Adherence to four lifestyle factors can lower the risk of death in CKD patients, according to a new study in the American Journal of Kidney Diseases.

The study found that CKD patients who don’t smoke, are physically active, eat a healthy diet (comprised of more fruits, vegetables and whole grains and less red meat and sugar) and have a body mass index between 20-25 kg/m2, reduced their risk of death by 68% compared to those who did not have these lifestyle qualities.

"We have learned from research studies of other chronic conditions such as heart disease and cancer that lifestyle factors and behaviors including diet, physical activity, cigarette smoking, and body mass index play a very important role in health outcomes including cardiovascular events and mortality,” said Ana C. Ricardo, MD, MPH, Assistant Professor of Medicine, University of Illinois, Chicago. “We wanted to know if these factors were as important in individuals with chronic kidney disease, and it appears they are.”

Using data collected during four years of follow-up from 3,006 adults enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study, researchers tracked the relationship between lifestyle factors and health outcomes such as chronic kidney disease progression, heart disease and death. Patients had a mean age of 58 ± 11, a mean eGFR of 43 ± 14 mL/min/1.73 m2, and 45% of them had diabetes.

Over four years, there were 726 cases of worsening kidney function, 355 heart events, and 437 deaths. Those who did not smoke cigarettes had better outcomes including slower progression of CKD, and reduced risk of heart attacks and death. Regular physical activity was also associated with reduced risk of death.

Somewhat surprisingly, a body mass index greater than 25 kg/m2was associated with lower risk of cardiovascular events while a body mass index greater than 30 kg/ m2 was associated with lower risk of death.

Healthy diet patterns, independently, didn’t predict better outcomes, but increased survival when combined with nonsmoking, regular exercise and a BMI between 20-25 kg/m2. All together, adherence to all four lifestyle factors was associated with a 68% decrease in risk of death.

“This demonstrates that a holistic approach that incorporates all aspects of a person’s lifestyle and behavior can have the most impact on improving life expectancy in those with CKD,” said Thomas Manley, Director of Scientific Activities for the National Kidney Foundation. “Healthy lifestyle modifications have consistently been shown to improve a patient’s prognosis, so it makes sense for healthcare practitioners to put more emphasis on helping their patients with CKD adopt healthy daily routines and habits.”

Aside from the surprising results of the body mass index on outcomes, all four lifestyle modifications were not associated significantly with CKD progression or heart events, indicating that more research is needed in this area.

“Our findings reinforce clinical care guidelines which recommend lifestyle modifications, and suggest that current physical activity and nonsmoking recommendations for the general population are also applicable to individuals with CKD,” said Ricardo. “Furthermore, our findings suggest that additional research is needed to investigate the optimal dietary recommendations and body mass index levels to prevent disease progression and poor outcomes among individuals with CKD.”