Kidney Disease: Healthy Heart Lifestyle May Slow Progression

Larry Hand

May 23, 2013

To protect against chronic kidney disease (CKD) progression and premature death from kidney failure, it might be wise to look at the heart. An article published online May 23 in the Journal of the American Society of Nephrology suggests that improving heart health can also be protective against CKD progression.

Paul Muntner, PhD, from the Department of Epidemiology, University of Alabama, Birmingham, and colleagues analyzed the records of 3093 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study for incidence of end-stage renal disease (ESRD) among individuals with CKD (estimated GFR [eGFR], <60 mL/minute per 1.73 m2). The researchers assessed how those individuals compared with the American Heart Association's Life's Simple 7 components for ideal heart health.

Life's Simple 7 components, which consist of 4 health behaviors (body mass index, physical activity, healthy diet, and cigarette smoking) and 3 health factors (blood pressure, cholesterol, and glucose), may also be a predictor of ESRD risk, the researchers write.

In this study population (mean age, 72.2 years; 42% black; 45% men), 160 people developed ESRD during a median follow-up of 4 years, and 610 died. The incidence rate for the glucose component, for example, was 22.0 per 1000 person years (95% confidence interval [CI], 16.1 - 30.1) for people with poor glucose status compared with 20.1 (95% CI, 16.2 - 25.0) for people with intermediate glucose status and 6.1 (95% CI, 4.5 - 8.3) for people with ideal glucose status.

In all, 2% of the population had zero components in the ideal range, 34% had 2 components in the ideal range, and 3% had 5 or more ideal components. People who had 2, 3, and 4 ideal components had progressively lower ESRD risks, and people who had 5 to 7 ideal components never developed ESRD compared with people with no or 1 ideal component. Mortality risk was similar.

Hazard ratios adjusted for age, sex, race, geographic region of residence, income, education, and history of stroke and heart disease were almost 50% lower for people who had 4 components in the ideal range (hazard ratio, 0.52; 95% CI, 0.27 - 0.98) than for people who had no or 1 ideal component. However, after the multivariable adjustment plus accounting for eGFR, the association was no longer significant, and it was also attenuated with albumin-to-creatine ratio factored in.

"Randomized clinical trials are needed to determine the actual risk reduction benefit that can be achieved through improvements in health behaviors and health factors," the researchers conclude.

In an accompanying editorial, Andrew I. Chin, MD, and Lorien S. Dalrymple, MD, MPH, from the Division of Nephrology, Department of Medicine, University of California, Davis, write: "As nephrologists, we can view these findings with either a 'glass half full' or a glass half empty' perspective. We feel that this study provides an opportunity to reconsider and reevaluate our approach to modifying health behaviors and factors in individuals living with CKD.... In the meantime, we suggest taking the optimistic viewpoint and advocating for a healthy lifestyle in our patients living with CKD."

This research was supported by the National Institute of Neurological Disorders and Stroke and Amgen Corporation. Dr. Dalrymple receives research support from the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases.

J Am Soc Nephrol. Published online May 23, 2013.

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