Adherence to a healthy lifestyle and all-cause mortality in CKD.

BACKGROUND AND OBJECTIVE: Among general populations, a healthy lifestyle has been associated with lower risk of death. This study evaluated this association in individuals with CKD.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 2288 participants with CKD (estimated GFR < 60 ml/min per 1.73 m(2) or microalbuminuria) in the Third National Health and Nutrition Examination Survey were included. A weighted healthy lifestyle score was calculated (range, -4 to 15, with 15 indicating healthiest lifestyle) on the basis of the multivariable Cox proportional hazards model regression coefficients of the following lifestyle factors: smoking habit, body mass index (BMI), physical activity, and diet. Main outcome was all-cause mortality, ascertained through December 31, 2006.

RESULTS: After median follow-up of 13 years, 1319 participants had died. Compared with individuals in the lowest quartile of weighted healthy lifestyle score, adjusted hazard ratios (95% confidence intervals) of all-cause mortality were 0.53 (0.41-0.68), 0.52 (0.42-0.63), and 0.47 (0.38-0.60) for individuals in the second, third, and fourth quartiles, respectively. Mortality increased 30% among individuals with a BMI of 18.5 to <22 kg/m(2) versus 22 to <25 kg/m(2) (P<0.05); decreased mortality was associated with never-smoking versus current smoking (0.54 [0.41-0.70]) and regular versus no physical activity (0.80 [0.65-0.99]). Diet was not significantly associated with mortality.

CONCLUSIONS: Compared with nonadherence, adherence to a healthy lifestyle was associated with lower all-cause mortality risk in CKD. Examination of individual components of the healthy lifestyle score, with adjustment for other components, suggested that the greatest reduction in all-cause mortality was related to nonsmoking.