Healthy lifestyle and risk of kidney disease progression, atherosclerotic events, and death in CKD: Findings from the Chronic Renal Insufficiency Cohort (CRIC) study

Ana C. Ricardo, Cheryl A. Anderson, Wei Yang, Xiaoming Zhang, Michael J. Fischer, Laura M. Dember, Jeffrey C. Fink, Anne Frydrych, Nancy G. Jensvold, Eva Lustigova, Lisa C. Nessel, Anna C. Porter, Mahboob Rahman, Julie A. Wright Nunes, Martha L. Daviglus, James P. Lash

Research output: Contribution to journalArticlepeer-review

76 Scopus citations


Background In general populations, healthy lifestyle is associated with fewer adverse outcomes. We estimated the degree to which adherence to a healthy lifestyle decreases the risk of renal and cardiovascular events among adults with chronic kidney disease (CKD). Study Design Prospective cohort. Setting & Participants 3,006 adults enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. Predictors 4 lifestyle factors (regular physical activity, body mass index [BMI] of 20-2, nonsmoking, and "healthy diet"), individually and in combination. Outcomes CKD progression (50% decrease in estimated glomerular filtration rate or end-stage renal disease), atherosclerotic events (myocardial infarction, stroke, or peripheral arterial disease), and all-cause mortality. Measurements Multivariable-adjusted Cox proportional hazards. Results During a median follow-up of 4 years, we observed 726 CKD progression events, 355 atherosclerotic events, and 437 deaths. BMI ≥ 25 kg/m2 and nonsmoking were associated with reduced risk of CKD progression (HRs of 0.75 [95% CI, 0.58-0.97] and 0.61 [95% CI, 0.45-0.82] for BMIs of 25 to 2, respectively, versus 20 to 2; HR for nonsmoking of 0.68 [95% CI, 0.55-0.84] compared to the current smoker reference group) and reduced risk of atherosclerotic events (HRs of 0.67 [95% CI, 0.46-0.96] for BMI of 25-2 and 0.55 [95% CI, 0.40-0.75] vs current smoker). Factors associated with reduced all-cause mortality were regular physical activity (HR, 0.64 [95% CI, 0.52-0.79] vs inactive), BMI ≥ 30 kg/m2 (HR, 0.64 [95% CI, 0.43-0.96] vs 20-2), and nonsmoking (HR, 0.45 [95% CI, 0.34-0.60] vs current smoker). BMI <20 kg/m2 was associated with increased all-cause mortality risk (HR, 2.11 [95% CI, 1.13-3.93] vs 20-2). Adherence to all 4 lifestyle factors was associated with a 68% lower risk of all-cause mortality compared to adherence to no lifestyle factors (HR, 0.32; 95% CI, 0.11-0.89). Limitations Lifestyle factors were measured only once. Conclusions Regular physical activity, nonsmoking, and BMI ≥ 25 kg/m2 were associated with lower risk of adverse outcomes in this cohort of individuals with CKD.

Original languageEnglish (US)
Pages (from-to)412-424
Number of pages13
JournalAmerican Journal of Kidney Diseases
Issue number3
StatePublished - Mar 1 2015
Externally publishedYes


  • body mass index (BMI)
  • cardiovascular events
  • Chronic kidney disease (CKD)
  • CKD progression
  • diet
  • healthy lifestyle
  • lifestyle modification
  • modifiable risk factor
  • mortality
  • physical activity
  • renal disease trajectory
  • smoking

ASJC Scopus subject areas

  • Nephrology


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