Zhu Wenting, Liu Qiushi, Zhang Lihua, Jiao Chenfeng, Xie Honglang
National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Medical University, Nanjing, China.
The Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Ren Fail. 2024 Dec;46(2):2437120. doi: 10.1080/0886022X.2024.2437120. Epub 2024 Dec 10.
There is a lack of sufficient information on the impact of physical activity (PA) and dietary quality (DQ) on mortality in patients with chronic kidney disease (CKD), and no study has yet examined the relationship between the combined effects of PA and DQ on the risk of death in patients with CKD in a representative adult population.
Adult CKD patients ( = 6,504) from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 were included in the study. Mortality outcomes were assessed by National Death Index records before 2/25/2019. Four lifestyle categories were established: low-PA individuals with unhealthy diets, low-PA individuals with healthy diets, high-PA individuals with unhealthy diets, and high-PA individuals with healthy diets. Cox proportional risk modeling was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of various lifestyle categories for all-cause and CVD mortality.
During a median follow-up period of 111 months, 1,971 participants with CKD died from all-cause mortality, and 567 died from CVD among 6,504 respondents. The high-PA CKD population with a healthier diet had a significantly lower risk of all-cause [0.75, 95% CI (0.64-0.87)] and CVD [0.69, 95% CI (0.51-0.93)] mortality than the low-PA, unhealthy diet participants did. The age and race subgroups showed significant interactions, with the older (≥60 years) and non-Hispanic black subgroups experiencing a more favorable risk-lowering effect for all-cause death.
CKD patients with healthy diets and adequate PA had lower risks of CVD and all-cause mortality than did low-PA individuals with unhealthy diets.
关于体力活动（PA）和饮食质量（DQ）对慢性肾脏病（CKD）患者死亡率的影响，目前缺乏足够信息，且尚无研究在具有代表性的成年人群中探讨PA和DQ的联合效应与CKD患者死亡风险之间的关系。
本研究纳入了1999 - 2018年美国国家健康与营养检查调查（NHANES）中的成年CKD患者（n = 6504）。通过2019年2月25日前的国家死亡指数记录评估死亡结局。建立了四种生活方式类别：PA水平低且饮食不健康的个体、PA水平低且饮食健康的个体、PA水平高且饮食不健康的个体以及PA水平高且饮食健康的个体。采用Cox比例风险模型计算各类生活方式类别全因死亡率和心血管疾病（CVD）死亡率的风险比（HRs）及95%置信区间（CIs）。
在中位随访期111个月期间，6504名受访者中，1971名CKD参与者死于全因死亡率，567名死于CVD。与PA水平低且饮食不健康的参与者相比，PA水平高且饮食更健康的CKD人群全因死亡率[0.75，95%CI（0.64 - 0.87）]和CVD死亡率[0.69，95%CI（0.51 - 0.93）]显著更低。年龄和种族亚组显示出显著的交互作用，年龄较大（≥60岁）的亚组和非西班牙裔黑人亚组在全因死亡方面的风险降低效果更明显。
与PA水平低且饮食不健康的个体相比，饮食健康且PA充足CKD患者的CVD和全因死亡率风险更低。
