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Abstract: TH-PO1082

Markers of Modifiable Health Behaviors, Cardiovascular Events, Death, and CKD

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Schrauben, Sarah J., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Amaral, Sandra, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Anderson, Amanda Hyre, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Dember, Laura M., University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States

Chronic kidney disease (CKD) guidelines focus on modifiable health behaviors in the effort to decrease the risk of death and atherosclerotic events, both of which are increased in CKD. However, the effectiveness of these recommendations is relatively unknown since they were based largely on general population research. We examined the relationship of markers of modifiable health behaviors and clinical outcomes among those with and without CKD.


Data pooled from Atherosclerotic Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Cardiovascular Health Study. CKD defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.732. Markers of modifiable behaviors: physical activity, blood pressure, smoking, diet, body mass index, and fasting blood glucose. Multivariable adjusted Cox proportional hazards models estimated risk of death and a composite of atherosclerotic events. Effect modification was explored for age.


Those with CKD (n = 8,542): mean 59.7 yrs, eGFR 54.7; without CKD (n=19,188): mean 60.2 yrs, eGFR 77.3. There was evidence of an interaction by age with behaviors for both outcomes. Results reported by <65 and 65+ yrs (see Table). Overall, recommended markers of health behaviors were associated with decreased death and atherosclerotic events. Particularly, controlled BP had a stronger association in CKD.


Markers of modifiable behaviors were associated with reduced risk of death and atherosclerotic events in CKD and without CKD. Blood pressure control had a stronger association among those with CKD.

Targets for Health Behaviors
Reported HR (95% CI)Non-CKDCKDNon-CKDCKD
Death<65 years (n=11,732)<65 years (n=6,000)≥65 years (n=5,936)≥65 years (n=2,051)
Non-Smoking0.48 (0.45-0.52)0.44 (0.40-049)0.66 (0.59-0.73)0.75 (0.62-0.90)
BP <130/80 mmHg0.72 (0.66-0.80)0.71 (0.63-0.81)0.91 (0.84-0.99)0.80 (0.70-.92)
BMI ≥18.5 to <25 kg/m21.13 (1.04-1.22)1.00 (0.89-1.12)1.22 (1.13-1.32)1.16 (1.02-1.31)
Phys Activity >150 min/wk0.92 (0.85-1.00)0.98 (0.88-1.09)0.73 (0.67-0.79)0.73 (0.64-0.83)
Diet Score ≥30.91 (0.84-0.98)1.04 (0.95-1.15)0.95 (0.88-1.02)0.91 (0.80-1.03)
Fasting blood glucose <1260.74 (0.63-0.87)0.61 (0.50-0.73)0.67 (0.59-0.77)0.87 (0.70-1.06)
Atherosclerotic Events    
Non-Smoking0.60 (0.54-0.67)0.62 (0.54-0.71)0.81 (0.68-0.96)1.00 (0.74-1.36)
BP <130/80 mmHg0.84 (0.74-0.94)0.76 (0.65-0.88)0.82 (0.72-0.93)0.75 (0.62-0.92)
BMI ≥18.5 to <25 kg/m20.85 (0.76-0.95)0.88 (0.76-1.02)1.04 (0.92-1.16)1.00 (0.83-1.21)
Phys Activity >150 min/wk0.99 (0.90-1.10)1.12 (0.97-1.29)0.80 (0.71-0.90)0.81 (0.68-0.98)
Diet Score ≥30.92 (0.84-1.01)1.12 (0.99-1.26)1.05 (0.94-1.17)1.10 (0.92-1.31)
Fasting blood glucose <1260.63 (0.52-0.76)0.81 (0.64-1.04)0.66 (0.55-0.80)1.00 (0.75-1.32)


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