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.

中文翻译：

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接受血液透析的成年人的健康生活方式和死亡率：DIET-HD 研究

基本原理和目标

健康的生活方式可促进心血管健康并降低普通人群的心脏相关死亡率，但其对接受维持性血液透析的人的益处尚不确定。

学习规划

前瞻性队列研究。

设置与参与者

在跨国私人透析网络中连续接受维持性血液透析的 9,757 名成年人中的 5,483 人（2014 年 1 月至 2017 年 6 月，中位透析时间：3.6 年）并拥有完整的生活方式数据。

暴露

根据美国心脏协会关于心血管预防的建议，改良的健康生活方式评分是涉及吸烟、体育活动、饮食和控制收缩压的 4 个组成部分的总和。

结果

心血管和全因死亡率。

分析方法

调整比例风险回归分析，将国家作为随机效应，以估计生活方式评分（低 [0-2 分] 作为参考，中 [3-5] 和高 [6-8]）与死亡率之间的关联。关联表示为调整后的风险比 (AHR)，CI 为 95%。

结果

在中位 3.8 年（共 17,451 人年）期间，共有 2,163 人死亡，其中 826 人与心血管疾病有关。与生活方式评分低的患者相比，生活方式评分中等和高的患者的全因死亡率AHR分别为0.75（95% CI，0.65-0.85）和0.64（95% CI，0.54-0.76）。与生活方式评分低的患者相比，生活方式评分中等和高的患者心血管死亡率的AHR分别为0.73（95% CI，0.59-0.91）和0.65（95% CI，0.49-0.85）。

限制

自我报告的生活方式，数据驱动的方法。

结论

在接受维持性血液透析的患者中，更健康的生活方式与较低的全因死亡率和心血管死亡率相关。