Heart healthy lifestyle may cut kidney disease patients' risk of kidney failure

(Press-News.org) Washington, DC (May 23, 2013) — Maintaining a heart healthy lifestyle may also help protect chronic kidney disease patients from developing kidney failure and dying prematurely, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings suggest that patients with kidney disease should be encouraged to improve their heart health.

Poor kidney health puts people at risk of developing heart problems, but it's unclear whether the opposite is true. Does heart health also affect kidney health?

To investigate, Paul Muntner, PhD (University of Alabama at Birmingham) and his colleagues used the American Heart Association's recently published tool (Life's Simple 7) that helps individuals assess their heart health. Life's Simple 7 lists seven domains including not smoking, being physically active, following a heart healthy diet, having a normal weight, and maintaining low blood sugar, blood pressure, and cholesterol levels. "Scores on the Life's Simple 7 tool have been associated with risk for having a heart attack but it was unclear whether a worse profile would be associated with an increased risk for developing kidney failure," said Dr. Munter.

The investigators looked for a link between Life's Simple 7 components with both kidney failure and death among 3,093 individuals with stage 3 or 4 chronic kidney disease. During an average follow-up of four years, 160 participants developed kidney failure and 610 participants died.

Among the major findings: Compared with individuals who had zero or one of the Life's Simple 7 components in the "ideal" range, those with two, three, and four ideal factors had progressively lower risks for kidney failure. People with four ideal factors cut their risk by nearly half. No participant with five to seven ideal factors developed kidney failure. Participants' risk of dying during the study followed similar trends, with those having four ideal factors cutting their risk by more than 40%. The relationship between ideal levels of Life's Simple 7 components and kidney failure and death was explained by individuals' kidney function levels, suggesting that kidney disease may confound or mediate the link between health behaviors and health.

"This study highlights the importance of maintaining a healthy lifestyle, not just on patients' risk for developing heart disease but also for the prevention of kidney failure," said Dr. Muntner. People who wish to evaluate their heart health can go to http://mylifecheck.heart.org/PledgePage.aspx?NavID=5&CultureCode=en-US to see how they can improve their heart health.

In an accompanying editorial, Andrew Chin, MD and Lorien Dalrymple, MD (University of California, Davis) noted that "this study provides an opportunity to reconsider and reevaluate our approach to modifying health behaviors and factors in individuals living with CKD." They added that whether a combination of health behavior changes in conjunction with optimal management of health factors alters the progression of CKD remains a topic worthy of continued study.

### Study co-authors include SuzanneJudd, PhD, Liyan Gao, PhD, Orlando Gutiérrez, MD, Dana Rizk, MD, William McClellan, MD, Mary Cushman, MD, and David Warnock, MD.

Disclosures: This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis or interpretation of the data. Additional funding was provided by an investigator-initiated grant-in-aid from Amgen Corporation. Amgen did not have any role in the design and conduct of the study, the collection, management, data analysis, or interpretation of the data, or the preparation or approval of the manuscript.

The article, entitled "Cardiovascular Risk factors in CKD Associate with Both ESRD and Mortality," will appear online at http://jasn.asnjournals.org/ on May 23, 2013, doi: 10.1681/ASN.2012070642.

The editorial, entitled "Ideal Cardiovascular Health and Progression of CKD: Perhaps not so 'Simple'," will appear online at http://jasn.asnjournals.org/ on May 23, 2013, doi: 10.1681/ASN.2013040388.

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Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.