Physical inactivity and chronic kidney disease in Australian adults: The AusDiab study

https://doi.org/10.1016/j.numecd.2009.08.010Get rights and content

Abstract

Background and Aims

Physical inactivity is associated with cardiovascular risk however its relationship to chronic kidney disease is largely unknown. We examined the association between leisure-time physical activity and risk of chronic kidney disease in a prospective, population-based cohort of Australians aged ≥25 years (AusDiab).

Methods and Results

The baseline sample included 10,966 adults (4951 males and 6015 females). From this sample, 6318 participants with complete baseline and 5-year follow-up urinalysis and serum creatinine measurements formed the study population for longitudinal analysis. Self-reported leisure-time physical activity was measured using a validated, interviewer–administered questionnaire. Compared with sufficiently active individuals (≥150 min physical activity per week), those who were inactive (0 min/week) were more likely to have albuminuria at baseline (multivariate-adjusted OR = 1.34, 95% CI 1.10–1.63). Inactivity (versus sufficient physical activity) was associated with increased age- and sex-adjusted odds of an estimated glomerular filtration rate <3rd percentile (OR = 1.30, 95% CI 1.02–1.65), although this was not significant after multivariate adjustment (OR = 1.17, 95% CI 0.91–1.50). Obese, inactive individuals were significantly more likely to have albuminuria at baseline (multivariate-adjusted OR = 1.74, 95% CI 1.35–2.25), compared with sufficiently active, non-obese individuals. Baseline physical activity status was not significantly associated with longitudinal outcomes.

Conclusions

Physical inactivity is cross-sectionally associated with albuminuria prevalence, particularly when combined with obesity. Future studies are needed to determine whether this association is causal and the importance of physical activity in CKD prevention.

Introduction

Chronic kidney disease (CKD) is now recognised to be widely prevalent in the general population [1], with key outcomes including progression to end-stage kidney disease requiring dialysis or transplantation and premature death due to cardiovascular disease [2]. Increasing severity of CKD is associated with graded increases in risk of death, cardiovascular events and hospitalisations [3]. Persistent albuminuria and reduced kidney function (measured according to glomerular filtration rate) are the principal markers of CKD. Both albuminuria and a low estimated glomerular filtration rate (eGFR) predict accelerated loss of kidney function, end-stage kidney failure, cardiovascular morbidity and mortality [3], [4], [5], [6], [7].

CKD shares several risk factors in common with cardiovascular disease, including diabetes, hypertension, smoking and obesity [8]. Physical activity is another important factor known to alter cardiovascular risk; whether physical inactivity is also a risk factor for CKD is less clear. Inadequate physical activity is an independent predictor of cardiovascular and all cause mortality even in lean persons [9], [10]. Conversely, the health benefits of regular physical activity include reduced risks of type 2 diabetes, high blood pressure, diabetes complications and cardiovascular events [11], [12], [13]. It is likely that inadequate physical activity is also an important modifiable risk factor in the development and progression of CKD, either directly or indirectly through favourable effects on diabetes, hypertension and obesity.

Greater leisure-time physical activity is shown to be associated with lower rates of nephropathy [13] and reduced risk of early kidney function decline [14] in diabetic individuals. Furthermore, inadequate physical activity has been linked with reduced kidney function, end-stage kidney disease and CKD-related death in analyses of population-based cohorts [15], [16]. To date, however, the relationship between physical inactivity and CKD has not been examined in prospective studies of the general population.

We used data from a prospective, population-based study of Australian adults to examine the associations between leisure-time physical activity and the prevalence and 5-year incidence of both albuminuria and a low eGFR. We hypothesised that inadequate physical activity is associated with increased prevalence and incidence of CKD, and that this association is independent of obesity.

Section snippets

Subjects

The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) is a population-based study of Australians ≥25 years [17]. A stratified cluster sampling method was used, with 25,984 households approached. Of 20,347 eligible adults participating in an initial interview, 11,247 took part in baseline biomedical examinations (1999–2000). The present report consists of: (1) cross-sectional analysis of the baseline cohort; and (2) longitudinal analysis of participants attending 5-year follow-up.

Results

Characteristics of the baseline sample (n = 10,966) are shown in Table 1. Inactive (0 min/week) individuals were predominantly female, older, had lower frequency of high school completion and were more often current smokers than individuals who had participated in any physical activity (>0 min) in the week preceding the baseline survey. Excessive alcohol consumption was more common in individuals who were sufficiently active (≥150 min/week) than among inactive persons. Graded relationships with

Discussion

In this study of Australian adults, physically inactive individuals were significantly more likely to have albuminuria at baseline compared with individuals who achieved the public health target of ≥150 min of physical activity per week. This association was independent of smoking, alcohol consumption, BMI, diabetes, blood pressure, cholesterol and previous cardiovascular events. A similar non-significant relationship was observed between inactivity and prevalence of a low eGFR. Obesity remained

Acknowledgements

The AusDiab study, co-coordinated by the Baker IDI Heart and Diabetes Institute, gratefully acknowledges the generous support given by: National Health and Medical Research Council (NHMRC grant 233200), Australian Government Department of Health and Ageing. Abbott Australasia Pty Ltd, Alphapharm Pty Ltd, AstraZeneca, Bristol-Myers Squibb, City Health Centre-Diabetes Service-Canberra, Department of Health and Community Services – Northern Territory, Department of Health and Human Services –

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