.64 [95% CI, 0.43-0.96] vs 20-2), and nonsmoking (HR, 0.45 [95% CI, 0.34-0.60] vs current smoker). BMI <20 kg/m2 was associated with increased all-cause mortality risk (HR, 2.11 [95% CI, 1.13-3.93] vs 20-2). 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/m2 were associated with lower risk of adverse outcomes in this cohort of individuals with CKD.
KW - body mass index (BMI)
KW - cardiovascular events
KW - Chronic kidney disease (CKD)
KW - CKD progression
KW - diet
KW - healthy lifestyle
KW - lifestyle modification
KW - modifiable risk factor
KW - mortality
KW - physical activity
KW - renal disease trajectory
KW - smoking
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U2 - 10.1053/j.ajkd.2014.09.016
DO - 10.1053/j.ajkd.2014.09.016
M3 - Article
C2 - 25458663
AN - SCOPUS:84924045316
SN - 0272-6386
VL - 65
SP - 412
EP - 424
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -