Department of Nephrology, The First Hospital of Jilin University, Changchun, China.
BMC Public Health. 2024 Oct 31;24(1):3020. doi: 10.1186/s12889-024-20498-6.
Chronic kidney disease (CKD) and overweight/obesity are significant global public health issues. Appropriate free-time physical activity (PA) is essential for overweight/obese patients with chronic kidney disease, but specific guidelines are lacking. The present study was conducted to determine the association between PA and all-cause mortality in these patients.
Data from 3,434 overweight/obese adults with CKD from the 1999-2016 National Health and Nutrition Examination Surveys were analyzed. Associations between clinical/laboratory findings and PA intensity (moderate and vigorous) were investigated. The all-cause mortality of patients in different PA categories were compared by Kaplan-Meier analysis. Factors associated with all-cause mortality were determined using a Cox proportional hazards model. A restricted cubic spline was employed to obtain a more flexible and detailed representation of the relationship between PA intensity and all-cause mortality, with better predictive capability.
The Kaplan-Meier analysis revealed that greater all-cause mortality was associated with < 10 min/week moderate/vigorous PA (log-rank p < 0.001). A greater survival probability was associated with ≥ 150 min/week vigorous PA or 10-149 min/week moderate PA (log-rank p < 0.001). Age, gender, vigorous PA, smoking status, alcohol consumption, diabetes status, eGFR, serum albumin level, uric acid level, and blood urea nitrogen level were identified as factors associated independently with mortality in the Cox proportional hazards analysis. The restricted cubic splines revealed that these relationships were non-linear (all p < 0.05). Kaplan-Meier analysis of data from patients who engaged in 10-450 min/week moderate/vigorous PA revealed significant differences between the 0-74-min/week and other vigorous PA groups (all log-rank p < 0.001).
Extended durations of vigorous PA are associated with reduced all-cause mortality in overweight/obese patients with CKD. Clinicians should recommend vigorous free-time PA to these patients, and public health interventions should target this goal to maximize patient health.
慢性肾脏病（CKD）和超重/肥胖是全球性的重大公共卫生问题。对于超重/肥胖的慢性肾脏病患者来说，适当的闲暇时间体力活动（PA）至关重要，但目前缺乏具体的指南。本研究旨在确定这些患者的 PA 与全因死亡率之间的关系。
对 1999-2016 年全国健康与营养调查中 3434 名超重/肥胖的 CKD 成年人的数据进行分析。研究了临床/实验室检查结果与 PA 强度（适度和剧烈）之间的关系。通过 Kaplan-Meier 分析比较不同 PA 类别的患者的全因死亡率。使用 Cox 比例风险模型确定与全因死亡率相关的因素。采用限制性三次样条函数获得 PA 强度与全因死亡率之间更灵活和详细的关系，具有更好的预测能力。
Kaplan-Meier 分析显示，每周 PA 时间<10 分钟/周中度/剧烈与全因死亡率增加相关（对数秩检验 p<0.001）。每周 PA 时间≥150 分钟/周剧烈或每周 10-149 分钟/周中度与更高的生存率相关（对数秩检验 p<0.001）。年龄、性别、剧烈 PA、吸烟状况、饮酒状况、糖尿病状况、eGFR、血清白蛋白水平、尿酸水平和血尿素氮水平被确定为 Cox 比例风险分析中与死亡率相关的独立因素。限制性三次样条函数显示这些关系是非线性的（均 p<0.05）。对每周进行 10-450 分钟/周适度/剧烈 PA 的患者数据进行 Kaplan-Meier 分析，结果显示 0-74 分钟/周和其他剧烈 PA 组之间存在显著差异（均对数秩检验 p<0.001）。
延长剧烈 PA 的时间与超重/肥胖的 CKD 患者全因死亡率降低相关。临床医生应向这些患者推荐闲暇时间剧烈 PA，公共卫生干预措施应以此为目标，以最大限度地提高患者的健康水平。
