Physical Activity and Rapid Decline in Kidney Function Among Older Adults

Department of Epidemiology, University of Washington, Seattle, 98195, USA.
Archives of internal medicine (Impact Factor: 17.33). 12/2009; 169(22):2116-23. DOI: 10.1001/archinternmed.2009.438
Source: PubMed


Habitual physical activity (PA) has both physiologic and metabolic effects that may moderate the risk of kidney function decline. We tested the hypothesis that higher levels of PA are associated with a lower risk of kidney function decline using longitudinal data from a large cohort of older adults.
We studied 4011 ambulatory participants aged 65 or older from the Cardiovascular Health Study (CHS) who completed at least 2 measurements of kidney function over 7 years. We calculated a PA score (range, 2-8) by summing kilocalories expended per week (ordinal score of 1-5 from quintiles of kilocalories per week) and walking pace (ordinal score for categories of <2, 2-3, and >3 mph). Rapid decline in kidney function decline (RDKF) was defined by loss of more than 3.0 mL/min/1.73 m(2) per year in glomerular filtration rate, which we estimated by using longitudinal measurements of cystatin C levels.
A total of 958 participants had RDKF (23.9%; 4.1 events per 100 person-years). The estimated risk of RDKF was 16% in the highest PA group (score of 8) and 30% in the lowest PA group (score of 2). After multivariate adjustment, we found that the 2 highest PA groups (scores of 7-8) were associated with a 28% lower risk of RDKF (95% confidence interval, 21%-41% lower risk) than the 2 lowest PA groups (score of 2-3). Greater kilocalories of leisure-time PA and walking pace were also each associated with a lower incidence of RDKF.
Higher levels of PA are associated with a lower risk of RDKF among older adults.

Download full-text


Available from: Cassianne Robinson-Cohen, Jan 15, 2014
21 Reads
  • Source
    • "A recent Cochrane review has highlighted the potential positive effects of regular leisure exercise on advanced CKD mainly through the improvement of cardiovascular risk (diabetes, high blood pressure) [11] [12] [13] [14] and aerobic capacity [11]. However, the effect of physical activity on early stages of CKD is not well-established [12], and few studies have focused specifically on it [15] [16] [17]. The eGFR is one of the essential determinants that characterize CKD. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic kidney disease is now regarded as a risk factor for cardiovascular disease. The impact of occupational or non-occupational physical activity (PA) on moderate decreases of renal function is uncertain. We aimed to identify the potential association of PA (occupational and leisure-time) on early decline of estimated glomerular filtration rate (eGFR) and to determine the potential mediating effect of PA on the relationship between eGFR and heart disease. From the PRIME study analyses were conducted in 1058 employed men. Energy expended during leisure, work and commuting was calculated. Linear regression analyses were used to determine the link between types of PA and moderate decrements of eGFR determined with the KDIGO guideline at the baseline assessment. Cox proportional hazards analyses were used to explore the potential effect of PA on the relationship between eGFR and heart disease, ascertained during follow-up over 10years. For these employed men, and after adjustment for known confounders of GFR change, more time spent sitting at work was associated with increased risk of moderate decline in kidney function, while carrying objects or being active at work was associated with decreased risk. In contrast, no significant link with leisure PA was apparent. No potential mediating effect of occupational PA was found for the relationship between eGFR and coronary heart disease. Occupational PA (potential modifiable factors) could provide a dual role on early impairment of renal function, without influence on the relationship between early decrease of e-GFR and CHD risk. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 09/2014; 177(3):1036-1041. DOI:10.1016/j.ijcard.2014.09.102 · 4.04 Impact Factor
  • Source
    • "In the present study daily physical activity was positively correlated with creatinine clearance. Indeed, previous studies have shown that habitual physical activity was positively associated with renal function [31–33]. Why decrease in creatinine clearance was associated with decreased physical activity? "
    [Show abstract] [Hide abstract]
    ABSTRACT: The present study was carried out to investigate independent relationship between daily physical activity, microalbuminuria, and kidney function. The demographic characteristics and laboratory parameters were recorded for all patients. The determination of daily activities was carried out by Nottingham Extended Activities of Daily Living Scale (NEADLS) which was performed for each patient in an interview. Totally 139 patients were enrolled. In the whole group NEADLS score was correlated with age (rho: -0.759, P < 0.0001), clinical systolic blood pressure (rho: -0.212, P: 0.018), blood urea nitrogen (rho: -0.516, P < 0.0001), creatinine (rho: -0.501, P < 0.0001), uric acid (rho: -0.308, P < 0.0001), albumin (rho: 0.382, P < 0.0001), total cholesterol (rho: -0.194, P: 0.022), LDL-cholesterol (rho: -0.230, P: 0.008), hemoglobin (rho: 0.256, P: 0.002), creatinine clearance (rho: 0.565, P < 0.0001), 24-hour urinary protein excretion (rho: -0.324, P < 0.0001), and 24-hour urinary albumin excretion (UAE) (rho: -0.483, P < 0.0001). The multivariate linear regression of independent factors corelated with logarithmically converted NEADLS score (as a dependent variable) has shown that age (P < 0.0001), presence of coronary artery disease (P: 0.011), hemoglobin (P: 0.020), 24-hour creatinine clearance (P: 0.004), and 24-hour urinary albumin excretion (P < 0.0001) were independently corelated with NEADLS score. In conclusion, both UAE and kidney function were independently associated with daily physical activity.
    International Journal of Nephrology 12/2013; 2013:248416. DOI:10.1155/2013/248416
  • Source
    • "Medication inventories were completed by CHS staff using participants’ prescription and nonprescription medication bottles (24). Total physical activity was quantified in kilocalories per week using validated questionnaires assessing a broad range of common activities (30). BMI was calculated as weight (kg) divided by height (m2). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Insulin resistance is a risk factor for cardiovascular and noncardiovascular diseases. Impaired kidney function is linked with insulin resistance and may affect relationships of insulin resistance with health outcomes. We performed a cohort study of 3,138 Cardiovascular Health Study participants (age ≥ 65 years) without diabetes. Insulin sensitivity index (ISI) was calculated from fasting and 2-h postload insulin and glucose concentrations. Associations of ISI and fasting insulin concentration with all-cause mortality were tested using Cox proportional hazards models, adjusting for demographic variables, prevalent cardiovascular disease, lifestyle variables, waist circumference, and LDL cholesterol. Subsequent models were additionally adjusted for or stratified by glomerular filtration rate estimated using serum cystatin C (eGFR). A total of 1,810 participants died during the 14.7-year median follow-up. Compared with the highest quartile of ISI, the lowest quartile (most insulin resistant) was associated with 21% (95% CI 6-41) and 11% (-3 to 29) higher risks of death without and with adjustment for eGFR, respectively. Compared with the lowest quartile of fasting insulin concentration, the highest quartile was associated with 22% (4-43) and 4% (-12 to 22) higher risks of death without and with adjustment for eGFR, respectively. Similar attenuation by eGFR was observed when blood pressure, triglycerides, HDL cholesterol, and C-reactive protein were included in models. Insulin resistance measured as ISI or fasting insulin concentration is associated with increased risk of death among older adults, adjusting for conventional confounding characteristics. Impaired kidney function may mediate or confound this relationship.
    Diabetes care 03/2012; 35(6):1355-60. DOI:10.2337/dc11-1657 · 8.42 Impact Factor
Show more