健康生活方式降低慢性肾病患者心脏风险

圣迭戈——美国伊利诺伊大学的Ana C. Ricardo博士在2012年肾脏周上报告的一项初步研究结果显示，健康生活方式可降低慢性肾病(CKD)患者心血管事件和死亡风险，但对肾脏事件风险无显著影响。

Ricardo博士指出，健康生活方式对普通人群影响的研究较为常见，但未见作为CKD患者不良结局预测指标的评价研究。此外，虽然也一些针对单一风险因素如吸烟与慢性肾病进展，以及锻炼与死亡率相关性研究，但未见有关多种健康生活方式因素综合影响的研究。

 
Ana C. Ricardo博士

为此，Ricardo博士及其同事对入组慢性肾功能不全队列(CRIC)研究的3,670例轻至中度肾病患者进行了4年随访研究，根据受试者健康生活方式评分，评估健康生活方式与临床结局的相关性。受试者健康生活方式评分由入组时下列因素评分(每个因素为1分)相加而成：目前不吸烟、参与适度锻炼(锻炼时间≥150分钟/周)、参与剧烈运动(锻炼时间≥75分钟/周)以及尿钠排出量<100 mEq/d。结局指标包括CKD进展(定义为估计肾小球滤过率下降≥50%或终末期肾病)、发生心血管事件(定义为心梗、卒中、心衰或外周动脉疾病)或死亡。应用多变量Cox比例风险回归模型，评估生活方式因素对上述结局的影响。

结果显示，86%的受试者坚持1或2种健康生活方式，更多的女性、非西班牙裔白人和大学毕业生健康生活方式评分达到3分。健康生活方式评分为1分者心血管事件和死亡风险下降35%，评分为2或3分者风险进一步下降，分别下降45%和 44%。此外，健康生活方式评分为1分者CKD进展风险下降30%，但未达到统计学显著水平，评分为2或3分者也未见风险进一步下降(分别为24%和7%)，其原因有待进一步分析。

研究者承认该研究存在观察性设计等局限性，上述结果也仅是初步研究结果，更多的分析尚在进行中。

肾脏周2012由美国肾病学会(ASN)主办，CRIC研究由美国国立糖尿病消化病肾病研究所(NIDDK)资助，Ricardo博士声称无相关利益冲突。

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By: DOUG BRUNK, Cardiology News Digital Network

SAN DIEGO – A healthy lifestyle cut the risk of cardiovascular events and death in chronic kidney disease, but it had no significant impact on the risk of renal events, preliminary results from an ongoing study have demonstrated.

"The impact of a healthy lifestyle has been studied most often in the general population, but lifestyle as a predictor of adverse outcomes has not been previously evaluated in individuals with CKD," Dr. Ana C. Ricardo said in an interview during a poster session at Kidney Week 2012.

"There have been studies looking at individual risk factors such as smoking and chronic kidney disease progression alone, and exercise and mortality alone; but none have examined the impact of adherence to multiple lifestyle factors."

The findings come from 4 years of follow-up in 3,670 men and women with mild to moderate kidney disease who are enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter, nationwide study supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to examine the epidemiology, management, and outcomes of CKD.

Dr. Ricardo, a nephrologist with the University of Illinois at Chicago, and her colleagues evaluated the association of a healthy lifestyle with clinical outcomes based on each participant’s healthy lifestyle score. This was calculated by allocating one point for each of the following factors measured at study entry: not currently smoking, engaged in moderate exercise (defined as 150 minutes or greater per week), engaged in vigorous exercise (defined as 75 minutes or greater per week), and having a urinary sodium output of less than 100 mEq/day.

Outcomes of interest were progression of CKD (defined as 50% or greater estimated glomerular filtration rate loss or end-stage renal disease), the development of cardiovascular events (defined as myocardial infarction, stroke, heart failure, or peripheral arterial disease), or death. The researchers used multivariable Cox proportional hazards regression models to determine the impact of the lifestyle factors on these outcomes.

Dr. Ricardo reported that 86% of participants adhered to one or two healthy lifestyle factors. Women, non-Hispanic whites, and college graduates were more likely to have a healthy lifestyle score of 3. Participants with a healthy lifestyle score of 1 had a 35% reduced risk of cardiovascular events or death. This risk was reduced further for those with a score of 2 or 3 (45% and 44%, respectively).

The researchers also found that patients with a healthy lifestyle score of 1 had a 30% reduced risk of CKD progression – but this risk reduction did not reach statistical significance, and risk was not reduced further among those with a score of 2 or 3 (24% and 7%, respectively). "We will explore this in further analyses," Dr. Ricardo said.

She acknowledged certain limitations of the study, including its observational design. "This is a work in progress," she said of the work. "We have more analysis to do. This is just the beginning."

Kidney Week 2012 was sponsored by the American Society of Nephrology. The CRIC study was funded by the NIDDK. Dr. Ricardo said that she had no relevant financial conflicts to disclose.