Modifiable Lifestyle Factors for Primary Prevention of CKD: A Systematic Review and Meta-Analysis

Abstract

Significance Statement: Although CKD incidence is increasing, no evidence-based lifestyle recommendations for CKD primary prevention apparently exist. To evaluate evidence associating modifiable lifestyle factors and incidence of CKD, the authors undertook a systematic review and meta-analysis. Their analysis, which included 104 observational studies of 2,755,719 participants, demonstrated consistency of evidence for a number of measures associated with preventing CKD onset, including increasing dietary intake of vegetables and potassium (21% reduced odds and 22% reduced odds, respectively), increasing physical activity levels (18% reduced odds), moderating alcohol consumption (15% reduced risk), lowering sodium intake (21% increased odds), and stopping tobacco smoking (18% increased risk). In the absence of clinical trial evidence, these findings can help inform public health recommendations and patient-centered discussions in clinical practice about lifestyle measures to prevent CKD. Background: Despite increasing incidence of CKD, no evidence-based lifestyle recommendations for CKD primary prevention apparently exist. Methods: To evaluate the consistency of evidence associating modifiable lifestyle factors and CKD incidence, we searched MEDLINE, Embase, CINAHL, and references from eligible studies from database inception through June 2019. We included cohort studies of adults without CKD at baseline that reported lifestyle exposures (diet, physical activity, alcohol consumption, and tobacco smoking). The primary outcome was incident CKD (eGFR<60 ml/min per 1.73 m 2 ). Secondary outcomes included other CKD surrogate measures (RRT, GFR decline, and albuminuria). Results: We identified 104 studies of 2,755,719 participants with generally a low risk of bias. Higher dietary potassium intake associated with significantly decreased odds of CKD (odds ratio [OR], 0.78; 95% confidence interval [95% CI], 0.65 to 0.94), as did higher vegetable intake (OR, 0.79; 95% CI, 0.70 to 0.90); higher salt intake associated with significantly increased odds of CKD (OR, 1.21; 95% CI, 1.06 to 1.38). Being physically active versus sedentary associated with lower odds of CKD (OR, 0.82; 95% CI, 0.69 to 0.98). Current and former smokers had significantly increased odds of CKD compared with never smokers (OR, 1.18; 95% CI, 1.10 to 1.27). Compared with no consumption, moderate consumption of alcohol associated with reduced risk of CKD (relative risk, 0.86; 95% CI, 0.79 to 0.93). These associations were consistent, but evidence was predominantly of low to very low certainty. Results for secondary outcomes were consistent with the primary finding. Conclusions: These findings identify modifiable lifestyle factors that consistently predict the incidence of CKD in the community and may inform both public health recommendations and clinical practice.