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Population-Attributable Fractions of Modifiable Lifestyle Factors for CKD and Mortality in Individuals With Type 2 Diabetes: A Cohort Study.
Am J Kidney Dis. 2016 Jul; 68(1):29-40.AJ

Abstract

BACKGROUND

We quantified the impact of lifestyle and dietary modifications on chronic kidney disease (CKD) by estimating population-attributable fractions (PAFs).

STUDY DESIGN

Observational cohort study.

SETTING & PARTICIPANTS

Middle-aged adults with type 2 diabetes but without severe albuminuria from the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET; n=6,916).

FACTORS

Modifiable lifestyle/dietary risk factors, such as physical activity, size of social network, alcohol intake, tobacco use, diet, and intake of various food items.

OUTCOMES

The primary outcome was CKD, ascertained as moderate to severe albuminuria or ≥5% annual decline in estimated glomerular filtration rate (eGFR) after 5.5 years. The competing risk for death was considered. PAF was defined as the proportional reduction in CKD or mortality (within 5.5 years) that would occur if exposure to a risk factor was changed to an optimal level.

RESULTS

At baseline, median urinary albumin-creatinine ratio and eGFR were 6.6 (IQR, 2.9-25.0) mg/mmol and 71.5 (IQR, 58.1-85.9) mL/min/1.73m(2), respectively. After 5.5 years, 704 (32.5%) participants developed albuminuria, 1,194 (55.2%) had a ≥5% annual eGFR decline, 267 (12.3%) had both, and 1,022 (14.8%) had died. Being physically active every day has PAFs of 5.1% (95% CI, 0.5%-9.6%) for CKD and 12.3% (95% CI, 4.9%-19.1%) for death. Among food items, increasing vegetable intake would have the largest impact on population health. Considering diet, weight, physical activity, tobacco use, and size of social network, exposure to less than optimum levels gives PAFs of 13.3% (95% CI, 5.5%-20.9%) for CKD and 37.5% (95% CI, 27.8%-46.7%) for death. For the 17.8 million middle-aged Americans with diabetes, improving 1 of these lifestyle behaviors to the optimal range could reduce the incidence or progression of CKD after 5.5 years by 274,000 and the number of deaths within 5.5 years by 405,000.

LIMITATIONS

Ascertainment of changes in kidney measures does not precisely match the definitions for incidence or progression of CKD.

CONCLUSIONS

Healthy lifestyle and diet are associated with less CKD and mortality and may have a substantial impact on population kidney health.

Authors+Show Affiliations

Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.Department of Nephrology, University of Erlangen-Nürnberg, Erlangen, Germany.Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada.Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada.Department of Medicine, McMaster University, Hamilton, Ontario, Canada.Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada.Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada.Department of Nephrology, University of Erlangen-Nürnberg, Erlangen, Germany; Schwabing General Hospital and KfH Kidney Center, Munich, Germany.Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria; Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. Electronic address: rainer.oberbauer@meduniwien.ac.at.No affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26830448

Citation

Dunkler, Daniela, et al. "Population-Attributable Fractions of Modifiable Lifestyle Factors for CKD and Mortality in Individuals With Type 2 Diabetes: a Cohort Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 68, no. 1, 2016, pp. 29-40.
Dunkler D, Kohl M, Teo KK, et al. Population-Attributable Fractions of Modifiable Lifestyle Factors for CKD and Mortality in Individuals With Type 2 Diabetes: A Cohort Study. Am J Kidney Dis. 2016;68(1):29-40.
Dunkler, D., Kohl, M., Teo, K. K., Heinze, G., Dehghan, M., Clase, C. M., Gao, P., Yusuf, S., Mann, J. F., & Oberbauer, R. (2016). Population-Attributable Fractions of Modifiable Lifestyle Factors for CKD and Mortality in Individuals With Type 2 Diabetes: A Cohort Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 68(1), 29-40. https://doi.org/10.1053/j.ajkd.2015.12.019
Dunkler D, et al. Population-Attributable Fractions of Modifiable Lifestyle Factors for CKD and Mortality in Individuals With Type 2 Diabetes: a Cohort Study. Am J Kidney Dis. 2016;68(1):29-40. PubMed PMID: 26830448.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Population-Attributable Fractions of Modifiable Lifestyle Factors for CKD and Mortality in Individuals With Type 2 Diabetes: A Cohort Study. AU - Dunkler,Daniela, AU - Kohl,Maria, AU - Teo,Koon K, AU - Heinze,Georg, AU - Dehghan,Mahshid, AU - Clase,Catherine M, AU - Gao,Peggy, AU - Yusuf,Salim, AU - Mann,Johannes F E, AU - Oberbauer,Rainer, AU - ,, Y1 - 2016/01/30/ PY - 2015/08/19/received PY - 2015/12/04/accepted PY - 2016/2/3/entrez PY - 2016/2/3/pubmed PY - 2017/6/1/medline KW - Chronic kidney disease (CKD) KW - albumin-creatinine ratio (ACR) KW - diet KW - disease prevention KW - disease progression KW - healthy behavior KW - lifestyle KW - modifiable risk factor KW - mortality KW - physical activity KW - population attributable fraction (PAF) KW - public health recommendations KW - renal function KW - type 2 diabetes mellitus SP - 29 EP - 40 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 68 IS - 1 N2 - BACKGROUND: We quantified the impact of lifestyle and dietary modifications on chronic kidney disease (CKD) by estimating population-attributable fractions (PAFs). STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: Middle-aged adults with type 2 diabetes but without severe albuminuria from the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET; n=6,916). FACTORS: Modifiable lifestyle/dietary risk factors, such as physical activity, size of social network, alcohol intake, tobacco use, diet, and intake of various food items. OUTCOMES: The primary outcome was CKD, ascertained as moderate to severe albuminuria or ≥5% annual decline in estimated glomerular filtration rate (eGFR) after 5.5 years. The competing risk for death was considered. PAF was defined as the proportional reduction in CKD or mortality (within 5.5 years) that would occur if exposure to a risk factor was changed to an optimal level. RESULTS: At baseline, median urinary albumin-creatinine ratio and eGFR were 6.6 (IQR, 2.9-25.0) mg/mmol and 71.5 (IQR, 58.1-85.9) mL/min/1.73m(2), respectively. After 5.5 years, 704 (32.5%) participants developed albuminuria, 1,194 (55.2%) had a ≥5% annual eGFR decline, 267 (12.3%) had both, and 1,022 (14.8%) had died. Being physically active every day has PAFs of 5.1% (95% CI, 0.5%-9.6%) for CKD and 12.3% (95% CI, 4.9%-19.1%) for death. Among food items, increasing vegetable intake would have the largest impact on population health. Considering diet, weight, physical activity, tobacco use, and size of social network, exposure to less than optimum levels gives PAFs of 13.3% (95% CI, 5.5%-20.9%) for CKD and 37.5% (95% CI, 27.8%-46.7%) for death. For the 17.8 million middle-aged Americans with diabetes, improving 1 of these lifestyle behaviors to the optimal range could reduce the incidence or progression of CKD after 5.5 years by 274,000 and the number of deaths within 5.5 years by 405,000. LIMITATIONS: Ascertainment of changes in kidney measures does not precisely match the definitions for incidence or progression of CKD. CONCLUSIONS: Healthy lifestyle and diet are associated with less CKD and mortality and may have a substantial impact on population kidney health. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26830448/Population_Attributable_Fractions_of_Modifiable_Lifestyle_Factors_for_CKD_and_Mortality_in_Individuals_With_Type_2_Diabetes:_A_Cohort_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(16)00002-0 DB - PRIME DP - Unbound Medicine ER -