title: Healthy lifestyle and risk of kidney disease progression, atherosclerotic events, and death in CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study.
abstract: BACKGROUND
  In general populations, healthy lifestyle is associated with fewer adverse outcomes. We estimated the degree to which adherence to a healthy lifestyle decreases the risk of renal and cardiovascular events among adults with chronic kidney disease (CKD).
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  3,006 adults enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study.
  
  
  METHODS
  4 lifestyle factors (regular physical activity, body mass index [BMI] of 20-<25kg/m(2), nonsmoking, and "healthy diet"), individually and in combination.
  
  
  RESULTS
  CKD progression (50% decrease in estimated glomerular filtration rate or end-stage renal disease), atherosclerotic events (myocardial infarction, stroke, or peripheral arterial disease), and all-cause mortality.
  
  
  METHODS
  Multivariable-adjusted Cox proportional hazards.
  
  
  RESULTS
  During a median follow-up of 4 years, we observed 726 CKD progression events, 355 atherosclerotic events, and 437 deaths. BMI≥25kg/m(2) and nonsmoking were associated with reduced risk of CKD progression (HRs of 0.75 [95% CI, 0.58-0.97] and 0.61 [95% CI, 0.45-0.82] for BMIs of 25 to <30 and ≥30kg/m(2), respectively, versus 20 to <25kg/m(2); HR for nonsmoking of 0.68 [95% CI, 0.55-0.84] compared to the current smoker reference group) and reduced risk of atherosclerotic events (HRs of 0.67 [95% CI, 0.46-0.96] for BMI of 25-<30 vs 20-<25kg/m(2) and 0.55 [95% CI, 0.40-0.75] vs current smoker). Factors associated with reduced all-cause mortality were regular physical activity (HR, 0.64 [95% CI, 0.52-0.79] vs inactive), BMI≥30kg/m(2) (HR, 0.64 [95% CI, 0.43-0.96] vs 20-<25kg/m(2)), and nonsmoking (HR, 0.45 [95% CI, 0.34-0.60] vs current smoker). BMI<20kg/m(2) was associated with increased all-cause mortality risk (HR, 2.11 [95% CI, 1.13-3.93] vs 20-<25kg/m(2)). Adherence to all 4 lifestyle factors was associated with a 68% lower risk of all-cause mortality compared to adherence to no lifestyle factors (HR, 0.32; 95% CI, 0.11-0.89).
  
  
  CONCLUSIONS
  Lifestyle factors were measured only once.
  
  
  CONCLUSIONS
  Regular physical activity, nonsmoking, and BMI≥25kg/m(2) were associated with lower risk of adverse outcomes in this cohort of individuals with CKD.
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL. Electronic address: aricar2@uic.edu.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Ricardo
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, CA.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Anderson
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL; Center for Management of Complex Chronic Care, Jesse Brown VA Medical Center, Chicago, IL.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fischer
authors.affiliation: Renal, Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Dember
authors.affiliation: Department of Medicine, University of Maryland, Baltimore, MD.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Fink
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: Anne
authors.initials: A
authors.lastname: Frydrych
authors.affiliation: Kaiser Permanente Northern California Division of Research, Oakland, CA.
authors.forename: Nancy G
authors.initials: NG
authors.lastname: Jensvold
authors.affiliation: Department of Epidemiology, Tulane University, New Orleans, LA.
authors.forename: Eva
authors.initials: E
authors.lastname: Lustigova
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Nessel
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Porter
authors.affiliation: Case Western Reserve University, University Hospitals Case Medical Center and Louis Stokes Cleveland VA Medical Center, Cleveland, OH.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Wright Nunes
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Daviglus
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
mesh_terms: D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis* / Q000401:mortality* / Q000517:prevention & control; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009043:Motor Activity / Q000502:physiology; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000401:mortality* / Q000517:prevention & control; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016540:Smoking Cessation
keywords: CKD progression; Chronic kidney disease (CKD); body mass index (BMI); cardiovascular events; diet; healthy lifestyle; lifestyle modification; modifiable risk factor; mortality; physical activity; renal disease trajectory; smoking