Guobin Su1, Valeria Saglimbene2, Germaine Wong3, Patrizia Natale2, Marinella Ruospo4, Jonathan C Craig5, Jorgen Hegbrant6, Juan Jesus Carrero7, Giovanni F M Strippoli8. 1. National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China; Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 2. Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia. 3. Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia. 4. Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. 5. College of Medicine and Public Health, Flinders University, Adelaide, Australia. 6. Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden. 7. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 8. Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia. Electronic address: gfmstrippoli@gmail.com.
Abstract
RATIONALE & OBJECTIVE: A healthy lifestyle promotes cardiovascular health and reduces cardiac-related mortality in the general population, but its benefits for people receiving maintenance hemodialysis are uncertain. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 5,483 of 9,757 consecutive adults receiving maintenance hemodialysis (January 2014 to June 2017, median dialysis vintage: 3.6 years) in a multinational private dialysis network and with complete lifestyle data. EXPOSURE: Based on the American Heart Association's recommendations for cardiovascular prevention, a modified healthy lifestyle score was the sum of 4 components addressing use of smoking tobacco, physical activity, diet, and control of systolic blood pressure. OUTCOME: Cardiovascular and all-cause mortality. ANALYTICAL APPROACH: Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between lifestyle score (low [0-2 points] as the referent, medium [3-5], and high [6-8]) and mortality. Associations were expressed as adjusted hazard ratio (AHR) with 95% CI. RESULTS: During a median of 3.8 years (17,451 person-years in total), there were 2,163 deaths, of which 826 were related to cardiovascular disease. Compared with patients who had a low lifestyle score, the AHRs for all-cause mortality among those with medium and high lifestyle scores were 0.75 (95% CI, 0.65-0.85) and 0.64 (95% CI, 0.54-0.76), respectively. Compared with patients who had a low lifestyle score, the AHRs for cardiovascular mortality among those with medium and high lifestyle scores were 0.73 (95% CI, 0.59-0.91) and 0.65 (95% CI, 0.49-0.85), respectively. LIMITATIONS: Self-reported lifestyle, data-driven approach. CONCLUSIONS: A healthier lifestyle is associated with lower all-cause and cardiovascular mortality among patients receiving maintenance hemodialysis.
RATIONALE & OBJECTIVE: A healthy lifestyle promotes cardiovascular health and reduces cardiac-related mortality in the general population, but its benefits for people receiving maintenance hemodialysis are uncertain. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 5,483 of 9,757 consecutive adults receiving maintenance hemodialysis (January 2014 to June 2017, median dialysis vintage: 3.6 years) in a multinational private dialysis network and with complete lifestyle data. EXPOSURE: Based on the American Heart Association's recommendations for cardiovascular prevention, a modified healthy lifestyle score was the sum of 4 components addressing use of smoking tobacco, physical activity, diet, and control of systolic blood pressure. OUTCOME: Cardiovascular and all-cause mortality. ANALYTICAL APPROACH: Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between lifestyle score (low [0-2 points] as the referent, medium [3-5], and high [6-8]) and mortality. Associations were expressed as adjusted hazard ratio (AHR) with 95% CI. RESULTS: During a median of 3.8 years (17,451 person-years in total), there were 2,163 deaths, of which 826 were related to cardiovascular disease. Compared with patients who had a low lifestyle score, the AHRs for all-cause mortality among those with medium and high lifestyle scores were 0.75 (95% CI, 0.65-0.85) and 0.64 (95% CI, 0.54-0.76), respectively. Compared with patients who had a low lifestyle score, the AHRs for cardiovascular mortality among those with medium and high lifestyle scores were 0.73 (95% CI, 0.59-0.91) and 0.65 (95% CI, 0.49-0.85), respectively. LIMITATIONS: Self-reported lifestyle, data-driven approach. CONCLUSIONS: A healthier lifestyle is associated with lower all-cause and cardiovascular mortality among patients receiving maintenance hemodialysis.
Authors: Ana María Armas-Padrón; Domingo Hernández; Miriam Sicilia-Sosvilla; Sergio Rodríguez-Bello; María Dolores López-Carmona; Pedro Ruiz-Esteban Journal: BMC Prim Care Date: 2022-09-09