title: Modifiable lifestyle and social factors affect chronic kidney disease in high-risk individuals with type 2 diabetes mellitus.
abstract: This observational study examined the association between modifiable lifestyle and social factors on the incidence and progression of early chronic kidney disease (CKD) among those with type 2 diabetes. All 6972 people from the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) with diabetes but without macroalbuminuria were studied. CKD progression was defined as decline in GFR of more than 5% per year, progression to end-stage renal disease, microalbuminuria, or macroalbuminuria at 5.5 years. Lifestyle/social factors included tobacco and alcohol use, physical activity, stress, financial worries, the size of the social network and education. Adjustments were made for known risks such as age, diabetes duration, GFR, albuminuria, gender, body mass index, blood pressure, fasting plasma glucose, and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers use. Competing risk of death was considered. At study end, 31% developed CKD and 15% had died. The social network score (SNS) was a significant independent risk factor of CKD and death, reducing the risk by 11 and 22% when comparing the third to the first tertile of the SNS (odds ratios of CKD 0.89 and death 0.78). Education showed a significant association with CKD but stress and financial worries did not. Those with moderate alcohol consumption had a significantly decreased CKD risk compared with nonusers. Regular physical activity significantly decreased the risk of CKD. Thus, lifestyle is a determinant of kidney health in people at high cardiovascular risk with diabetes.
authors.affiliation: 1] Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada [2] University of Erlangen-Nürnberg, Department of Nephrology, Erlangen, Germany [3] Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dunkler
authors.affiliation: 1] Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada [2] University of Erlangen-Nürnberg, Department of Nephrology, Erlangen, Germany [3] Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
authors.forename: Maria
authors.initials: M
authors.lastname: Kohl
authors.affiliation: Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.affiliation: Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Janice
authors.initials: J
authors.lastname: Pogue
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Peggy
authors.initials: P
authors.lastname: Gao
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Hertzel
authors.initials: H
authors.lastname: Gerstein
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.affiliation: 1] Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria [2] KH Elisabethinen Linz and Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Rainer
authors.initials: R
authors.lastname: Oberbauer
authors.affiliation: 1] Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada [2] University of Erlangen-Nürnberg, Department of Nephrology, Erlangen, Germany [3] Schwabing General Hospital, and KfH Kidney Center, Munich, Germany.
authors.forename: Johannes F E
authors.initials: JF
authors.lastname: Mann
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology; D000428:Alcohol Drinking / Q000453:epidemiology; D001007:Anxiety / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology