RT Journal Article
SR Electronic
T1 The association of exercise and sedentary behaviours with incident end-stage renal disease: the Southern Community Cohort Study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e030661
DO 10.1136/bmjopen-2019-030661
VO 9
IS 8
A1 Mindy Pike
A1 Jacob Taylor
A1 Edmond Kabagambe
A1 Thomas G Stewart
A1 Cassianne Robinson-Cohen
A1 Jennifer Morse
A1 Elvis Akwo
A1 Khaled Abdel-Kader
A1 Edward D Siew
A1 William J Blot
A1 T Alp Ikizler
A1 Loren Lipworth
YR 2019
UL http://bmjopen.bmj.com/content/9/8/e030661.abstract
AB 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.