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Healthy Lifestyle and Mortality Among Adults Receiving Hemodialysis : The DIET-HD Study

Su, Guobin ; Saglimbene, Valeria ; Wong, Germaine ; Natale, Patrizia ; Ruospo, Marinella ; Craig, Jonathan C. ; Hegbrant, Jorgen LU ; Carrero, Juan Jesus and Strippoli, Giovanni F.M. (2022) In American Journal of Kidney Diseases 79(5). p.1-698
Abstract

Rationale & Objective: A healthy lifestyle promotes cardiovascular health and reduces cardiac-related mortality in the general population, but its benefits for people receiving maintenance hemodialysis are uncertain. Study Design: Prospective cohort study. Setting & Participants: 5,483 of 9,757 consecutive adults receiving maintenance hemodialysis (January 2014 to June 2017, median dialysis vintage: 3.6 years) in a multinational private dialysis network and with complete lifestyle data. Exposure: Based on the American Heart Association's recommendations for cardiovascular prevention, a modified healthy lifestyle score was the sum of 4 components addressing use of smoking tobacco, physical activity, diet, and control of systolic... (More)

Rationale & Objective: A healthy lifestyle promotes cardiovascular health and reduces cardiac-related mortality in the general population, but its benefits for people receiving maintenance hemodialysis are uncertain. Study Design: Prospective cohort study. Setting & Participants: 5,483 of 9,757 consecutive adults receiving maintenance hemodialysis (January 2014 to June 2017, median dialysis vintage: 3.6 years) in a multinational private dialysis network and with complete lifestyle data. Exposure: Based on the American Heart Association's recommendations for cardiovascular prevention, a modified healthy lifestyle score was the sum of 4 components addressing use of smoking tobacco, physical activity, diet, and control of systolic blood pressure. Outcome: Cardiovascular and all-cause mortality. Analytical Approach: Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between lifestyle score (low [0-2 points] as the referent, medium [3-5], and high [6-8]) and mortality. Associations were expressed as adjusted hazard ratio (AHR) with 95% CI. Results: During a median of 3.8 years (17,451 person-years in total), there were 2,163 deaths, of which 826 were related to cardiovascular disease. Compared with patients who had a low lifestyle score, the AHRs for all-cause mortality among those with medium and high lifestyle scores were 0.75 (95% CI, 0.65-0.85) and 0.64 (95% CI, 0.54-0.76), respectively. Compared with patients who had a low lifestyle score, the AHRs for cardiovascular mortality among those with medium and high lifestyle scores were 0.73 (95% CI, 0.59-0.91) and 0.65 (95% CI, 0.49-0.85), respectively. Limitations: Self-reported lifestyle, data-driven approach. Conclusions: A healthier lifestyle is associated with lower all-cause and cardiovascular mortality among patients receiving maintenance hemodialysis.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Blood pressure, body mass index (BMI), cardiovascular disease (CVD), chronic kidney disease (CKD), cohort, diet, DIET-HD, end-stage renal disease (ESRD), hemodialysis, lifestyle, modifiable risk factor, mortality, physical activity, smoking
in
American Journal of Kidney Diseases
volume
79
issue
5
pages
1 - 698
publisher
Elsevier
external identifiers
  • pmid:34547395
  • scopus:85121115203
ISSN
0272-6386
DOI
10.1053/j.ajkd.2021.07.022
language
English
LU publication?
yes
id
cfc6de96-85d5-4d62-aff3-7a1fb6a6e136
date added to LUP
2022-02-01 16:37:12
date last changed
2024-05-19 22:14:42
@article{cfc6de96-85d5-4d62-aff3-7a1fb6a6e136,
  abstract     = {{<p>Rationale &amp; Objective: A healthy lifestyle promotes cardiovascular health and reduces cardiac-related mortality in the general population, but its benefits for people receiving maintenance hemodialysis are uncertain. Study Design: Prospective cohort study. Setting &amp; Participants: 5,483 of 9,757 consecutive adults receiving maintenance hemodialysis (January 2014 to June 2017, median dialysis vintage: 3.6 years) in a multinational private dialysis network and with complete lifestyle data. Exposure: Based on the American Heart Association's recommendations for cardiovascular prevention, a modified healthy lifestyle score was the sum of 4 components addressing use of smoking tobacco, physical activity, diet, and control of systolic blood pressure. Outcome: Cardiovascular and all-cause mortality. Analytical Approach: Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between lifestyle score (low [0-2 points] as the referent, medium [3-5], and high [6-8]) and mortality. Associations were expressed as adjusted hazard ratio (AHR) with 95% CI. Results: During a median of 3.8 years (17,451 person-years in total), there were 2,163 deaths, of which 826 were related to cardiovascular disease. Compared with patients who had a low lifestyle score, the AHRs for all-cause mortality among those with medium and high lifestyle scores were 0.75 (95% CI, 0.65-0.85) and 0.64 (95% CI, 0.54-0.76), respectively. Compared with patients who had a low lifestyle score, the AHRs for cardiovascular mortality among those with medium and high lifestyle scores were 0.73 (95% CI, 0.59-0.91) and 0.65 (95% CI, 0.49-0.85), respectively. Limitations: Self-reported lifestyle, data-driven approach. Conclusions: A healthier lifestyle is associated with lower all-cause and cardiovascular mortality among patients receiving maintenance hemodialysis.</p>}},
  author       = {{Su, Guobin and Saglimbene, Valeria and Wong, Germaine and Natale, Patrizia and Ruospo, Marinella and Craig, Jonathan C. and Hegbrant, Jorgen and Carrero, Juan Jesus and Strippoli, Giovanni F.M.}},
  issn         = {{0272-6386}},
  keywords     = {{Blood pressure; body mass index (BMI); cardiovascular disease (CVD); chronic kidney disease (CKD); cohort; diet; DIET-HD; end-stage renal disease (ESRD); hemodialysis; lifestyle; modifiable risk factor; mortality; physical activity; smoking}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1--698}},
  publisher    = {{Elsevier}},
  series       = {{American Journal of Kidney Diseases}},
  title        = {{Healthy Lifestyle and Mortality Among Adults Receiving Hemodialysis : The DIET-HD Study}},
  url          = {{http://dx.doi.org/10.1053/j.ajkd.2021.07.022}},
  doi          = {{10.1053/j.ajkd.2021.07.022}},
  volume       = {{79}},
  year         = {{2022}},
}