Good Lifestyle Choices Prevent Kidney as Well as CV Disease

Pam Harrison

September 16, 2020

Many of the same healthy lifestyle choices recommended for the prevention of cardiovascular disease (CVD) also stall the development of chronic kidney disease (CKD), according to a new systematic review and meta-analysis in a healthy adult population.

"No evidence-based lifestyle recommendations for the primary prevention of CKD" have previously been apparent, write Jaimon Kelly, PhD, a postdoctoral fellow, Griffith University, South East Queensland, Australia, and colleagues in their article published online August 31 in the Journal of the American Society of Nephrology.

"We discovered that lifestyle plays a big role and identified a number of recommendations that can be conveyed to healthy people wanting to reduce their risk of developing chronic kidney disease," said Kelly in a press release.

"We found higher intake of potassium and vegetables, lower intake of sodium, physical activity, moderate alcohol consumption, and avoidance of tobacco smoking to be consistently associated with lower risk of CKD," he and his colleagues emphasize.

Adherence to these recommendations could reduce the risk of CKD by 14% to 22%, they calculate.

"In the absence of randomized intervention studies in the field, this study is the best evidence we have to date on what lifestyle choices can help for primary prevention of kidney disease," said senior author, Juan Jesus Carrero, PhD, professor of epidemiology at the Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Sweden.

"The results can be used in the development of public health recommendations and in discussions with patients on how to lower their risk of kidney disease," he added.

The researchers stress that the advice applies to healthy people at risk of developing kidney problems and that people already suffering from renal disease are to follow other lifestyle recommendations to avoid unnecessary strain on their kidneys.

Studies Looked at Diet, Physical Activity, Smoking, and Alcohol Intake

Their research looked at the association between lifestyle factors and risk of incident CKD in 51 studies involving 1,221,018 adults who did not have established CKD at baseline.

"The primary outcome was incident CKD, defined as the development of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 during follow-up," the investigators observe.

Thirty-one studies involving 176,625 participants explored the association between dietary factors and risk of CKD and 10 studies involving 78,301 participants assessed the effect that physical activity has on the same risk endpoint.

The effect that alcohol consumption has on incident CKD is described in 14 studies involving 211,072 participants, and the impact of smoking on CKD risk is outlined in 12 studies involving 985,086 participants.

Lifestyle factors associated with CKD risk in adults are summarized in below.

Table 1. Factors Associated With Risk of CKD in Adults

Factor Odds ratio
Higher vegetable intake 0.79
Higher potassium intake 0.78
Physical activity 0.82
Moderate alcohol intake 0.87
Smoking 1.18
Higher sodium intake 1.21


Markers of Kidney Damage

The meta-analysis also showed risk factors aligned with other markers of kidney damage, including the need for renal replacement therapy (RRT), a decline in eGFR, and risk of albuminuria.

For example, the risk of a decline in eGFR was 51% lower in participants with a higher potassium intake (relative risk [RR], 0.49), the authors note.

Higher levels of vegetable consumption were associated with a higher potassium intake, and the latter was "associated with reduced incident CKD and GFR decline, adding to the growing evidence base for the protective association of potassium intake," they observe.

"Similarly, higher sodium intake showed a consistent association with increased risk of incident CKD, RRT, and GFR decline," Kelly and colleagues note.

And among those who were more physically active, risk of a decline in eGFR was 34% lower in those who were less physically active (OR, 0.76). Likewise, the risk of albuminuria was 12% lower among physically active adults (OR, 0.88).

This finding aligns with the results of other studies and supports the idea that physical activity — defined as at least 30 minutes/day of physical activity — reduces the risk of kidney damage.

Meanwhile, the inverse association between alcohol intake and risk of CKD, as well as secondary endpoints of RRT and eGFR decline, has been previously supported by multiple studies, the researchers point out.

However, this association would appear to hold true only for moderate alcohol consumption in the range of 1 to 4 drinks/day, as higher levels of alcohol consumption are believed to directly damage the kidney.

Lastly, the risk of RRT was 59% higher among current and former smokers compared with never smokers (RR, 1.59), and the risk of albuminuria was 67% higher among smokers compared with never smokers (OR, 1.67).

"Taken together, these risk factors for kidney function decline clearly support a public health message to avoid tobacco smoking to prevent kidney disease as well as CVD," Kelly and colleagues advise.

The study received no funding. Kelly has reported receiving consultancy fees from Amgen and HealthCert.

J Am Soc Nephrol. Published online August 31, 2020. Abstract

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