Modifiable lifestyle factors for primary prevention of chronic kidney disease: a systematic review and meta-analysis

Jaimon T Kelly, Guobin Su, La Zhang, Xindong Qin, Skye Marshall, Ailema Gonzalez-Oritz, Catherine M Clase, Katrina Louise Campbell, Hong Xu, Juan-Jesus Carrero

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Despite increasing incidence of CKD, no evidence-based lifestyle recommendations for CKD primary prevention apparently exist.

Methods: To evaluate the consistency of evidence associating modifiable lifestyle factors and CKD incidence, we searched MEDLINE, Embase, CINAHL, and references from eligible studies from database inception through June 2019. We included cohort studies of adults without CKD at baseline that reported lifestyle exposures (diet, physical activity, alcohol consumption, and tobacco smoking). The primary outcome was incident CKD (eGFR<60 ml/min per 1.73 m2). Secondary outcomes included other CKD surrogate measures (RRT, GFR decline, and albuminuria).

Results: We identified 104 studies of 2,755,719 participants with generally a low risk of bias. Higher dietary potassium intake associated with significantly decreased odds of CKD (odds ratio [OR], 0.78; 95% confidence interval [95% CI], 0.65 to 0.94), as did higher vegetable intake (OR, 0.79; 95% CI, 0.70 to 0.90); higher salt intake associated with significantly increased odds of CKD (OR, 1.21; 95% CI, 1.06 to 1.38). Being physically active versus sedentary associated with lower odds of CKD (OR, 0.82; 95% CI, 0.69 to 0.98). Current and former smokers had significantly increased odds of CKD compared with never smokers (OR, 1.18; 95% CI, 1.10 to 1.27). Compared with no consumption, moderate consumption of alcohol associated with reduced risk of CKD (relative risk, 0.86; 95% CI, 0.79 to 0.93). These associations were consistent, but evidence was predominantly of low to very low certainty. Results for secondary outcomes were consistent with the primary finding.

Conclusions:
These findings identify modifiable lifestyle factors that consistently predict the incidence of CKD in the community and may inform both public health recommendations and clinical practice.
Original languageEnglish
JournalJournal of the American Society of Nephrology : JASN
Early online date31 Aug 2020
DOIs
Publication statusE-pub ahead of print - 31 Aug 2020

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