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American Journal of Kidney Diseases

Healthy Lifestyle and Risk of Kidney Disease Progression, Atherosclerotic Events, and Death in CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Published:November 19, 2014DOI:https://doi.org/10.1053/j.ajkd.2014.09.016

      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/m2, 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 <30 and ≥30 kg/m2, respectively, versus 20 to <25 kg/m2; 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/m2 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-<25 kg/m2), 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-<25 kg/m2). 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.

      Index Words

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