Robinson-Cohen Cassianne, Katz Ronit, Mozaffarian Dariush, Dalrymple Lorien S, de Boer Ian, Sarnak Mark, Shlipak Mike, Siscovick David, Kestenbaum Bryan
Department of Epidemiology, University of Washington, Seattle, 98195, USA.
Arch Intern Med. 2009 Dec 14;169(22):2116-23. doi: 10.1001/archinternmed.2009.438.
Habitual physical activity (PA) has both physiologic and metabolic effects that may moderate the risk of kidney function decline. We tested the hypothesis that higher levels of PA are associated with a lower risk of kidney function decline using longitudinal data from a large cohort of older adults.
We studied 4011 ambulatory participants aged 65 or older from the Cardiovascular Health Study (CHS) who completed at least 2 measurements of kidney function over 7 years. We calculated a PA score (range, 2-8) by summing kilocalories expended per week (ordinal score of 1-5 from quintiles of kilocalories per week) and walking pace (ordinal score for categories of <2, 2-3, and >3 mph). Rapid decline in kidney function decline (RDKF) was defined by loss of more than 3.0 mL/min/1.73 m(2) per year in glomerular filtration rate, which we estimated by using longitudinal measurements of cystatin C levels.
A total of 958 participants had RDKF (23.9%; 4.1 events per 100 person-years). The estimated risk of RDKF was 16% in the highest PA group (score of 8) and 30% in the lowest PA group (score of 2). After multivariate adjustment, we found that the 2 highest PA groups (scores of 7-8) were associated with a 28% lower risk of RDKF (95% confidence interval, 21%-41% lower risk) than the 2 lowest PA groups (score of 2-3). Greater kilocalories of leisure-time PA and walking pace were also each associated with a lower incidence of RDKF.
Higher levels of PA are associated with a lower risk of RDKF among older adults.
习惯性身体活动（PA）具有生理和代谢效应，可能会降低肾功能下降的风险。我们使用来自一大群老年人的纵向数据，检验了较高水平的PA与较低的肾功能下降风险相关这一假设。
我们研究了心血管健康研究（CHS）中4011名65岁及以上的非卧床参与者，他们在7年中完成了至少2次肾功能测量。我们通过将每周消耗的千卡数（根据每周千卡数的五分位数得出的1-5级评分）和步行速度（<2、2-3和>3英里/小时类别的等级评分）相加来计算PA评分（范围为2-8）。肾功能快速下降（RDKF）定义为每年肾小球滤过率下降超过3.0 mL/min/1.73 m²，我们通过胱抑素C水平的纵向测量来估算。
共有958名参与者出现RDKF（23.9%；每100人年4.1例）。PA最高组（评分为8）的RDKF估计风险为16%，PA最低组（评分为2）为30%。多变量调整后，我们发现PA最高的两组（评分为7-8）与PA最低的两组（评分为2-3）相比，RDKF风险降低了28%（95%置信区间，风险降低21%-41%）。更多的休闲时间PA千卡数和步行速度也分别与较低的RDKF发病率相关。
较高水平的PA与老年人较低的RDKF风险相关。
