Amount and pattern of physical activity and sedentary behavior are associated with kidney function and kidney damage: The Maastricht Study

Physical exercise: a polypill against chronic kidney disease

We are currently facing a pandemic of physical inactivity that might contribute to the growing prevalence of chronic kidney disease (CKD). Here, we summarize currently available evidence on the association between physical activity and CKD, and also review the effects of exercise intervention in affected patients. Physical activity/exercise might act as a polypill against CKD, preventing its development or even exerting beneficial effects once it is established (i.e. improvements in patients' physical fitness and cardiovascular risk, as well as in kidney function). Exercise benefits are also found at advanced CKD stages or in patients under hemodialysis. The biological mechanisms behind the clinical evidence are also discussed. An active lifestyle appears as a cornerstone in CKD prevention and management.

Occupational Sitting Time, Leisure Physical Activity, and All-Cause and Cardiovascular Disease Mortality

Importance

For the first time, the 2020 World Health Organization guidelines on physical activity recommended reducing sedentary behaviors owing to their health consequences. Less is known on the specific association of prolonged occupational sitting with health, especially in the context of low physical activity engagement.

Objective

To quantify health risks associated with prolonged occupational sitting and to determine whether there is a certain threshold of physical activity that may attenuate it.

Design, Setting, and Participants

This prospective cohort study included participants in a health surveillance program in Taiwan who were followed-up between 1996 and 2017. Data on occupational sitting, leisure-time physical activity (LTPA) habits, lifestyle, and metabolic parameters were collected. Data analysis was performed in December 2020.

Main Outcomes and Measures

The all-cause and cardiovascular disease (CVD) mortality associated with 3 occupational sitting volumes (mostly sitting, alternating sitting and nonsitting, and mostly nonsitting) were analyzed applying multivariable Cox regression models to calculate the hazard ratios (HRs) for all participants and by subgroups, including 5 LTPA levels and a personal activity intelligence (PAI)-oriented metric. Deaths occurring within the initial 2 years of follow-up were excluded to prevent reverse causality.

Results

The total cohort included 481 688 participants (mean [SD] age, 39.3 [12.8] years; 256 077 women [53.2%]). The study recorded 26 257 deaths during a mean (SD) follow-up period of 12.85 (5.67) years. After adjusting for sex, age, education, smoking, drinking, and body mass index, individuals who mostly sat at work had a 16% higher all-cause mortality risk (HR, 1.16; 95% CI, 1.11-1.20) and a 34% increased mortality risk from CVD (HR, 1.34; 95% CI, 1.22-1.46) compared with those who were mostly nonsitting at work. Individuals alternating sitting and nonsitting at work did not experience increased risk of all-cause mortality compared with individuals mostly nonsitting at work (HR, 1.01; 95% CI, 0.97-1.05). For individuals mostly sitting at work and engaging in low (15-29 minutes per day) or no (<15 minutes per day) LTPA, an increase in LTPA by 15 and 30 minutes per day, respectively, was associated with a reduction in mortality to a level similar to that of inactive individuals who mostly do not sit at work. In addition, individuals with a PAI score exceeding 100 experienced a notable reduction in the elevated mortality risk associated with prolonged occupational sitting.

Conclusions and Relevance

As part of modern lifestyles, prolonged occupational sitting is considered normal and has not received due attention, even though its deleterious effect on health outcomes has been demonstrated. In this study, alternating between sitting and nonsitting at work, as well as an extra 15 to 30 minutes per day of LTPA or achieving a PAI score greater than 100, attenuated the harms of prolonged occupational sitting. Emphasizing the associated harms and suggesting workplace system changes may help society to denormalize this common behavior, similar to the process of denormalizing smoking.

The Impact of Sedentary Behavior on Renal Function Decline in 132,123 Middle Aged and Older Adults: A Nationwide Cohort Study

BACKGROUND Prior studies suggest that sedentary behavior is a well-known risk factor for cardiometabolic diseases. However, the longitudinal association between overall siting time and kidney function decline is not known. MATERIAL AND METHODS We performed a nationwide prospective cohort study in individuals aged more than 40 years enrolled in the China Cardiometabolic Disease and Cancer Cohort (4C) study. A total of 132 123 individuals were included in this study. Sitting time was measured with the short version of the International Physical Activity Questionnaire (IPAQ). Kidney function decline was defined as an eGFR <60 mL/min/1.73 m² or more than a 30% decrease in eGFR from baseline. Multivariate Cox proportional hazards regression analyses were conducted to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of the relation between kidney function decline and sitting time. RESULTS During a mean follow-up of 3.8 years, 3890 (2.9%) participants experienced kidney function decline. Longer sitting time was significantly associated with the risk of kidney function decline (aHR, 1.136; 95% CI, 1.036-1.247, P=0.007, comparing participants with baseline sitting time in the lowest quartile with those in the highest quartile) after adjustment for potential confounders. CONCLUSIONS Longer sitting time was independently and prospectively associated with a higher risk of kidney function decline. Sedentary behavior might represent a modifiable risk factor for chronic kidney disease (CKD) prevention.

Physical exercise as a friend not a foe in acute kidney diseases through immune system modulation

Regular and moderate exercise is being used for therapeutic purposes in treating several diseases, including cancer, cardiovascular diseases, arthritis, and even chronic kidney diseases (CKDs). Conversely, extenuating physical exercise has long been pointed out as one of the sources of acute kidney injury (AKI) due to its severe impact on the body's physiology. AKI development is associated with increased tubular necrosis, which initiates a cascade of inflammatory responses. The latter involves cytokine production, immune cell (macrophages, lymphocytes, and neutrophils, among others) activation, and increased oxidative stress. AKI can induce prolonged fibrosis stimulation, leading to CKD development. The need for therapeutic alternative treatments for AKI is still a relevant issue. In this context arises the question as to whether moderate, not extenuating, exercise could, on some level, prevent AKI. Several studies have shown that moderate exercise can help reduce tissue damage and increase the functional recovery of the kidneys after an acute injury. In particular, the immune system can be modulated by exercise, leading to a better recovery from different pathologies. In this review, we aimed to explore the role of exercise not as a trigger of AKI, but as a modulator of the inflammatory/immune system in the prevention or recovery from AKI in different scenarios. In AKI induced by ischemia and reperfusion, sepsis, diabetes, antibiotics, or chemotherapy, regular and/or moderate exercise could modulate the immune system toward a more regulatory immune response, presenting, in general, an anti-inflammatory profile. Exercise was shown to diminish oxidative stress, inflammatory markers (caspase-3, lactate dehydrogenase, and nitric oxide), inflammatory cytokines (interleukin (IL)-1b, IL-6, IL-8, and tumor necrosis factor-α (TNF-α)), modulate lymphocytes to an immune suppressive phenotype, and decrease tumor necrosis factor-β (TGF-β), a cytokine associated with fibrosis development. Thus, it creates an AKI recovery environment with less tissue damage, hypoxia, apoptosis, or fibrosis. In conclusion, the practice of regular moderate physical exercise has an impact on the immune system, favoring a regulatory and anti-inflammatory profile that prevents the occurrence of AKI and/or assists in the recovery from AKI. Moderate exercise should be considered for patients with AKI as a complementary therapy.

Association of physical activity with endothelial dysfunction among adults with and without chronic kidney disease: The Maastricht Study

BACKGROUND AND AIMS

Physical activity (PA) constitutes an established protective factor while sedentary behavior (SB) an emerging independent risk factor for cardiovascular diseases. This study evaluated the association of PA and SB with endothelial dysfunction (ED) depending on kidney function status.

METHODS

Cross-sectional data from the prospective, population-based Maastricht Study were used. PA and SB were measured using the ActivPAL3 accelerometer 24h/day for eight consecutive days. ED was evaluated by plasma levels of soluble vascular cell adhesion protein-1, intercellular adhesion molecule-1, E-selectin and von Willebrand factor, which were combined into an ED score with higher values depicting higher ED.

RESULTS

Overall, 2,668 participants, 323 with chronic kidney disease, were included. In normal kidney function individuals, the ED score presented a significant negative association with total, lower-intensity and moderate-to-vigorous PA duration and a positive association with total sedentary time, sedentary breaks and sedentary bout duration. In participants with chronic kidney disease, a significant negative association of ED score with total [β: -4.42, 95% confidence intervals (95% CI): -7.98; -0.87] and lower-intensity (β: -7.08, 95% CI: -13.41; -0.74) PA duration, as well as a positive association of ED score with sedentary bout duration (β: 43.72, 95% CI: 9.85; 77.59) were noted. The strength of associations did not significantly differ across kidney function subgroups (p > 0.05).

CONCLUSIONS

This analysis showed that PA duration is inversely associated with ED both among patients with normal kidney function and chronic kidney disease. In chronic kidney disease, longer sedentary bouts were associated with greater endothelial dysfunction.

Metabolomic Signatures of Sedentary Behavior and Cardiometabolic Traits in US Hispanics/Latinos: Results from HCHS/SOL

PURPOSE

The aim of this study was to understand the serum metabolomic signatures of moderate-to-vigorous physical activity (MVPA) and sedentary behavior, and further associate their metabolomic signatures with incident cardiometabolic diseases.

METHODS

This analysis included 2711 US Hispanics/Latinos from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) aged 18-74 yr (2008-2011). An untargeted, liquid chromatography-mass spectrometry was used to profile the serum metabolome. The associations of metabolites with accelerometer-measured MVPA and sedentary time were examined using survey linear regressions adjusting for covariates. The weighted correlation network analysis identified modules of correlated metabolites in relation to sedentary time, and the modules were associated with incident diabetes, dyslipidemia, and hypertension over the 6-yr follow-up.

RESULTS

Of 624 metabolites, 5 and 102 were associated with MVPA and sedentary behavior at false discovery rate (FDR) <0.05, respectively, after adjusting for socioeconomic and lifestyle factors. The weighted correlation network analysis identified 8 modules from 102 metabolites associated with sedentary time. Four modules (branched-chain amino acids, erythritol, polyunsaturated fatty acid, creatine) were positively, and the other four (acyl choline, plasmalogen glycerol phosphatidyl choline, plasmalogen glycerol phosphatidyl ethanolamine, urea cycle) were negatively correlated with sedentary time. Among these modules, a higher branched-chain amino acid score and a lower plasmalogen glycerol phosphatidyl choline score were associated with increased risks of diabetes and dyslipidemia. A higher erythritol score was associated with an increased risk of diabetes, and a lower acyl choline score was linked to an increased risk of hypertension.

CONCLUSIONS

In this study of US Hispanics/Latinos, we identified multiple serum metabolomic signatures of sedentary behavior and their associations with risk of incident diabetes, hypertension, and dyslipidemia. These findings suggest a potential role of circulating metabolites in the links between sedentary behavior and cardiometabolic diseases.

Association between sedentary behavior and chronic kidney disease in Korean adults

BACKGROUND

Chronic kidney disease (CKD) is a significant health care burden, with a worldwide prevalence of approximately 11%. The general population spends over 50% of the awake time sedentary activities. However, to the best of our knowledge, no study has evaluated the association between sedentary time and CKD, with a focus on both kidney damage and kidney function, in the South Korean population. Accordingly, the present study aimed to address this gap in the knowledge.

METHOD

We used data from the 8^th Korea National Health and Nutrition Examination Survey. The analysis included 9,534 participants, especially excluded those who had been diagnosed with kidney disease or who were currently undergoing treatment. Sedentary behavior was self-reported by the participants. An estimated glomerular filtration rate (eGFR) and/or albuminuria were used as measures for detection of CKD according to the guidelines of the Kidney Disease Improving Global Outcomes. We analyzed the data using multiple logistic regression.

RESULTS

Among the women, the risk of CKD was significantly greater among those who sat for ≥ 12 h/d relative to those who sat for < 6 h/d, after adjusting for physical activity and other covariates (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.01-2.06). Similarly, among those who sat over 12 h/d, those who engaged in low levels of physical activity had a higher risk of CKD than those who engaged in high levels of activity (OR: 1.65, 95% CI: 1.04-2.61). No statistically significant results were found for men.

CONCLUSION

Excessive sedentary behavior was associated with an increased risk of CKD, especially albuminuria, regardless of the level of physical activity, only in women. These findings emphasize the importance of avoiding excessive sitting for a long time and increasing overall physical activity levels.

An Evaluation of Alternative Technology-Supported Counseling Approaches to Promote Multiple Lifestyle Behavior Changes in Patients With Type 2 Diabetes and Chronic Kidney Disease

OBJECTIVES

Although technology-supported interventions are effective for reducing chronic disease risk, little is known about the relative and combined efficacy of mobile health strategies aimed at multiple lifestyle factors. The purpose of this clinical trial is to evaluate the efficacy of technology-supported behavioral intervention strategies for managing multiple lifestyle-related health outcomes in overweight adults with type 2 diabetes (T2D) and chronic kidney disease (CKD).

DESIGN AND METHODS

Using a 2 × 2 factorial design, adults with excess body weight (body mass index ≥27 kg/m2, age ≥40 years), T2D, and CKD stages 2-4 were randomized to an advice control group, or remotely delivered programs consisting of synchronous group-based education (all groups), plus (1) Social Cognitive Theory-based behavioral counseling and/or (2) mobile self-monitoring of diet and physical activity. All programs targeted weight loss, greater physical activity, and lower intakes of sodium and phosphorus-containing food additives.

RESULTS

Of 256 randomized participants, 186 (73%) completed 6-month assessments. Compared to the ADVICE group, mHealth interventions did not result in significant changes in weight loss, or urinary sodium and phosphorus excretion. In aggregate analyses, groups receiving mobile self-monitoring had greater weight loss at 3 months (P = .02), but between 3 and 6 months, weight losses plateaued, and by 6 months, the differences were no longer statistically significant.

CONCLUSIONS

When engaging patients with T2D and CKD in multiple behavior changes, self-monitoring diet and physical activity demonstrated significantly larger short-term weight losses. Theory-based behavioral counseling alone was no better than baseline advice and demonstrated no interaction effect with self-monitoring.

Association between physical activity and risk of renal function decline and mortality in community-dwelling older adults: a nationwide population-based cohort study

BACKGROUND

Physical activity (PA) is an important risk factor associated with health outcomes. However, the relationship between PA and kidney function decline in older adults remains unclear. We examined the influence of PA on kidney function decline and mortality in community-dwelling older adults.

METHODS

Adults aged ≥ 65 years with an estimated glomerular filtration rate (eGFR) > 60 mL/min/1.73 m² who had available health checkup data from 2009 to 2010 were included. The cohort was followed annually through December 2015 for anthropometric, sociodemographic, and medical information including outcomes and biennially for laboratory information from the health checkup. We divided these patients into three groups according to self-reported PA (Inactive group: no leisure-time PA, Active group: vigorous activity for at least 80 min/week or a sum of moderate-intensity activity and walking for at least 300 min/week, Low-active group: level of PA between the definitions of the other two groups). Associations between the intensity of PA and death, cardiovascular death, and ≥ 50% eGFR decline were investigated.

RESULTS

Among 102,353 subjects, 32,984 (32.23%), 54,267 (53.02%), and 15,102 (14.75%) were classified into the inactive, low-active, and active groups, respectively. The active group was younger, contained a higher proportion of men, and had higher frequencies of hypertension, diabetes mellitus, drinking, and smoking than the other groups. The active group had significantly lower incidence rates of mortality, cardiovascular mortality, and kidney function decline than the other groups (all p < 0.001). The active group also showed lower all-cause (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.70-0.82) and cardiovascular mortality (HR, 0.64; 95% CI, 0.53-0.78) and protection against ≥ 50% eGFR decline (HR, 0.81; 95% CI, 0.68-0.97) compared with the inactive group in the fully adjusted Cox proportional hazards regression model.

CONCLUSIONS

High PA was an independent modifiable lifestyle factor for reducing mortality and protecting against declines in kidney function in older adults.

Associations of Prolonged Occupational Sitting with the Spectrum of Kidney Disease: Results from a Cohort of a Half-Million Asian Adults

BACKGROUND

Kidney diseases are viewed as continuously progressing diseases from microalbuminuria and chronic kidney disease (CKD), to end-stage renal disease (ESRD) and its mortality including deaths. The report on the association between prolonged sitting and kidney diseases is limited.

METHODS

We examined a cohort of 455,506 participants in a screening program in Taiwan conducted between 1996 and 2017. Data on occupational sedentary behavior and physical activity were collected with a standardized questionnaire. The outcomes of ESRD and death were identified by linking with the Catastrophic Illness Dataset and Cause of Death Data. The association between prolonged sitting and CKD, the incidence of ESRD, and death were assessed using logistic regression models to compute odds ratios (ORs) and Cox proportional hazards models for hazard ratios (HRs).

RESULTS

More than half of the participants, i.e., 265,948 (58.4%), were categorized as "prolonged sitting" during their work. During a median of 13 years of follow-up, we identified 2227 individuals undergoing dialysis and 25,671 deaths. Prolonged occupational sitting was significantly associated with a higher risk of CKD (OR: 1.26, 95% confidence interval: 1.21, 1.31), ESRD (HR: 1.19, 95% CI 1.03, 1.38), and kidney-specific mortality (HR: 1.43, 95% CI 1.07, 1.91) compared to mostly standing participants after controlling for physical activity and other risk factors. Inactive prolonged sitting carries a significantly higher risk of ESRD than physically active mostly standing participants (HR: 1.34, 95% CI 1.04, 1.73). However, active prolonged sitting decreased the risk of ESRD (HR: 1.03, 95% CI 0.79, 1.34) compared to inactive prolonged sitting.

CONCLUSION

The results suggest that prolonged occupational sitting is associated with a greater risk of the spectrum of kidney disease, proteinuria, CKD, dialysis (ESRD), and mortality for all causes and kidney diseases. Physical activity, even at a minimal level of 15 min/day (90 min/week) of moderate-intensity exercise, was associated with a reduction in these risks.

Prevention of cardiorenal damage: importance of albuminuria

Chronic kidney disease (CKD) is projected to become a leading global cause of death by 2040, and its early detection is critical for effective and timely management. The current definition of CKD identifies only advanced stages, when kidney injury has already destroyed &gt;50% of functioning kidney mass as reflected by an estimated glomerular filtration rate &lt;60 mL/min/1.73 m2 or a urinary albumin/creatinine ratio &gt;six-fold higher than physiological levels (i.e. &gt; 30 mg/g). An elevated urinary albumin-excretion rate is a known early predictor of future cardiovascular events. There is thus a ‘blind spot’ in the detection of CKD, when kidney injury is present but is undetectable by current diagnostic criteria, and no intervention is made before renal and cardiovascular damage occurs. The present review discusses the CKD ‘blind spot’ concept and how it may facilitate a holistic approach to CKD and cardiovascular disease prevention and implement the call for albuminuria screening implicit in current guidelines. Cardiorenal risk associated with albuminuria in the high-normal range, novel genetic and biochemical markers of elevated cardiorenal risk, and the role of heart and kidney protective drugs evaluated in recent clinical trials are also discussed. As albuminuria is a major risk factor for cardiovascular and renal disease, starting from levels not yet considered in the definition of CKD, the implementation of opportunistic or systematic albuminuria screening and therapy, possibly complemented with novel early biomarkers, has the potential to improve cardiorenal outcomes and mitigate the dismal 2040 projections for CKD and related cardiovascular burden.

Daily patterns of physical activity, sedentary behavior, and prevalent and incident depression-The Maastricht Study

This study aims to compare the accelerometer-measured daily patterns of PA and sedentary behavior among participants with and without prevalent/incident depressive symptoms. We used data from 5582 individuals in The Maastricht Study (59.9 ± 8.6 years, 50.3% women). Daily patterns of sedentary time, light-intensity physical activity (LiPA), moderate-to-vigorous physical activity (MVPA), and sit-to-stand transitions were objectively measured at baseline with the activPAL3 activity monitor. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire, both at baseline and annually (median follow-up: 5.1 years). General linear models were used to compare patterns of physical activity and sedentary behavior between those with and without prevalent/incident depressive symptoms. Participants with prevalent depressive symptoms had significantly more sedentary time (18.6 min/day) and lower LiPA (26.8 min/day) and MVPA (4.8 min/day) than participants without depressive symptoms. Considering the daily patterns, participants with prevalent depressive symptoms had significantly more sedentary time early in the afternoon (12:00-18:00), early evening (18:00-21:00), and during the night (00:00-03:00), less time in LiPA in all periods between 09:00-21.00 and less MVPA in the morning (09:00:12:00), early afternoon (12:00-15:00), and evening (18:00-21:00), than those without. Similar differences in activity and sedentary behavior patterns between those and without incident depressive symptoms were observed albeit the differences were smaller. Overall, we did not find specific time slots particularly associated with both prevalent and incident depressive symptoms. These findings may indicate that less sedentary time and more intense PA can be important targets for the prevention of depression irrespective of the timing of the day.

Novel sedentary cage induced sedentariness in rats: evidence from relevant biomarkers

BACKGROUND

Sedentary behavior or physical inactivity is considered a foremost contributor to the rise in obesity and overweight and a risk factor for several non-communicable diseases. However, its effect on the etiopathogenesis of some diseases is underestimated in both developed and developing countries worldwide. The present study designed a novel sedentary cage with a view to achieving sedentariness in rats, and also investigated the effectiveness of the cage in achieving sedentariness by assessing some markers of cardiometabolic risks in Wistar rats.

METHODS

Adult male Wistar rats were divided into 3 groups of six rats. Rats in Group 1 were the control. The sedentary groups were 4-hr. sedentary and 8-hr. sedentary. The sedentary rats were subjected to restrained movements for 4 and 8 hours daily in the sedentary cage for 3 months. Anthropometric indices, food consumption and blood pressure parameters of the rats were measured. Microalbuminuria and serum glucose, uric acid, albumin, nitric oxide, endothelin-1, insulin, inflammatory markers were also Measured.

RESULTS

Results indicated significant increases in body weight, BMI, Lee index, food consumption, systolic and diastolic pressure and decrease in serum nitric oxide bioavailability in the 8-hr sedentary rats. There were also significant increases in serum glucose, uric acid, endothelin-1, insulin, CRP and microalbuminuria in the 8-hr. sedentary rats in comparison with the control. The interleukin-6 and TNF-α also revealed a significant increase in the 8-hr. sedentary rats compared with the control. However, there was no significant difference in cortisol level across all the groups.

CONCLUSIONS

We concluded that the novel sedentary cage successfully caused sedentariness in the rats as evident by the alteration in the cardiometabolic health in the rats, especially the group that were made sedentary for 8 h.

Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults: An Ancillary Analysis of the LIFE Study Randomized Clinical Trial

Importance

Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to our knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults.

Objective

To evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFRCysC) change in older adults.

Design, Setting, and Participants

This ancillary analysis of the Lifestyle Interventions and Independence For Elders randomized clinical trial enrolled 1199 community-dwelling, sedentary adults aged 70 to 89 years with mobility limitations and available blood specimens. The original trial was conducted across 8 academic centers in the US from February 2010 through December 2013. Data for this study were analyzed from March 29, 2021, to February 28, 2022.

Interventions

Structured, 2-year, partially supervised, moderate-intensity physical activity and exercise (strength, flexibility) intervention compared with a health education control intervention with 2-year follow-up. Physical activity was measured by step count and minutes of moderate-intensity activity using accelerometers.

Main Outcomes and Measures

The primary outcome was change in eGFRCysC. Rapid eGFRCysC decline was defined by the high tertile threshold of 6.7%/y.

Results

Among the 1199 participants in the analysis, the mean (SD) age was 78.9 (5.2) years, and 800 (66.7%) were women. At baseline, the 2 groups were well balanced by age, comorbidity, and baseline eGFRCysC. The physical activity and exercise intervention resulted in statistically significantly lower decline in eGFRCysC over 2 years compared with the health education arm (mean difference, 0.96 mL/min/1.73 m2; 95% CI, 0.02-1.91 mL/min/1.73 m2) and lower odds of rapid eGFRCysC decline (odds ratio, 0.79; 95% CI, 0.65-0.97).

Conclusions and Relevance

Results of this ancillary analysis of a randomized clinical trial showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFRCysC among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFRCysC.

Trial Registration

ClinicalTrials.gov Identifier: NCT01072500.

The Effect of Nutrition and Exercise on Body Composition, Exercise Capacity, and Physical Functioning in Advanced CKD Patients

Patients with stages 4 and 5 chronic kidney disease (CKD), and particularly chronic dialysis patients, commonly are found to have substantially reduced daily physical activity in comparison to age- and sex-matched normal adults. This reduction in physical activity is associated with a major decrease in physical exercise capacity and physical performance. The CKD patients are often physically deconditioned, and protein energy wasting (PEW) and frailty are commonly present. These disorders are of major concern because physical dysfunction, muscle atrophy, and reduced muscle strength are associated with poor quality of life and increased morbidity and mortality in CKD and chronic dialysis patients. Many randomized controlled clinical trials indicate that when CKD and chronic dialysis are provided nutritional supplements or undergo exercise training their skeletal muscle mass and exercise capacity often increase. It is not known whether the rise in skeletal muscle mass and exercise capacity associated with nutritional support or exercise training will reduce morbidity or mortality rates. A limitation of these clinical trials is that the sample sizes of the different treatment groups were small. The aim of this review is to discuss the effects of nutrition and exercise on body composition, exercise capacity, and physical functioning in advanced CKD patients.

Daily behavioral and sleep patterns are associated with aging-induced male-specific disorders in individuals with reduced renal function

BACKGROUND

The development of aging-induced male-specific disorders is accelerated by impaired renal function. Although aging-induced male-specific disorders are clinically serious complications in individuals with reduced renal function, their practical management strategies remain obscure. The purpose of this cross-sectional study was to investigate the association between daily behavioral and sleep patterns and aging-induced male-specific disorders in individuals with reduced renal function.

METHODS

Eighty men with glomerular filtration rate stage 2-4 (age, 67 ± 9 years), sedentary behavior and physical activity were assessed using a triaxial accelerometer. The mean sleep time was calculated from the sleep time during the accelerometer measurement. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Aging-induced male-specific disorders were assessed using the Aging Males' Symptoms Questionnaire (AMS).

RESULTS

A lower moderate to vigorous-intensity physical activity (MVPA) time and a higher PSQI score were independently associated with a higher AMS score. Moreover, when the participants were divided into four groups according to the median MVPA values and the PSQI score (more or less than 6 points), the AMS score was the highest in those with a lower MVPA time and a higher PSQI score. In the mediation analysis, the PSQI score did not mediate a correlation between the MVPA time and AMS score. MVPA time also did not mediate a correlation between the PSQI and AMS scores.

CONCLUSIONS

Collectively, these findings suggest that increasing MVPA time and improving sleep quality may contribute to attenuating aging-induced male-specific disorders in individuals with reduced renal function.

Unstable Housing and Kidney Disease: A Primer

Stable housing is essential for health. Over 580,000 Americans experienced homelessness during one night in 2020, and over 37 million households spend over 30% of their income on housing. Unstable housing has been associated with mortality, acute care utilization, communicable and non-communicable diseases, a higher risk of kidney disease, and kidney disease progression. In this review, we define various forms of unstable housing, provide an overview of the interaction between unstable housing and health, and discuss existing evidence associating housing and kidney disease. We provide historical context for unstable housing in the United States, and detail policy, community, and individual-level factors that contribute to the risk of unstable housing. Unstable housing likely affects kidney health via a complex interplay of individual and structural factors. Various screening tools are available for use by providers. Special considerations should be made when working with individuals experiencing unstable housing to meet their unique needs, facilitate health care engagement, and optimize outcomes. Housing interventions have been shown to improve outcomes and should be examined for their role in kidney disease.

Sedentarism, A Modifiable Risk Factor for Developing Chronic Kidney Disease in Healthy People

Background

Chronic kidney disease (CKD) is a consequence of the interaction of many pathophysiological processes, manifested by a decrease in the glomerular filtration rate (GFR) and abnormal kidney function. Sedentary behavior is associated with decreased kidney function, and regular physical activity could have the potential to reduce the risk of developing CKD, although this is not entirely clear. The objective of this study was to investigate the relationship between sedentary behavior and the development of CKD.

Methods

A search was carried out in different databases and metasearchers from January 2015 to June 2020 for cross-sectional, case-control, and cohort studies, in which the association of a sedentary lifestyle or physical inactivity with the appearance of CKD was evaluated in healthy people. Eight articles were obtained, including six cross-sectional studies, one case-control, and one cohort study. The quality of evidence for the main outcomes was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) model.

Results

Most of the studies included in this systematic review agree that there is an association between a sedentary lifestyle and CKD; however, not all used the same definition of this disease, in the same way, the definitions of physical activity and sedentary behavior were different between these studies, as well as the methods of measuring sedentary behavior.

Conclusion

CKD could be associated with sedentary behavior in previously healthy people. It was not possible to determine a measure of association with the available scientific evidence, as the study designs were heterogeneous. Modifiable risk factors should be considered in different population groups to reduce the risk of CKD.

Replacing sedentary time for physical activity on bone density in patients with chronic kidney disease

INTRODUCTION

This study aimed to examine the cross-sectional associations of sedentary time and physical activity time with bone density in patients with chronic kidney disease (CKD). The isotemporal substitution (IS) modeling was used to estimate the beneficial effects of behavioral changes (e.g., replacing sedentary time with physical activity time) on bone density in these patients.

MATERIALS AND METHODS

A total of 92 patients with CKD (age: 65 ± 9 years; estimated glomerular filtration rate: 57 ± 22 mL/min/1.73 m²) were included in this cross-sectional study. The times spent in sedentary behavior (SB), light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were assessed using a triaxial accelerometer. Through quantitative ultrasound measurements, the stiffness index, as a measure of bone density, was calculated using the speed of sound and broadband ultrasound attenuation.

RESULTS

In multivariate analyses, the stiffness index was beneficially associated with the MVPA time (β = 0.748), but was not significantly associated with the SB and LPA times. The IS models showed that replacing 10 min/day of SB with the equivalent LPA time was not significantly associated with the stiffness index; however, replacing 10 min/day of SB with the equivalent MVPA time was beneficially associated with the stiffness index (β = 0.804).

CONCLUSION

These results suggest that a small increase in MVPA time (e.g., 10 min/day) may attenuate the decline in bone density in patients with CKD. Our findings may provide insight for the development of novel strategies for improving bone health in patients with CKD.

Moderate-to-vigorous physical activity and sedentary behavior are independently associated with renal function: a cross-sectional study

BACKGROUND

Little is known about whether insufficient moderate-to-vigorous physical activity (MVPA) and longer sedentary behavior (SB) are independently associated with estimated glomerular filtration rate (eGFR) and CKD, whether they interact with known risk factors for CKD, and the effect of replacing sedentary time with an equivalent duration of physical activity on kidney function.

METHODS

We examined the cross-sectional association of MVPA and SB with eGFR and CKD in 66,603 Japanese cohort study in 14 areas from 2004 to 2013. MVPA and SB were estimated using a self-reported questionnaire, and CKD was defined as eGFR<60 mL/min/1.73 m². Multiple linear regression analyses, logistic regression analyses, and an isotemporal substitution model were applied.

RESULTS

After adjusting for potential confounders, higher MVPA and longer SB were independently associated with higher eGFR (P_{for trend MVPA}<0.0001) and lower eGFR (P_{for trend SB}<0.0001), and a lower odds ratio (OR) of CKD (adjusted OR of MVPA≥20 MET·h/day: 0.76 [95%CI: 0.68-0.85] compared to MVPA<5 MET·h/day) and a higher OR of CKD (adjusted OR of SB≥16 h/day: 1.81 [95%CI: 1.52-2.15] compared to SB<7 h/day), respectively. The negative association between MVPA and CKD was stronger in men, and significant interactions between sex and MVPA were detected. Replacing 1 hour of SB with 1 hour of physical activity was associated with about 3 to 4% lower OR of CKD.

CONCLUSIONS

These findings indicate that replacing SB with physical activity may benefit kidney function, especially in men, adding to the possible evidence on CKD prevention.

Frailty in Pancreas Transplantation

There are a variety of definitions and criteria used in clinical practice to define frailty. In the absence of a gold-standard definition, frailty has been operationally defined as meeting 3 out of 5 phenotypic criteria indicating compromised function: low grip strength, low energy, slowed walking speed, low physical activity, and unintentional weight loss. Frailty is a common problem in solid organ transplant candidates who are in the process of being listed for a transplant, as well as after transplantation. Patients with diabetes or chronic kidney disease (CKD) are known to be at increased risk of being frail. As pancreas transplantation is exclusively performed among patients with diabetes and the majority of them also have CKD, pancreas transplant candidates and recipients are at high risk of being frail. Sarcopenia, fatigue, low walking speed, low physical activity, and unintentional weight loss, which are some of the phenotypes of frailty, are very prevalent in this population. In various solid organs, frail patients are less likely to be listed or transplanted and have high waitlist mortality. Even after a transplant, they have increased risk of prolonged hospitalization, readmission, and delayed graft function. Given the negative impact of frailty on solid organ transplants, we believe that frailty would have a similar or even worse impact on pancreas transplantation. Due to the paucity of data specifically among pancreas transplant recipients, here we include frailty data from patients with CKD, diabetes, and various solid organ transplant recipients.

Sedentary Behavior in Older Adults With Preclinical Cognitive Impairment With and Without Chronic Kidney Disease

Older adults with preclinical cognitive impairment can have chronic conditions and lifestyle factors that influence health. Sedentary behavior is common in older adults with and without chronic kidney disease (CKD). The objective of the current study was to determine the differences in sedentary behavior for older adults with preclinical cognitive impairment with and without CKD. Our study evaluated 48 older adults with preclinical cognitive impairment with and without CKD who underwent assessment of sedentary behavior via accelerometry. We found that older adults with preclinical cognitive impairment with and without CKD were sedentary, but there were no significant differences between groups. Fragmentation index was different (p < 0.05), with a lower fragmentation index found in those with CKD. Sedentary behavior should be assessed and evaluated as a potential target for interventions to improve health in these at-risk older adults; however, further investigation is needed. [Journal of Gerontological Nursing, 47(6), 35-42.].

Causal effects of physical activity or sedentary behaviors on kidney function: an integrated population-scale observational analysis and Mendelian randomization study

BACKGROUND

An investigation for the causality of the effects of physical activity and specific sedentary activities on kidney function in the general population is warranted.

METHODS

In this observational cohort study, first, the clinical associations of the prevalence of stages 3-5 chronic kidney disease (CKD) and the eGFR with physical activity, determined by self-report or objective wrist-band accelerometer results, and sedentary activities (watching television, using a computer, and driving) were investigated in 329,758 UK Biobank participants. To assess causality, a two-sample Mendelian randomization (MR) analysis was performed to investigate the associations of a genetic predisposition to physical activity and a sedentary lifestyle with the risk of kidney function impairment in an independent CKDGen genome-wide association study (N = 567,460). The findings were replicated with the 321,024 UK white British Biobank participants in the allele-score-based one-sample MR.

RESULTS

A higher degree of self-reported or accelerometer-determined moderate-to-vigorous physical activity was associated with a higher eGFR, while a longer time spent watching television was significantly associated with a lower eGFR and a higher prevalence of CKD. The two-sample MR demonstrated that the genetic predisposition to a higher degree of physical activity was associated with a lower risk of CKD and a higher eGFR, while the genetically predicted television watching duration was associated with a higher risk of CKD and a lower eGFR. The other sedentary behaviors yielded inconsistent results. The findings were similarly replicated in the one-sample MR.

CONCLUSION

Physical activity and television watching causally affect kidney function in the general population.

Sedentary Behavior and Change in Kidney Function: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

BACKGROUND

There is accumulating evidence linking prolonged sedentary time to adverse health outcomes. The effect of sedentary behavior on kidney function has not been evaluated in US Hispanics/Latinos, a population disproportionately affected by CKD.

METHODS

We evaluated the association between accelerometer-measured (1 week) sedentary time at baseline and kidney function among 7134 adults without CKD at entry in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), who completed a baseline visit with accelerometry (2008-2011) and a follow-up visit (2014-2017). Outcomes included: (1) change in kidney function (eGFR and urine albumin-to-creatinine ratio, ACR), (2) incident low eGFR (eGFR <60 ml/min per 1.73 m2 and eGFR decline ≥1 ml/min per year), and (3) incident albuminuria (ACR ≥17 mg/g in men or ≥25 mg/g in women). Linear regression using survey procedures was used to evaluate change in kidney function (eGFR and ACR), and Poisson regression with robust variance was used to evaluate incident low eGFR and albuminuria.

RESULTS

The median sedentary time was 12 hours/d. Over a median follow-up of 6.1 years, the mean relative change in eGFR was -0.50% per year, and there were 167 incident low eGFR events. On multivariable analysis, each 1 hour increase in sedentary time was associated with a longitudinal decline in eGFR (-0.06% per year, 95% CI, -0.10 to -0.02). There was a significant interaction with sex, and on stratified analyses, higher sedentary time was associated with eGFR decline in women but not men. There was no association between sedentary time and the other outcomes.

CONCLUSIONS

Sedentary time was associated with a small longitudinal decline in eGFR, which could have important implications in a population that experiences a disproportionate burden of CKD but further investigation is needed.

Association of Nutrition Education and Its Interaction with Lifestyle Factors on Kidney Function Parameters and Cardiovascular Risk Factors among Chronic Kidney Disease Patients in Taiwan

We evaluated the interactive effects of nutrition education (NE) and lifestyle factors on kidney function parameters and cardiovascular risk factors among chronic kidney disease (CKD) patients. This cross-sectional cohort study recruited 2176 CKD stages 3-5 patients aged > 20 years from Integrated Chronic Kidney Disease Care Network, Shuang Ho Hospital, Taiwan between December 2008 and April 2019. The multivariable regression analysis was performed to investigate the interactive effects of NE with lifestyle factors on kidney function parameters and cardiovascular risk factors. Relative excess risk due to interaction (RERI) and attributable proportion (AP) were applied to assess additive interaction. Patients who were smoking or physically inactive but received NE had better estimated glomerular filtration rate (eGFR) (β: 3.83, 95% CI: 1.17-6.49 or β: 3.67, 95% CI: 2.04-5.29) compared to those without NE. Patients with smoking and NE significantly reduced risks for having high glycated hemoglobin A_1c (HbA_1c) by 47%, high low-density lipoprotein cholesterol (LDL-C) by 38%, and high corrected calcium (C-Ca) by 50% compared to those without NE. Moreover, NE and smoking or inactive physical activity exhibited an excess risk of high C-Ca (RERI: 0.47, 95% CI: 0.09-0.85 for smoking or RERI: 0.46, 95% CI: 0.01-0.90 and AP: 0.51, 95% CI: 0.03-0.99 for physical activity). Our study suggests that CKD patients who were enrolled in the NE program had better kidney function. Thus, NE could be associated with slowing kidney function decline and improving cardiovascular risk factors.

Association Between Midlife Physical Activity and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study

RATIONALE & OBJECTIVE

Physical activity is associated with lower risk for cardiovascular disease, diabetes, and hypertension, which have shared risk factor profiles with chronic kidney disease (CKD). However, there are conflicting findings regarding the relationship between physical activity and CKD. The objective was to evaluate the association between physical activity and CKD development over long-term follow-up using the Atherosclerosis Risk in Communities (ARIC) Study.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

14,537 participants aged 45 to 64 years.

PREDICTORS

Baseline physical activity status was assessed using the modified Baecke Physical Activity Questionnaire at visit 1 (1987-1989) and categorized according to the 2018 Physical Activity Guidelines for Americans to group participants as inactive, insufficiently active, active, and highly active.

OUTCOMES

Incident CKD defined as estimated glomerular filtration rate (eGFR)<60mL/min/1.73m2 at follow-up and≥25% decline in eGFR relative to baseline, CKD-related hospitalization or death, or initiation of kidney replacement therapy.

ANALYTICAL APPROACH

Cox proportional hazards regression.

RESULTS

At baseline, 37.8%, 24.2%, 22.7%, and 15.3% of participants were classified as inactive, insufficiently active, active, and highly active, respectively. During a median follow-up of 24 years, 33.2% of participants developed CKD. After adjusting for age, sex, race-center, education, smoking status, diet quality, diabetes, coronary heart disease, hypertension, antihypertensive medication, body mass index, and baseline eGFR, higher categories of physical activity were associated with lower risk for CKD compared with the inactive group (HRs for insufficiently active, 0.95 [95% CI, 0.88-1.02]; active, 0.93 [95% CI, 0.86-1.01]; highly active, 0.89 [95% CI, 0.81-0.97]; P for trend = 0.007).

LIMITATIONS

Observational design and self-reported physical activity that was based on leisure time activity only. Due to low numbers, participants who were not Black or White were excluded.

CONCLUSIONS

Highly active participants had lower risk for developing CKD compared with inactive participants.

A longitudinal study of working hours and chronic kidney disease in healthy workers: The Kangbuk Samsung Health Study

OBJECTIVES

Long working hours are linked to an increased risk of exposure to work safety hazards that threaten the health of workers. To date, only a few cross-sectional studies regarding the relationship between working characteristics, such as over-workload and chronic kidney disease (CKD) have been reported. Therefore, in this longitudinal study, we aimed to examine the direct relationship between long working hours and the incidence of CKD.

METHODS

We included 97 856 participants without CKD in the Kangbuk Samsung Health Study. Using a self-report questionnaire, we evaluated weekly working hours, which were categorized into 35-40, 41-52, and >52 hours. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2 . Hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CKD were estimated using Cox proportional hazards regression analyses with weekly working 35-40 hours as the reference.

RESULTS

During a median follow-up of 4.0 years, 185 participants developed incident CKD (incidence density, 4.83 per 104 person-years). Multivariable-adjusted HRs (95% CI) of incident CKD for weekly working >52 hours compared with working 35-40 hours were 1.99 (1.22-3.25). In subgroup analyses, the significant association between working >52 hours and incident CKD was consistently observed in groups of age ≥40 years, men, and obesity with no interaction.

CONCLUSIONS

Our large-scale cohort study of young- to middle-aged men and women demonstrated a significant association between long working hours and an increased risk of incident CKD.

Thigh-worn accelerometry for measuring movement and posture across the 24-hour cycle: a scoping review and expert statement

Introduction

The Prospective Physical Activity Sitting and Sleep consortium (ProPASS) is an international collaboration platform committed to harmonise thigh-worn accelerometry data. The aim of this paper is to (1) outline observational thigh-worn accelerometry studies and (2) summarise key strategic directions arising from the inaugural ProPASS meeting.

Methods

(1) We performed a systematic scoping review for observational studies of thigh-worn triaxial accelerometers in free-living adults (n≥100, 24 hours monitoring protocols). (2)Attendees of the inaugural ProPASS meeting were sent a survey focused on areas related to developing ProPASS: important terminology (Q1); accelerometry constructs (Q2); advantages and distinct contribution of the consortium (Q3); data pooling and harmonisation (Q4); data access and sharing (Q5 and Q6).

Results

(1) Eighty eligible articles were identified (22 primary studies; n~17 685). The accelerometers used most often were the ActivPAL3 and ActiGraph GT3X. The most commonly collected health outcomes were cardiometabolic and musculoskeletal. (2) None of the survey questions elicited the predefined 60% agreement. Survey responses recommended that ProPASS: use the term physical behaviour or movement behaviour rather than 'physical activity' for the data we are collecting (Q1); make only minor changes to ProPASS's accelerometry construct (Q2); prioritise developing standardised protocols/tools (Q4); facilitate flexible methods of data sharing and access (Q5 and Q6).

Conclusions

Thigh-worn accelerometry is an emerging method of capturing movement and posture across the 24 hours cycle. In 2020, the literature is limited to 22 primary studies from high-income western countries. This work identified ProPASS's strategic directions-indicating areas where ProPASS can most benefit the field of research: use of clear terminology, refinement of the measured construct, standardised protocols/tools and flexible data sharing.

Occupational sedentary behavior and prediction of proteinuria in young to middle-aged adults: a retrospective cohort study

BACKGROUND

Although sedentary behavior is a risk factor of cardiometabolic diseases and mortality, little information is available about a clinical impact of occupational sedentary behavior on chronic kidney disease (CKD).

METHODS

The present retrospective cohort study included 10,212 workers of a national university in Japan who underwent annual health checkups between April 2006 and March 2013. Main exposure of interest was self-reported occupational sedentary behavior at the baseline visit. The outcome was the incidence of proteinuria defined as dipstick urinary protein of 1 + or more. The association between sedentary workers and the incidence of proteinuria was assessed using Cox proportional hazards models adjusting for clinically relevant factors, including television viewing time, the major home sedentary behavior.

RESULTS

During median 4.8 years (interquartile range 2.1-7.9) of the observational period, the incidence of proteinuria was observed in 597 (12.0%) males and 697 (13.3%) females. In males, sedentary workers were identified as a significant predictor of proteinuria (multivariable-adjusted hazard ratio of non-sedentary and sedentary workers: 1.00 [reference] and 1.35 [1.11-1.63]), along with longer television viewing time (< 30 min, 30-60 min, 1-2 h, 2-3 h, and > 3 h/day: 1.15 [0.93-1.42], 1.00 [reference], 1.24 [1.00-1.53], 1.41 [1.03-1.93], and 1.77 [1.13-2.76]), whereas not daily exercise time. In females, neither sedentary workers nor television viewing time was associated with the incidence of proteinuria.

CONCLUSIONS

In conclusion, male sedentary workers were at high risk of proteinuria. Occupational sedentary behavior may be a potentially modifiable target for the prevention of CKD.

Supervised Exercise Intervention and Overall Activity in CKD

INTRODUCTION

Patients are often instructed to engage in multiple weekly sessions of exercise to increase physical activity. We aimed to determine whether assignment to a supervised exercise regimen increases overall weekly activity in individuals with chronic kidney disease (CKD).

METHODS

We performed a secondary analysis of a pilot randomized 2 × 2 factorial design trial examining the effects of diet and exercise (10%-15% reduction in caloric intake, 3 supervised exercise sessions/wk, combined diet restriction/exercise, and control). Activity was measured as counts detected by accelerometer. Counts data were collected on all days for which an accelerometer was worn at baseline, month 2, and month 4 follow-up. The primary outcome was a relative change from baseline in log-transformed counts/min. Generalized estimating equations were used to compare the primary outcome in individuals in the exercise group and the nonexercise group.

RESULTS

We examined 111 individuals randomized to aerobic exercise or usual activity (n = 48 in the exercise group and n = 44 controls). The mean age was 57 years, 42% were female, and 28% were black. Median overall adherence over all time was 73%. Median (25th, 75th percentile) counts/min over nonsupervised exercise days at months 2 and 4 were 237.5 (6.5, 444.4) for controls and 250.9 (7.7, 529.8) for the exercise group (P = 0.74). No difference was observed in the change in counts/min between the exercise and control groups over 3 time points (β [fold change], 0.96, 95% confidence interval [CI], 0.91, 1.02).

CONCLUSION

Engaging in a supervised exercise program does not increase overall weekly physical activity in individuals with stage 3 to 4 CKD.

Associations of accelerometer-measured physical activity and sedentary time with chronic kidney disease: The Framingham Heart Study

BACKGROUND

Few studies examined the individual and conjoint associations of accelerometer-measured physical activity (PA) and sedentary times with the prevalence of chronic kidney disease (CKD) among older adults.

METHODS

We evaluated 1,268 Framingham Offspring Study participants (mean age 69.2 years, 53.8% women) between 2011 and 2014. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.732 and/or urine albumin-to-creatinine ratio (UACR) ≥25/35 μg/mg (men/women). We used multivariable logistic regression models to relate time spent being sedentary and active with the odds of CKD. We then performed compositional data analysis to estimate the change in the eGFR and UACR when a fixed proportion of time in one activity behavior (among the following: moderate to vigorous physical activity [MVPA], light intensity physical activity [LIPA], and sedentary) is reallocated to another activity behavior.

RESULTS

Overall, 258 participants had prevalent CKD (20.4%; 120 women). Higher total PA ([MVPA+LIPA], adjusted-odds ratio [OR] per 30 minutes/day increase, 0.86; 95% CI, 0.78-0.96) and higher LIPA (OR per 30 minutes/day increase, 0.87; 95% CI, 0.76-0.99) were associated with lower odds of CKD. Additionally, higher sedentary time (OR per 30 minutes/day increase, 1.16; 95% CI, 1.04-1.29) was associated with higher odds of CKD. Reallocating 5% of the time from LIPA to sedentary was associated with the largest predicted difference in eGFR (-1.06 ml/min/1.73m2). Reallocating 1% of time spent in MVPA to sedentary status predicted the largest difference in UACR (14.37 μg/mg).

CONCLUSION

The findings suggest that increasing LIPA and maintaining MVPA at the expense of sedentary time may be associated with a lower risk of CKD in community-based older adults.

Sedentary behaviour, physical activity, and renal function in older adults: isotemporal substitution modelling

Background

Physical inactivity and sedentary behaviour (too much sitting) can contribute to renal dysfunction. However, the potential benefits of behavioural change (e.g. replacing sedentary behaviour with physical activity) on renal function are not well understood. We used isotemporal substitution to model potential impacts of behaviours on renal function by replacing time spent in one behaviour to another.

Methods

In 174 older Japanese adults (age, 50–83 years; females, 76%), the time spent in sedentary behaviour, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were assessed using an uniaxial accelerometer. Renal function was evaluated by the estimated glomerular filtration rate (eGFR) from serum creatinine and cystatin C levels.

Results

In univariate analyses, eGFR was significantly, albeit weakly, correlated with time spent in sedentary behaviour (r_s = − 0.229), LPA (r_s = 0.265), and MVPA (r_s = 0.353). In the isotemporal substitution models, replacement of 30 min/day of sedentary behaviour with an equivalent LPA time was not significantly associated with eGFR (β = 2.26, p = 0.112); however, replacement with an equivalent time of MVPA was beneficially associated with eGFR (β = 5.49, p < 0.05).

Conclusions

These cross-sectional findings suggest that sedentary behaviour (detrimentally) and physical activity (beneficially) may affect renal function and that replacing sedentary behaviour with MVPA may benefit renal health in older adults.

Sedentary behavior and kidney function in adults: a narrative review

There is increasing evidence for an association between SB and CKD, an emerging public health problem particularly affecting old people. For this reason a systematic literature search was carried out in Embase and PubMed (Jan 2000-Dec 2018) looking for an association between SB and kidney function. A total of 10 studies met the inclusion criteria (7 cross-sectional and 3 longitudinal investigations). A sedentary lifestyle was positively and independently of several confounders related to an impaired kidney function (chronic kidney disease or decrease of glomerular filtration rate), particularly in cross-sectional studies; however, more studies are needed to further establish the current evidence and to explore the exact independent mechanisms of sedentary behavior in relation to kidney function. Due to the inconsistency of the few longitudinal studies, future investigations are required to explore if SB is prospectively associated with a higher risk of developing CKD.

Association between lifestyle factors and decreased kidney function in older adults: a community-based cross-sectional analysis of the Taipei City elderly health examination database

BACKGROUND

Impaired kidney function is the hallmark of chronic kidney disease (CKD), and is associated with increased risk of all-cause mortality in the elderly. In the present cross-sectional population-based study, we aimed to evaluate the associations between lifestyle factors (exercise habit, alcohol consumption, smoking history, and betel nut chewing) and decreased kidney function.

METHODS

The data from the Taipei City Elderly Health Examination Database (2006 to 2012) were extracted. Associations between risk factors and reduced estimated Glomerular filtration rate (eGFR) were evaluated by regression and stratification analyses.

RESULTS

A total of 297,603 participants were included in the final analysis, and 29.7% of them had reduced eGFR. Smoking was significantly associated with an elevated risk of reduced eGFR. While, physical exercise conferred to a significantly decreased adjusted odds ratio (aOR) in reduced eGFR (regular exercise, aOR = 0.79; occasional exercise, aOR = 0.87). Furthermore, the protective effect of exercise habit against reduced eGFR was not affected by comorbid conditions, such as hypertension, diabetes, obesity, and cardiovascular disease.

CONCLUSIONS

Engaging in physical exercise was beneficially associated with reduced eGFR in older individuals. Longitudinal or prospective studies are warranted for confirmation and extrapolation of the current findings.

Undiagnosed chronic kidney disease and its associated risk factors in an agricultural Moroccan adult's population

INTRODUCTION

Chronic kidney disease is among the major non-communicable diseases with increasing prevalence. This study aimed to estimate the prevalence of chronic kidney disease and its associated risk factors among Moroccan population sample from Sidi Bennour province.

METHODS

An observational, descriptive and analytical study was conducted in an agricultural community of Morocco. A sample of 182 subjects aged 18 or older, randomly selected from the province health care centers. The information on the participants was collected using a structured questionnaire, blood samples were collected and the serum creatinine was determined. Subsequent glomerular filtration rate (eGFR) was estimated by the modification of diet in renal disease formula and the chronic kidney disease was defined by an eGFR<60 mL/min/1.73 m².

RESULTS

The participants mean age was 53.58±12.06 years, with a sex ratio of 0.30 and the prevalence of chronic kidney disease was 4.4%. The risk factors associated with chronic kidney disease were age, hypertension, and nephrotoxic treatment, that are significantly correlated with renal impairment (P=0.006 for age, P=0.008 for hypertension and P=0.001 for nephrotoxic medication used respectively).

CONCLUSIONS

The study data show that chronic kidney disease should be of important consideration in any strategy to address non-communicable diseases and associated risk factors.

Identifying characteristics of indicators of sedentary behavior using objective measurements

Objective

Recent attention has been focused on sedentary behavior (SB) affecting health outcomes, but the characteristics of indicators reflecting SB remain to be identified. This cross‐sectional study aims to identify the characteristics of indicators of SB, focusing on the examination of correlations, reliability, and validity of sedentary variables assessed by the smartphone app.

Method

Objectively measured data of SB of eligible 46 Japanese workers obtained from smartphones were used. We assessed the characteristics of current indicators being used with a 10‐minute or 30‐minute thresholds, in addition to the conventional indicators of total sedentary time, mean sedentary bout duration, and total number of sedentary bouts. They were evaluated from three perspectives: (a) association among the indicators, (b) reliability of the indicators, and (c) criterion validity.

Results

Total sedentary time under 10 minutes (U10) and U30 had negative associations with Total sedentary time (r = −.47 and −.21 respectively). The correlation between Mean sedentary bout duration and Total number of sedentary bouts was −.84, whereas between Mean sedentary bout duration 10, 30 and Total number of sedentary bouts were −.54 and −.21, respectively. The intraclass correlation coefficients of almost all indicators were around .80. Mean sedentary bout duration, Mean sedentary bout duration 10, Total number of sedentary bouts, Total sedentary time 30, U30 and U10 have significant differences between three BMI groups.

Conclusion

This study comprehensively revealed the rationale of advantage in the current indicator being used with a 10‐minute or 30‐minute threshold, rather than the conventional total amount of SB.

The association of exercise and sedentary behaviours with incident end-stage renal disease: the Southern Community Cohort Study

OBJECTIVE

To examine whether lifestyle factors, including sedentary time and physical activity, could independently contribute to risk of end-stage renal disease (ESRD).

STUDY DESIGN

Case-cohort study.

SETTING

South-eastern USA.

PARTICIPANTS

The Southern Community Cohort Study recruited ~86 000 black and white participants from 2002 to 2009. We assembled a case cohort of 692 incident ESRD cases and a probability sample of 4113 participants.

PREDICTORS

Sedentary time was calculated as hours/day from daily sitting activities. Physical activity was calculated as metabolic equivalent (MET)-hours/day from engagement in light, moderate and vigorous activities.

OUTCOMES

Incident ESRD.

RESULTS

At baseline, among the subcohort, mean (SD) age was 52 (8.6) years, and median (25th, 75th centile) estimated glomerular filtration rate (eGFR) was 102.8 (85.9-117.9) mL/min/1.73 m². Medians (25th-75th centile) for sedentary time and physical activity were 8.0 (5.5-12.0) hours/day and 17.2 (8.7-31.9) MET-hours/day, respectively. Median follow-up was 9.4 years. We observed significant interactions between eGFR and both physical activity and sedentary behaviour (p<0.001). The partial effect plot of the association between physical activity and log relative hazard of ESRD suggests that ESRD risk decreases as physical activity increases when eGFR is 90 mL/min/1.73 m². The inverse association is most pronounced at physical activity levels >27 MET-hours/day. High levels of sitting time were associated with increased ESRD risk only among those with reduced kidney function (eGFR ≤30 mL/min/1.73 m²); this association was attenuated after excluding the first 2 years of follow-up.

CONCLUSIONS

In a population with a high prevalence of chronic kidney disease risk factors such as hypertension and diabetes, physical activity appears to be associated with reduced risk of ESRD among those with preserved kidney function. A positive association between sitting time and ESRD observed among those with advanced kidney disease is likely due to reverse causation.