中年体力活动与新发肾脏疾病之间的关联：社区动脉粥样硬化风险（ARIC）研究
Association Between Midlife Physical Activity and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study.
作者信息
Parvathaneni Kaushik, Surapaneni Aditya, Ballew Shoshana H, Palta Priya, Rebholz Casey M, Selvin Elizabeth, Coresh Josef, Grams Morgan E
机构信息
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Division of General Medicine, Department of Medicine, Columbia University, New York, NY.
出版信息
Am J Kidney Dis. 2021 Jan;77(1):74-81. doi: 10.1053/j.ajkd.2020.07.020. Epub 2020 Sep 21.
RATIONALE & OBJECTIVE: Physical activity is associated with lower risk for cardiovascular disease, diabetes, and hypertension, which have shared risk factor profiles with chronic kidney disease (CKD). However, there are conflicting findings regarding the relationship between physical activity and CKD. The objective was to evaluate the association between physical activity and CKD development over long-term follow-up using the Atherosclerosis Risk in Communities (ARIC) Study.
STUDY DESIGN
Prospective cohort study.
SETTING & PARTICIPANTS: 14,537 participants aged 45 to 64 years.
PREDICTORS
Baseline physical activity status was assessed using the modified Baecke Physical Activity Questionnaire at visit 1 (1987-1989) and categorized according to the 2018 Physical Activity Guidelines for Americans to group participants as inactive, insufficiently active, active, and highly active.
OUTCOMES
Incident CKD defined as estimated glomerular filtration rate (eGFR)<60mL/min/1.73m at follow-up and≥25% decline in eGFR relative to baseline, CKD-related hospitalization or death, or initiation of kidney replacement therapy.
ANALYTICAL APPROACH
Cox proportional hazards regression.
RESULTS
At baseline, 37.8%, 24.2%, 22.7%, and 15.3% of participants were classified as inactive, insufficiently active, active, and highly active, respectively. During a median follow-up of 24 years, 33.2% of participants developed CKD. After adjusting for age, sex, race-center, education, smoking status, diet quality, diabetes, coronary heart disease, hypertension, antihypertensive medication, body mass index, and baseline eGFR, higher categories of physical activity were associated with lower risk for CKD compared with the inactive group (HRs for insufficiently active, 0.95 [95% CI, 0.88-1.02]; active, 0.93 [95% CI, 0.86-1.01]; highly active, 0.89 [95% CI, 0.81-0.97]; P for trend = 0.007).
LIMITATIONS
Observational design and self-reported physical activity that was based on leisure time activity only. Due to low numbers, participants who were not Black or White were excluded.
CONCLUSIONS
Highly active participants had lower risk for developing CKD compared with inactive participants.
原理与目的
身体活动与心血管疾病、糖尿病和高血压的较低风险相关，而这些疾病与慢性肾脏病（CKD）具有共同的风险因素特征。然而，关于身体活动与CKD之间的关系存在相互矛盾的研究结果。目的是利用社区动脉粥样硬化风险（ARIC）研究评估长期随访期间身体活动与CKD发生之间的关联。
研究设计
前瞻性队列研究。
设置与参与者
14537名年龄在45至64岁之间的参与者。
预测因素
在第1次访视（1987 - 1989年）时使用改良的贝克身体活动问卷评估基线身体活动状况，并根据《2018年美国身体活动指南》将参与者分为不活动、活动不足、活动和高度活动四类。
结果
随访期间估算肾小球滤过率（eGFR）<60mL/min/1.73m²且相对于基线eGFR下降≥25%、与CKD相关的住院或死亡，或开始肾脏替代治疗定义为新发CKD。
分析方法
Cox比例风险回归。
结果
在基线时，分别有37.8%、24.2%、22.7%和15.3%的参与者被分类为不活动、活动不足、活动和高度活动。在中位随访24年期间，33.2%的参与者发生了CKD。在调整年龄、性别、种族中心、教育程度、吸烟状况、饮食质量、糖尿病、冠心病、高血压、抗高血压药物、体重指数和基线eGFR后，与不活动组相比，身体活动程度较高的类别与较低的CKD风险相关（活动不足组的风险比[HR]为0.95[95%CI，0.88 - 1.02]；活动组为0.93[95%CI，0.86 - 1.01]；高度活动组为0.89[95%CI，0.81 - 0.97]；趋势P = 0.007）。
局限性
观察性设计以及仅基于休闲时间活动的自我报告身体活动。由于数量较少，非黑种人或白种人的参与者被排除。
结论
与不活动的参与者相比，高度活动的参与者发生CKD的风险较低。
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