Association between healthy lifestyle and risk of chronic kidney disease: a prospective cohort study of 0.5 million Chinese adults

Chronic kidney disease (CKD) is a fast growing global public health concern, with lifestyle factors contributing significantly to its risk. The purpose of this study was to investigate the relationship between a healthy lifestyle and the risk of incident CKD. We examined healthy lifestyle and CKD risk in 502,621 China Kadoorie Biobank (CKB) participants. Six low-risk lifestyle factors were assessed: 1) non-smoking or quitting for at least 6 months, 2) drinking alcohol weekly, 3) engaging in moderate or greater physical activity, 4) following a healthy diet, 5) maintaining a body mass index (BMI) of 18.5–23.9 kg/m2, and 6) having a waist-to-hip ratio (WHR) of < 0.90 for men and < 0.85 for women. Adequate physical activity was defined as achieving at least the gender-specific median level of total metabolic equivalent task hours per day. A Simplified Healthy Eating Index score in the highest quartile indicated a healthy diet.The proportion of CKD cases that could have been prevented was estimated using the population attributable risk percent. In multivariable-adjusted analyses, all six low-risk lifestyle factors—never smoking or quitting not for illness, drinking alcohol weekly, maintaining a healthy diet, having a normal BMI, and possessing a normal WHR—were independently linked to a reduced risk of CKD. Participants with a minimum of five low-risk lifestyle factors demonstrated a 47% decrease in the relative risk of CKD compared to individuals without any low-risk lifestyle factors. Approximately 39.8% (95% CI: 31.5–47.8%) of CKD cases are attributable to an unhealthy lifestyle. A healthy lifestyle significantly reduces the incidence of CKD, demonstrating the long-term benefits of lifestyle changes.