健康生活方式与慢性肾脏病（CKD）患者肾病进展、动脉粥样硬化事件及死亡风险：慢性肾功能不全队列（CRIC）研究结果

Healthy lifestyle and risk of kidney disease progression, atherosclerotic events, and death in CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study.

作者信息

Ricardo Ana C, Anderson Cheryl A, Yang Wei, Zhang Xiaoming, Fischer Michael J, Dember Laura M, Fink Jeffrey C, Frydrych Anne, Jensvold Nancy G, Lustigova Eva, Nessel Lisa C, Porter Anna C, Rahman Mahboob, Wright Nunes Julie A, Daviglus Martha L, Lash James P

机构信息

Department of Medicine, University of Illinois at Chicago, Chicago, IL.

Department of Family and Preventive Medicine, University of California, San Diego, CA.

出版信息

Am J Kidney Dis. 2015 Mar;65(3):412-24. doi: 10.1053/j.ajkd.2014.09.016. Epub 2014 Nov 20.

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-<25kg/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≥25kg/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 ≥30kg/m(2), respectively, versus 20 to <25kg/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-<25kg/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≥30kg/m(2) (HR, 0.64 [95% CI, 0.43-0.96] vs 20-<25kg/m(2)), and nonsmoking (HR, 0.45 [95% CI, 0.34-0.60] vs current smoker). BMI<20kg/m(2) was associated with increased all-cause mortality risk (HR, 2.11 [95% CI, 1.13-3.93] vs 20-<25kg/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≥25kg/m(2) were associated with lower risk of adverse outcomes in this cohort of individuals with CKD.

背景

在一般人群中，健康的生活方式与较少的不良后果相关。我们估计了坚持健康生活方式能在多大程度上降低慢性肾脏病（CKD）成人发生肾脏和心血管事件的风险。

研究设计

前瞻性队列研究。

研究地点与参与者

3006名参与慢性肾功能不全队列（CRIC）研究的成年人。

预测因素

4种生活方式因素（规律的体育活动、体重指数[BMI]为20至<25kg/m²、不吸烟以及“健康饮食”），单独及综合考虑。

研究结果

慢性肾脏病进展（估计肾小球滤过率下降50%或终末期肾病）、动脉粥样硬化事件（心肌梗死、中风或外周动脉疾病）以及全因死亡率。

测量方法

多变量调整的Cox比例风险模型。

结果

在中位随访4年期间，我们观察到726例慢性肾脏病进展事件、355例动脉粥样硬化事件以及437例死亡。BMI≥25kg/m²和不吸烟与慢性肾脏病进展风险降低相关（BMI为25至<30kg/m²和≥30kg/m²时，与20至<25kg/m²相比，风险比[HR]分别为0.75[95%置信区间，0.58 - 0.97]和0.61[95%置信区间，0.45 - 0.82]；与当前吸烟者参考组相比，不吸烟的HR为0.68[95%置信区间，0.55 - 0.84]），且与动脉粥样硬化事件风险降低相关（BMI为25至<30kg/m²与20至<25kg/m²相比，HR为0.67[95%置信区间，0.46 - 0.96]，与当前吸烟者相比，HR为0.55[95%置信区间，0.40 - 0.75]）。与全因死亡率降低相关的因素包括规律的体育活动（与不活动相比，HR为0.64[95%置信区间，0.52 - 0.79]）、BMI≥30kg/m²（与20至<25kg/m²相比，HR为0.64[95%置信区间，0.43 - 0.96]）以及不吸烟（与当前吸烟者相比，HR为0.45[95%置信区间，0.34 - 0.60]）。BMI<20kg/m²与全因死亡风险增加相关（与20至<25kg/m²相比，HR为2.11[95%置信区间，1.13 - 3.93]）。与不坚持任何生活方式因素相比，坚持所有4种生活方式因素与全因死亡率风险降低68%相关（HR为0.32；95%置信区间，0.11 - 0.89）。

局限性

生活方式因素仅测量了一次。

结论

在这一慢性肾脏病队列中，规律的体育活动、不吸烟以及BMI≥25kg/m²与较低的不良后果风险相关。