Physical activity patterns and chronic kidney disease risk: a 5-year study in stage 1 cardiovascular-kidney-metabolic syndrome.

Evidence on the effects of sarcopenic obesity (SO) on incident chronic kidney disease (CKD) and rapid kidney function decline (RKFD) in the Chinese population is limited. This study aimed to prospectively examine the associations of SO with incident CKD and RKFD among middle-aged and older Chinese adults. This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative longitudinal study of Chinese adults aged 45 and older. The analysis included 4201 individuals from the 2011 wave, with renal outcomes ascertained from the 2015 wave. The effects of SO on incident CKD and RKFD were assessed using logistic regression models. Robustness was tested through subgroup and sensitivity analyses. Over four years of follow-up, 228 cases of incident CKD and 213 cases of RKFD were observed. After multivariable adjustment, participants in the "sarcopenic obesity" group showed a 78% increased risk of incident CKD (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.09-2.90) and a 79% increased risk of RKFD (OR 1.79, 95% CI 1.03-3.13), compared to the "nonsarcopenia without obesity" group. Consistent results were observed across subgroups stratified by gender, education level, marital status, geographic area, lifestyle factors, and comorbidities, with no significant interactions detected. In a population-based cohort of middle-aged and older Chinese adults, SO was independently associated with elevated risks of incident CKD and RKFD, without interaction effects. These findings underscore the importance of timely intervention for SO to prevent adverse kidney outcomes. Key message What is already known on this topic? The relationship between sarcopenic obesity (SO) and the risk of chronic kidney disease (CKD) and renal function decline has been established in Korean and Japanese individuals with type 2 diabetes mellitus. However, it is uncertain if these findings apply to other populations, particularly those without diabetes. Additionally, the influence of diabetes on these associations needs further exploration, and the link between SO and rapid kidney function decline (RKFD) remains unestablished. Evidence regarding the effects of SO on incident CKD and RKFD in the Chinese population is limited, highlighting the necessity for this study to fill these gaps in knowledge. What this study adds This study is the first to prospectively explore the association of SO with incident CKD and RKFD in middle-aged and older Chinese adults. We identified SO as a significant risk factor for increased incidence of both CKD and RKFD. These findings expand the understanding of the impact of SO beyond individuals with diabetes mellitus, indicating that SO is a universal risk factor for adverse kidney outcomes in aging populations, irrespective of demographic and health characteristics. How this study might affect research, practice, or policy This study identifies SO as an independent risk factor for incident CKD and RKFD in middle-aged and older Chinese adults. The findings suggest that SO is a modifiable risk factor for kidney health, underscoring the necessity for timely interventions to prevent adverse kidney outcomes. Given the rising prevalence of SO and kidney disease in aging populations worldwide, these results highlight the importance of incorporating SO management into public health and clinical strategies. Questions pending answer What role do specific lifestyle factors (e.g. diet, physical activity) play in mitigating or exacerbating kidney function decline in individuals with SO? Are there genetic markers that predispose individuals with SO to a higher risk of incident CKD and RKFD? What are the underlying molecular mechanisms linking SO to incident CKD and RKFD?

BackgroundThis study aimed to assess the association between waist-to-height ratio (WHtR) and the risk of rapid kidney function decline (RKFD) and chronic kidney disease (CKD).MethodsThis study analyzed 4374 participants from the China Health and Retirement Longitudinal Study (CHARLS). WHtR was calculated as waist circumference (cm) divided by height (cm). RKFD was defined as an annualized estimated glomerular filtration rate (eGFR) decline ≥ 5 mL/min/1.73 m2, and CKD as RKFD with eGFR < 60 mL/min/1.73 m2 at the final follow-up. Linear mixed-effects models were used to assess the association between baseline WHtR and annual changes of eGFR. Cox proportional hazards models were employed to estimate the association between baseline WHtR and the risks of RKFD and CKD. Restricted cubic spline (RCS) analysis was conducted explored the dose-response relationships.ResultsOver a mean 3.99-year follow-up, 200 participants (4.57%) developed RKFD, and 66 (1.51%) developed CKD. Each 1-SD increase in WHtR was associated with a greater decline in eGFR (β = -0.242, 95%CI: -0.355 to -0.130) and increased risks of RKFD (HR = 1.298, 95% CI: 1.111 to 1.517) and CKD (HR = 1.518, 95% CI: 1.184 to 1.945) after full adjustment. Compared with the first WHtR quartile group (Q1), the risk of RKFD was significantly increased in Q3 (HR = 1.969, 95%CI: 1.234 to 3.142) and Q4 groups (HR = 2.203, 95%CI: 1.360 to 3.568), whereas the risk of CKD was increased in Q4 group (HR = 3.931, 95%CI: 1.618 to 9.549). RCS analysis demonstrated a positive linear association between baseline WHtR and the incidence of RKFD and CKD (P for nonlinear = 0.403 and 0.492, respectively).ConclusionsElevated WHtR is significantly associated with accelerated eGFR decline and higher risks of RKFD and CKD in middle-aged and older Chinese adults.Clinical trial numberNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12882-025-04474-9.

Introduction: The cohort study aimed to assess the association of nighttime sleep duration and the change in nighttime sleep duration with chronic kidney disease (CKD) and whether the association between nighttime sleep duration and CKD differed by daytime napping. Methods: This study included 11,677 individuals from the China Health and Retirement Longitudinal Study (CHARLS) and used data from the 2011 baseline survey and four follow-up waves. Nighttime sleep duration was divided into three groups: short (<7 h per night), optimal (7–9 h), and long nighttime sleep duration (>9 h). Daytime napping was divided into two groups: no nap and with a nap. We used Cox proportional hazards model to examine the effect of nighttime sleep duration at baseline and change in nighttime sleep duration on incident CKD and a joint effect of nighttime sleep duration and nap time on onset CKD. Results: With a follow-up of 7 years, the incidence of CKD among those with short, optimal, and long nighttime sleep duration was 9.89, 6.75, and 9.05 per 1,000 person-years, respectively. Compared to individuals with optimal nighttime sleep duration, short nighttime sleepers had a 44% higher risk of onset CKD (hazard ratio [HR]: 1.44, 95% confidence interval [CI]: 1.21–1.72). Compared to participants with persistent optimal nighttime sleep duration, those with persistent short or long nighttime sleep duration had an increased risk of incident CKD (HR: 1.44, 95% CI: 1.15–1.80). We found a lower incidence of CKD in participants with short nighttime sleep duration and a nap (HR: 0.74, 95% CI: 0.60–0.93), compared to those with short nighttime sleep duration and no nap. Conclusion: Short nighttime sleep duration and persistent long or short nighttime sleep duration were associated with a higher risk of onset CKD. Keeping persistent optimal nighttime sleep duration may help reduce CKD risk later in life. Daytime napping may be protective against CKD incidence.

Chronic kidney disease (CKD) has become a significant global public health challenge, which was reported to be highly correlated with the triglyceride glucose-body mass index (TyG-BMI). Nevertheless, literature exploring the association between changes in the TyG-BMI and CKD incidence is scant, with most studies focusing on individual values of the TyG-BMI. We aimed to investigate whether cumulative average in the TyG-BMI were associated with CKD incidence. Data in our study were obtained from the China Health and Retirement Longitudinal Study (CHARLS), which is an ongoing nationally representative prospective cohort study. The exposure was the cumulative average TyG-BMI from 2011 to 2015. The TyG-BMI was calculated by the formula ln [TG (mg/dl) × FBG (mg/dl)/2] × BMI (kg/m2), and the cumulative average TyG-BMI was calculated as follows: (TyG-BMI2011+ TyG-BMI2015)/2. Logistic regressions were used to determine the association between different quartiles of cumulative average TyG-BMI and CKD incidence. Meanwhile, restricted cubic spline was applied to examine the potential nonlinear association of the cumulative average TyG-BMI and CKD incidence. In addition, subgroup analysis was used to test the robustness of results. Of the 6117 participants (mean [SD] age at baseline, 58.64 [8.61] years), 2793 (45.7%) were men. During the 4 years of follow-up, 470 (7.7%) incident CKD cases were identified. After adjusting for potential confounders, compared to the participants in the lowest quartile of cumulative average TyG-BMI, participants in the 3rd and 4th quartile had a higher risk of CKD onset. The ORs and 95%CIs were [1.509(1.147, 1.990)] and [1.452(1.085, 1.948)] respectively. In addition, restricted cubic spline showed the cumulative average TyG-BMI had a liner association (p-nonlinear = 0.139). The cumulative average in the TyG-BMI was independently associated with the risk of CKD in middle-aged and older adults. Monitoring long-term changes in the TyG-BMI may assist with the early identification of individuals at high risk of CKD.

Depressive symptoms and sleep duration in relation to chronic kidney disease: Evidence from the China health and retirement longitudinal study

The association of nighttime sleep duration and quality with chronic kidney disease in middle-aged and older Chinese: a cohort study

As the global trend of population aging intensifies, frailty among the elderly has emerged as a significant public Health concern. This study examines the relationship between physical activity levels and the Frailty Index in older adults, utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS). The study sample included 10,240 Chinese adults aged ≥ 60 years.Frailty was assessed using the Frailty Index (FI), which was calculated based on the accumulation of age-related health deficits. The level of physical activity were determined using the International Physical Activity Questionnaire (IPAQ) and expressed in terms of metabolic equivalent (MET) units. The dose-response relationship between physical activity and the Frailty Index was examined using restricted cubic splines (RCS) and logistic regression analysis. The results demonstrated a significant inverse relationship between physical activity level and the risk of frailty. Specifically, participants in the highest quartile of physical activity had a 45% lower risk of frailty compared to those in the lowest quartile (OR = 0.55, 95% CI: 0.48–0.63). The protective effect of physical activity remained robust across various models, even after adjusting for potential confounders, such as age, sex, education level, marital status, and health behaviors. The RCS model revealed a nonlinear relationship between physical activity and frailty risk, higher levels of physical activity significantly reduce the risk of frailty in the elderly, with moderate-to high-intensity physical activity playing a crucial role in decreasing the prevalence of frailty. However, further increase in activity beyond a certain point may not yield additional benefits.

Background and Aims Little is known about the association between sarcopenia and chronic kidney disease (CKD) among Chinese adults older than 45. The present study sought to investigate the relationship between sarcopenia and CKD based on a large, nationally representative survey. Method The China Health and Retirement Longitudinal Study (CHARLS) provided data for the study in four waves in 2011, 2013, 2015, and 2018. Based on the Asia Working Group for Sarcopenia 2019 (AWGS 2019) criteria, sarcopenia and possible sarcopenia were defined. CKD was defined as eGFR less than 60 mL/min/1.73 m2, calculated according to the CKD Epidemiology Collaboration (CKD-EPI) equation, or self-reported CKD. Logistic regression models were conducted to analyze the cross-sectional relationship between sarcopenia and CKD. Cox proportional hazards regression models were used to examine the effect of sarcopenia on CKD. Stratified analyses were used to assess the association between sarcopenia status and CKD in various subgroups. Results Totally, 12323 participants over 45 years old (48.2% males; mean age 59.3 ± 9.5 years) were enrolled in a cross-sectional study in 2011, and further 10445 individuals were followed up in 2013, 2015 and 2018. The prevalence of CKD was 8.4% (1040/12323) in general populations, 7.2% (556/7703) in individuals without sarcopenia, 10.1% (380/3760) in adults with possible sarcopenia, and 12.1% (104/860) in individuals with sarcopenia, respectively. In cross-sectional study, possible sarcopenia [OR (95% CI): 1.236 (1.069-1.430)] was significantly associated with CKD (P &amp;lt; 0.01). While sarcopenia was not significantly associated with CKD. 783 cases (7.5%) with incident CKD events were identified during the 7 years of follow-up. In subgroup analyses, the incidence of CKD was 1.855 (95% CI 1.176-2.928) in the sarcopenia group compared with non-sarcopenia group among the female participants. The sarcopenia group (HR: 1.639, 95% CI 1.099-2.443) was independently associated with a higher incidence of CKD among non-smokers. Low muscle mass alone was not significantly associated with an increased risk of incident CKD (P &amp;gt; 0.05). Conclusion In our cross-sectional analysis, possible sarcopenia determined by AWGS2019 criteria was associated with a higher prevalence of CKD. In our longitudinal study, sarcopenia assessed using AWGS2019 criteria was associated with a higher risk of CKD in Chinese women over 45 years old or non-smokers.

Bidirectional association between chronic liver disease and chronic kidney disease: a longitudinal study based on CHARLS 2011-2020 data.

Estimated glucose disposal rate (eGDR), lipid accumulation product, Chinese visceral adiposity index, triglyceride-glucose, TyG-body mass index, TyG-waist circumference (TyG-WC), metabolic score for insulin resistance (METS-IR), and atherogenic index of plasma (AIP) are considered surrogate markers of insulin resistance (IR). However, there is currently a lack of comparative studies on the ability of different surrogate markers of insulin resistance to predict rapid decline in kidney function and the occurrence of chronic kidney disease (CKD) in non-diabetic populations. This study is based on data from the China Health and Retirement Longitudinal Study (CHARLS). Multivariable logistic regression models and trend regression analyses were used to examine the relationships between eight surrogate markers of insulin resistance and rapid decline in kidney function as well as the risk of CKD. Finally, the area under the curve of the surrogate markers of insulin resistance was calculated using receiver operating characteristic analysis. Each one SD increase in AIP was significantly associated with a reduced risk of rapid decline in kidney function and CKD, with adjusted ORs of 1.391 and 1.560, respectively. Dose-response analysis revealed nonlinear associations between TyG-WC and METS-IR with the risk of rapid decline in kidney function, and between eGDR and TyG-WC with CKD (P nonlinearity ≥ 0.05). ROC analysis indicated that AIP had significantly higher AUC values for predicting the risk of rapid decline in kidney function and CKD in the non-diabetic population, with AUCs of 0.676 and 0.608, respectively. AIP demonstrates strong potential in predicting the risk of rapid decline in kidney function and CKD in the Chinese middle-aged and elderly non-diabetic population, and this predictive ability is not influenced by sex or age.

BackgroundMusculoskeletal disease (MSD) is a major cause of disability among older adults, and understanding the role of physical activity (PA) in preventing these conditions is crucial. This study aimed to explore the association between PA levels and MSD risk among adults aged 45 and above, clarify the dose‒response relationship, and provide tailored guidelines.MethodsUsing data from the China Health and Retirement Longitudinal Study (CHARLS), a cross-sectional analysis was conducted on 15,909 adults aged 45 and over. The study population was divided into MSD (n = 7014) and nMSD (n = 8895) groups based on musculoskeletal health status. PA levels were assessed using the International Physical Activity Questionnaire and categorized into low intensity physical activity (LIPA), moderate vigorous physical activity (MVPA), and vigorous physical activity (VPA). Multivariable logistic regression models and restricted cubic spline regression were used to examine the relationship between PA levels and MSD risk in middle-aged and older adults. Sensitivity analyses and stratified analyses were also performed.ResultsThe main outcome measures were musculoskeletal diseases prevalence and PA levels. MVPA and VPA reduced MSD risk by 19% [OR = 0.81, 95% CI (0.72, 0.90), P < 0.001] and 12% [OR = 0.88, 95% CI (0.79, 0.98), P < 0.05], respectively. What’s more, after adjusting for confounding factors, VPA increased risk by 32% [OR = 1.32, 95% CI (1.04, 1.66), P < 0.05]. The relationship was nonlinear, showing a U-shaped pattern with age and hypertension status as significant moderators. The optimal PA energy expenditure was identified as approximately 1500 metabolic equivalents of tasks (METs) per week for adults aged 45–74, 1400 METs per week for those aged 75 and above, and 1600 METs per week for hypertensive adults aged 45 and older.ConclusionsFor adults aged 45 years and older, VPA significantly increases the risk of MSD. Adults aged 45 years and older should adjust their weekly METs based on their age. Additionally, those with hypertension should moderately increase their weekly METs to promote optimal musculoskeletal health.

Background and Aims Frailty is a complex age-related clinical condition characterized by a decline in physiological capacity of several organ systems, with a resultant increased susceptibility to stressors. Little is known about the association between frailty and chronic kidney disease (CKD) among Chinese adults. The present study sought to investigate the relationship between frailty and CKD based on a large, nationally representative survey. Method The participants were 4231 adults aged ≥50 years from the China Health and Retirement Longitudinal Study (CHARLS). Based on the FRAIL scale, frailty and prefrailty were defined. CKD was defined as eGFR less than 60 mL/min/1.73 m2, calculated according to the CKD Epidemiology Collaboration (CKD-EPI) equation, or self-reported CKD. Logistic regression models were conducted to analyze the cross-sectional relationship between frailty and CKD. Cox proportional hazards regression models were used to examine the effect of frail status and frail components on CKD. Results We found that prevalence of frailty in CKD individuals was 13.9% while in patients without CKD was 8.4%. The prevalence of CKD in robust group was 6.0%, in prefrail group was 10.1% and in frail group was 14.0%. In frail status, after adjusted, the incidence of CKD was 1.713 (95% CI 1.109-2.646) in the frail group compared with robust group (P = 0.015). While there was no statistical difference in the incidence of CKD among the prefrail group and robust group. In frail components, after adjusted, weight loss was associated with higher risk of CKD [HR (95% CI): 1.617 (1.170-2.235)]. Conclusion We found that the prevalence of frailty was relatively high in the population. In frail status, both prefrail and frail were associated with a higher risk of CKD. In frail components, weight loss was associated with an increase incidence of CKD. Frailty is reversible, so early identification of frailty may reduce the incidence of CKD and improve the adverse consequences associated with CKD.

Adverse Childhood Experiences have been well-documented as a risk factor for chronic kidney disease (CKD) in adulthood. However, the link between childhood health and adulthood CKD risk is still unclear. This study aimed to explore the connection between childhood health and the likelihood of developing CKD in adulthood. Participants were drawn from the third wave of the China Health and Retirement Longitudinal Study (CHARLS). The CKD was identified based on the estimated Glomerular Filtration Rate (eGFR) and self-reported doctor-diagnosed kidney disease. Childhood health status was assessed through a standard questionnaire and categorized into excellent, fair, and poor groups. The prevalence of CKD was 11.7% (1,480 out of 12,609). The eGFR levels in the self-reported Fair and Poor groups were significantly lower than those in the Excellent group (p < 0.05). Compared to the Excellent group, individuals in the Poor group reported a higher risk of CKD (OR = 1.38; 95% CI: 1.12-1.70; p = 0.002), even after adjusting for factors such as age, sex, smoking, alcohol consumption, physical activity, highest education level, use of Chinese traditional medicine, diabetes, hypertension, BMI, marital status, and annual household income (OR = 1.24; 95% CI: 1.01-1.54; p = 0.047). The CKD prevalence is notably high in the Chinese adults aged more than 45 years, and a history of poor health in childhood may significantly contribute to the risk of CKD in later life.

Chronic kidney disease (CKD) is characterized as a progressive dysfunction of the kidney. The estimated glucose disposal rate (eGDR) is widely recognized as a dependable marker of insulin resistance (IR). Nonetheless, the potential link between eGDR and CKD incidence remains insufficiently clarified. This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS). The outcome of this study was CKD events. We performed adjusted Cox proportional hazards regression, restricted cubic splines (RCS), and mediation analyses. Among the 6,737 participants followed for a median of 108 months, 1,356 (20.13%) developed CKD. Relative to the lowest quartile (Q1) of eGDR, the adjusted HR for the highest quartile (Q4) was 0.85 (95% CI: 0.72–0.99). Each standard deviation increase in eGDR was linked to a 7% reduction in CKD risk (HR: 0.93, 95% CI: 0.88–0.99). The RCS curve indicated a linear relationship between eGDR and CKD risk (threshold = 8.21). The cardiovascular disease (CVD) significantly mediated 27.0% of the association between eGDR and CKD risk. This study demonstrates a significant inverse correlation between eGDR levels and CKD risk in middle-aged and elderly individuals within the Chinese population. Moreover, CVD emerges as a key intermediary linking eGDR and the heightened risk of CKD.

Background This study aimed to evaluate the association between conventional and unconventional lipid parameters and the risk of future chronic kidney disease (CKD) and progression of renal function decline. Methods Data from 4,542 participants who were free of CKD at baseline were analyzed using information from the China Health and Retirement Longitudinal Study (2011–2015). The follow-up period was four years. The primary endpoints were incident CKD and rapid progression of renal function decline. The associations between lipid parameters and the risk of CKD and rapid progression of renal function decline were assessed using restricted cubic splines (RCS) and logistic regression analysis. Results Logistic regression analysis showed that high-density lipoprotein cholesterol (HDL-C) was negatively associated with CKD risk, while remnant cholesterol (RC) and the atherogenic index of plasma (AIP) were positively associated. Triglycerides (TG), RC, and AIP were positively correlated with rapid renal function decline, whereas low-density lipoprotein cholesterol (LDL-C) and HDL-C were negatively correlated. Among these parameters, AIP was the most strongly associated with CKD [adjusted odds ratio (OR) (95% CI): 2.091 (1.199, 3.649), p = 0.009] and rapid progression of renal function decline [adjusted OR (95% CI): 3.996 (2.632, 6.068), p < 0.001]. Conclusion LDL-C and HDL-C were negatively associated with rapid progression of renal function decline, while TG, RC, and AIP were positively associated with this outcome. Among the lipid parameters examined, AIP was the most strongly associated with CKD and rapid progression of renal function decline.