Relationship between the exposure to cumulative cardiovascular health behaviors and factors and chronic kidney disease—The Kailuan study

Abstract

It is unclear whether ideal cardiovascular health (CVH) behaviors and factors, particularly cumulative exposure to ideal CVH (cumCVH), is associated with chronic kidney disease (CKD). The aim of the study was to examine the effect of cumCVH on CKD using the data from the Kailuan study. The study included the 27,970 (21,199 males) of the Kailuan community (China). The participants were 19 to 98 years of age. They were followed in 2008–2009, 2010–2011, and 2012–2013 by the same medical staff that did the initial physical examinations in 2006–2007. Participants were censored on the visit reporting CKD. A CVH score was created based on the seven AHA health metrics. The cumCVH score was CVH1×timev1-v2+CVH2×timev2-v3+CVH3×timev3-v4. In the fully adjusted model, compared with the lowest quintile of cumCVH, individuals in the highest quintile had a 75% lower risk of CKD (95% confidence interval (CI): 66–82%). Every additional year lived with a 1-unit increase in ideal CVH was associated with an 11% (95% CI: 9–13%) reduction in the incidence of CKD. Furthermore, when we excluded each of the six metrics from the cumCVH score in turn, the association was unaffected after the exclusion of individual risk factors. Ideal CVH is associated with a reduced incidence of CKD. Measurements of cumCVH are more likely to reflect the lifetime risk of CKD and possibly of other health outcomes.

Association of ideal cardiovascular health metrics with incident low estimated glomerular filtration rate: More than a decade follow-up in the Tehran Lipid and Glucose Study (TLGS)

“…Individual-level data analysis conducted on 34 multinational cohorts from the CKD Prognosis Consortium, including 5 222 711 subjects from 28 countries, indicated that among diabetic and non-diabetic individuals, hypertension, having higher BMI, and ever smoker were significant predictors of CKD development [ 32 ]. Similar to our study, previous studies have also found that being in the healthier categories of BMI, BP and FPG was associated with a lower risk of CKD [ 11 , 19 , 20 ]. The results derived from the ARIC study showed that being in the intermediate and ideal categories of BMI was associated with 20% and 26% reduced risk of CKD, respectively.…”

“…Another study assessed the association of ICVHM and ESRD; it showed a graded association between a higher score of ICVHM and a lower incidence rate of ESRD, as those with 4 ICVHM had about 50% lower risk for the event compared to the reference category. However, this association was no longer significant after adjusting for eGFR, while our significant HRs persisted [ 11 , 19 , 20 ].…”

“…To our knowledge, only three prospective studies conducted among the general population examined the association between ICVHM and kidney impairment [ 11 , 19 , 20 ]. Comparing our findings with these studies is difficult due to differences in categories of ICVHM, the level of confounder adjustment, duration of follow-up, and definition of CKD event.…”

“…Rebholz et al in the context of the ARIC study, found in 14832 subjects with a mean (SD) age of 54.7 (5.5) years, compared to 0 ideal health factors, having five or ≥ 6 health factors were associated with 73% and 81% lower risk of CKD. [ 11 ] Hou et al in China found that among all age groups (< 40, 40–59, and ≥ 60 years), each one score increase in ICVHM per year was associated with 11% (0.89, 0.87–0.91) reduction of CKD risk; however, the authors did not consider eGFR as an important confounder in their analysis [ 11 , 19 , 20 ]. Another study assessed the association of ICVHM and ESRD; it showed a graded association between a higher score of ICVHM and a lower incidence rate of ESRD, as those with 4 ICVHM had about 50% lower risk for the event compared to the reference category.…”

“…The results derived from the ARIC study showed that being in the intermediate and ideal categories of BMI was associated with 20% and 26% reduced risk of CKD, respectively. The corresponding values for BP were 27% and 50%, and for FPG, were 60% and 63% [ 11 , 19 , 20 ]. Contrary to our results, Hou et al and Rebholz et al found significant associations between smoking and low PA with an increased risk of developing CKD [ 11 , 19 ].…”