Effect of Kidney Function on Relationships between Lifestyle Behaviors and Mortality or Cardiovascular Outcomes: A Pooled Cohort Analysis

Sarah J. Schrauben; Jesse Y. Hsu; Sandra Amaral; Amanda H. Anderson; Harold I. Feldman; Laura M. Dember

doi:10.1681/ASN.2020040394

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Visual Abstract

Significance Statement

Healthy lifestyle behaviors reduce death and cardiovascular disease among individuals with preserved kidney function, but the benefits of these behaviors among those with reduced kidney function, a group at higher risk for cardiovascular disease, have not been established. In this pooled analysis of three community-based cohort studies that included 27,271 adults, healthy lifestyle behaviors (not smoking, maintaining body mass index in the recommended range, engaging in regular physical activity, consuming a healthy diet, and no more than a moderate intake of alcohol), analyzed individually and in combination, were associated with significantly reduced risk of death and cardiovascular disease events among individuals with or without reduced kidney function. These findings highlight the importance of lifestyle behaviors as potentially modifiable risk factors for people with kidney disease.

Abstract

Background Adherence to healthy behaviors reduces risks of cardiovascular disease and death in the general population. However, among people with kidney disease, a group at higher risk for cardiovascular disease, such benefits have not been established.

Methods We pooled data from three cohort studies with a total of 27,271 participants. Kidney function was categorized on the basis of eGFR (≥60, 45 to <60, and <45 ml/min per 1.73 m²). We used proportional hazard frailty models to estimate associations between healthy behaviors (not smoking, at recommended body mass index [BMI], physical activity, healthy diet, and moderate to no alcohol intake) and outcomes (all-cause death, major coronary events, ischemic stroke, and heart failure events).

Results All recommended lifestyle behaviors were significantly associated with lower risks of death, regardless of eGFR. Not smoking (versus current) and any moderate to vigorous physical activity (versus none) was significantly associated with reduced risks of major coronary and heart failure events, regardless of eGFR. Any (versus no) moderate or vigorous physical activity significantly associated with decreased risk of ischemic stroke events only among those with eGFR ≥60. Moderate to no daily alcohol intake (versus excessive) was significantly associated with an increased risk of major coronary events, regardless of eGFR. For heart failure events, a BMI of 18.5 to 30 associated with decreased risk, regardless of eGFR. Across all eGFR categories, the magnitude of risk reduction for death and all cardiovascular outcomes increased with greater numbers of recommended lifestyle behaviors.

Conclusions Recommended lifestyle behaviors are associated with lower risk of death and cardiovascular disease events among individuals with or without reduced kidney function, supporting lifestyle behaviors as potentially modifiable risk factors for people with kidney disease.

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