Chen Hongyu, Tang Haoxian, Huang Jingtao, Luo Nan, Zhang Xuan, Wang Xin
Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Department of Clinical Medicine, Shantou University Medical College, Shantou, China.
Am J Nephrol. 2023;54(11-12):516-527. doi: 10.1159/000533257. Epub 2023 Aug 17.
The current prevalence of chronic kidney disease (CKD) is substantial, and CKD individuals face a heightened risk of mortality, encompassing both all-cause and cause-specific outcomes. The current study aims to investigate the potential impact of adhering to Life's Essential 8 (LE8) on reducing mortality among CKD individuals.
Using the National Health and Nutrition Survey (NHANES) data from 2005 to 2018, we analyzed 22,420 US adults (≥20 years old). CKD is defined by urinary albumin-to-creatinine ratio (≥30 mg/g or 3 mg/mmol) and estimated glomerular filtration rate (<60 mL/min/1.73 m2). The components of LE8, including diet, physical activity (PA), nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure (BP), were measured and given a score of 0-100. The total LE8 score was the unweighted average of all components and was divided into low cardiovascular health (CVH) (0-49), moderate CVH (50-79), and high CVH (80-100). A Cox proportional hazards regression model was used to explore the associations of LE8 with all-cause, cardiovascular disease (CVD), and cancer mortality, which were followed prospectively by the National Center for Health Statistics until December 31, 2019.
In the overall population, individuals with moderate CVH had a 47% lower risk of CKD, while high CVH was linked to a 55% lower risk compared to low CVH. During a median follow-up of 7.58 years, CKD individuals had a 93% higher all-cause mortality rate and a 149% higher CVD mortality rate compared to those without CKD. Among the CKD individuals, every 10-point increase in the LE8 score was associated with reduced risks of 17% for all-cause mortality (especially PA, nicotine exposure, blood glucose, and BP), 18% for CVD mortality (especially PA), and 12% for cancer mortality (especially PA and sleep health). In additional and sensitivity analysis, the results remained significant after further consideration of potential confounding of renal function. Additionally, LE8 demonstrated superior risk stratification for CVD mortality among CKD patients compared with LS7. Interaction was observed between LE8 and age, education level, marital status, and drinking status.
The current study demonstrates that adherence to higher LE8 levels within CKD individuals is associated with a reduced risk of both all-cause and cause-specific mortality.
慢性肾脏病（CKD）目前的患病率很高，CKD患者面临着更高的死亡风险，包括全因死亡和特定病因死亡。本研究旨在探讨坚持“生命八大要素”（LE8）对降低CKD患者死亡率的潜在影响。
利用2005年至2018年的美国国家健康与营养检查调查（NHANES）数据，我们分析了22420名美国成年人（≥20岁）。CKD通过尿白蛋白与肌酐比值（≥30mg/g或3mg/mmol）和估算肾小球滤过率（<60mL/min/1.73m²）来定义。对LE8的各项组成部分，包括饮食、身体活动（PA）、尼古丁暴露、睡眠、体重指数、血脂、血糖和血压（BP）进行测量，并给予0至100分的评分。LE8总评分是所有组成部分的未加权平均值，分为低心血管健康（CVH）（0至49分）、中度CVH（50至79分）和高CVH（80至100分）。使用Cox比例风险回归模型探讨LE8与全因、心血管疾病（CVD）和癌症死亡率之间的关联，这些数据由美国国家卫生统计中心进行前瞻性跟踪，直至2019年12月31日。
在总体人群中，中度CVH的个体患CKD的风险降低47%，而高CVH与低CVH相比，风险降低55%。在中位随访7.58年期间，与无CKD的个体相比，CKD个体的全因死亡率高93%，CVD死亡率高149%。在CKD个体中，LE8评分每增加10分，全因死亡率风险降低17%（尤其是PA、尼古丁暴露、血糖和BP），CVD死亡率风险降低18%（尤其是PA），癌症死亡率风险降低12%（尤其是PA和睡眠健康）。在额外的敏感性分析中，进一步考虑肾功能的潜在混杂因素后，结果仍然显著。此外，与LS7相比，LE8在CKD患者的CVD死亡率风险分层方面表现更优。观察到LE8与年龄、教育水平、婚姻状况和饮酒状况之间存在相互作用。
本研究表明，CKD个体坚持更高水平的LE8与全因和特定病因死亡率风险降低相关。
