Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA.
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
Nephrol Dial Transplant. 2020 Aug 1;35(8):1436-1443. doi: 10.1093/ndt/gfaa038.
Insufficient physical activity (PA) may increase the risk of all-cause mortality and cardiovascular disease (CVD) morbidity and mortality among kidney transplant recipients (KTRs), but limited research is available. We examine the relationship between PA and the development of CVD events, CVD death and all-cause mortality among KTRs.
A total of 3050 KTRs enrolled in an international homocysteine-lowering randomized controlled trial were examined (38% female; mean age 51.8 ± 9.4 years; 75% white; 20% with prevalent CVD). PA was measured at baseline using a modified Yale Physical Activity Survey, divided into tertiles (T1, T2 and T3) from lowest to highest PA. Kaplan-Meier survival curves were used to graph the risk of events; Cox proportional hazards regression models examined the association of baseline PA levels with CVD events (e.g. stroke, myocardial infarction), CVD mortality and all-cause mortality over time.
Participants were followed up to 2500 days (mean 3.7 ± 1.6 years). The cohort experienced 426 CVD events and 357 deaths. Fully adjusted models revealed that, compared to the lowest tertile of PA, the highest tertile experienced a significantly lower risk of CVD events {hazard ratio [HR] 0.76 [95% confidence interval (CI) 0.59-0.98]}, CVD mortality [HR 0.58 (95% CI 0.35-0.96)] and all-cause mortality [HR 0.76 (95% CI 0.59-0.98)]. Results were similar in unadjusted models.
PA was associated with a reduced risk of CVD events and all-cause mortality among KTRs. These observed associations in a large, international sample, even when controlling for traditional CVD risk factors, indicate the potential importance of PA in reducing CVD and death among KTRs.
体力活动不足（PA）可能会增加肾移植受者（KTR）全因死亡率和心血管疾病（CVD）发病率和死亡率的风险，但相关研究有限。我们研究了 PA 与 KTR 中心血管事件的发生、CVD 死亡和全因死亡率之间的关系。
共纳入了一项国际同型半胱氨酸降低随机对照试验中的 3050 名 KTR（38%为女性；平均年龄 51.8±9.4 岁；75%为白人；20%患有 CVD）。使用改良耶鲁体力活动量表在基线时测量 PA，分为最低到最高 PA 的三分位（T1、T2 和 T3）。Kaplan-Meier 生存曲线用于绘制事件风险图；Cox 比例风险回归模型检验了基线 PA 水平与 CVD 事件（如中风、心肌梗死）、CVD 死亡率和全因死亡率随时间的关系。
参与者的随访时间最长为 2500 天（平均 3.7±1.6 年）。该队列发生了 426 例 CVD 事件和 357 例死亡。完全调整的模型显示，与 PA 最低三分位相比，最高三分位的 CVD 事件风险显著降低{风险比（HR）0.76（95%置信区间（CI）0.59-0.98)}、CVD 死亡率[HR 0.58（95% CI 0.35-0.96）]和全因死亡率[HR 0.76（95% CI 0.59-0.98）]。未调整模型的结果相似。
PA 与 KTR 中心血管事件和全因死亡率的风险降低相关。这些在大型国际样本中的观察结果，甚至在控制传统 CVD 风险因素后，表明 PA 在降低 KTR 中心血管疾病和死亡方面的潜在重要性。
