慢性肾脏病患者中体力活动与死亡风险的前瞻性关联研究

史可香; 王雪; 余灿清; 吕筠; 郭彧; 孙点剑一; 裴培; 夏庆梅; 陈君石; 陈铮鸣; 李立明; 代表中国慢性病前瞻性研究项目协作组

Abstract

史可香,王雪,余灿清,吕筠,郭彧,孙点剑一,裴培,夏庆梅,陈君石,陈铮鸣,李立明,代表中国慢性病前瞻性研究项目协作组.慢性肾脏病患者中体力活动与死亡风险的前瞻性关联研究[J].Chinese journal of Epidemiology,2023,44(5):720-726

慢性肾脏病患者中体力活动与死亡风险的前瞻性关联研究

Prospective association between physical activity and mortality in patients with chronic kidney disease

Received:October 25, 2022

DOI：10.3760/cma.j.cn112338-20221025-00906

KeyWord: 慢性肾脏病体力活动死亡心血管疾病

English Key Word: Chronic kidney disease Physical activity Mortality Cardiovascular disease

FundProject:国家自然科学基金(82192904,82192901,82192900);国家重点研发计划(2016YFC0900500);中国香港Kadoorie Charitable基金;中央高校基本科研业务费医-X种子基金(BMU2022MX025)

Author Name	Affiliation	E-mail
Shi Kexiang	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Wang Xue	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Yu Canqing	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness& Response, Beijing 100191, China	yucanqing@pku.edu.cn
Lyu Jun	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness& Response, Beijing 100191, China
Guo Yu	Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing 100037, China
Sun Dianjianyi	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness& Response, Beijing 100191, China
Pei Pei	Peking University Center for Public Health and Epidemic Preparedness& Response, Beijing 100191, China
Xia Qingmei	Peking University Center for Public Health and Epidemic Preparedness& Response, Beijing 100191, China
Chen Junshi	China National Center for Food Safety Risk Assessment, Beijing 100022, China
Chen Zhengming	Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
Li Liming	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness& Response, Beijing 100191, China
for the China Kadoorie Biobank Collaborative Group	1 Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China 2 Peking University Center for Public Health and Epidemic Preparedness& Response, Beijing 100191, China 3 Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing 100037, China 4 China National Center for Food Safety Risk Assessment, Beijing 100022, China 5 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom

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Abstract:

目的探究中国成年慢性肾脏病（CKD）患者中体力活动与全因死亡、心血管疾病（CVD）死亡和CKD死亡风险的前瞻性关联。方法利用中国慢性病前瞻性研究基线调查的数据，采用Cox比例风险回归模型分析总体力活动、不同类型、不同强度体力活动水平与全因死亡、CVD死亡、CKD死亡风险的关联。结果共纳入6 676名CKD患者，随访时间M（Q₁，Q₃）为11.99（11.13，13.03）年，死亡698名（10.46%）。与总体力活动水平最低组相比，总体力活动水平最高组全因死亡、CVD死亡、CKD死亡风险较低，风险比（HR）值（95%CI）分别为0.61（0.47~0.80）、0.40（0.25~0.65）、0.25（0.07~0.85）。工作、交通、家务相关体力活动与全因死亡、CVD死亡风险呈不同程度的负相关。其中，与工作相关体力活动水平最低组相比，最高组全因死亡（HR=0.56，95%CI：0.38~0.82）、CVD死亡（HR=0.39，95%CI：0.20~0.74）风险较低；与交通相关体力活动水平最低组相比，最高组CVD死亡风险较低（HR=0.43，95%CI：0.22~0.84）；与家务相关体力活动水平最低组相比，最高组全因死亡（HR=0.61，95%CI：0.45~0.82）、CVD死亡（HR=0.44，95%CI：0.26~0.76）、CKD死亡（HR=0.03，95%CI：0.01~0.17）风险较低；未发现休闲相关体力活动与死亡风险间的关联。低强度、中高强度体力活动均与全因死亡、CVD死亡、CKD死亡风险呈负相关，低强度体力活动水平最高组对应的HR值（95%CI）分别为0.64（0.50~0.82）、0.42（0.26~0.66）、0.29（0.10~0.83），中高强度体力活动水平最高组对应的HR值（95%CI）分别为0.63（0.48~0.82）、0.39（0.24~0.64）、0.23（0.07~0.73）。结论体力活动可以降低CKD患者全因死亡、CVD死亡和CKD死亡的风险。

English Abstract:

Objective To investigate the prospective association of physical activity with all-cause, cardiovascular disease (CVD), and chronic kidney disease (CKD) mortality in CKD patients in China. Methods Cox proportional hazard models were used to evaluate the association of total, domain-specific, and intensity-specific physical activity with the risk of all-cause, CVD, and CKD mortality based on data from the baseline survey of China Kadoorie Biobank. Results During a median follow-up of 11.99 (11.13, 13.03) years, there were 698 deaths in 6 676 CKD patients. Compared with the bottom tertile of total physical activity, participants in the top tertile had a lower risk of all-cause, CVD, and CKD mortality, with hazard ratios (HRs) (95%CIs) of 0.61 (0.47-0.80), 0.40 (0.25-0.65), and 0.25 (0.07-0.85), respectively. Occupational, commuting, and household physical activity were negatively associated with the risk of all-cause and CVD mortality to varying degrees. Participants in the top tertile of occupational physical activity had a lower risk of all-cause (HR=0.56, 95%CI: 0.38-0.82) and CVD (HR=0.39, 95%CI: 0.20-0.74) mortality, those in the top tertile of commuting physical activity had a lower risk of CVD mortality (HR=0.43, 95%CI: 0.22-0.84), and those in the top tertile of household physical activity had a lower risk of all-cause (HR=0.61, 95%CI: 0.45-0.82), CVD (HR=0.44, 95%CI: 0.26-0.76) and CKD (HR=0.03, 95%CI: 0.01-0.17) mortality, compared with the bottom tertile of corresponding physical activity. No association of leisure-time physical activity with mortality was observed. Both low and moderate-vigorous intensity physical activity were negatively associated with the risk of all-cause, CVD and CKD mortality. The corresponding HRs (95%CIs) were 0.64 (0.50-0.82), 0.42 (0.26-0.66) and 0.29 (0.10-0.83) in the top tertile of low intensity physical activity, and the corresponding HRs (95%CIs) were 0.63 (0.48-0.82), 0.39 (0.24-0.64) and 0.23 (0.07-0.73) in the top tertile of moderate-vigorous intensity physical activity. Conclusion Physical activity can reduce the risk of all-cause, CVD, and CKD mortality in CKD patients.

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