Association of physical activity levels and estimated glomerular filtration rate with all-cause mortality: a 10-year cohort study

Aim: Many studies have demonstrated that physical inactivity and reduced renal function are associated with an increased risk of all-cause mortality. However, most of this evidence is derived from non-Chinese populations. This study aimed to investigate the association of physical activity (PA) with the risk of all-cause mortality among Chinese adults with and without impaired kidney function. Materials & methods: We conducted a prospective cohort study among a population in Jiangsu Province, China. Cox proportional hazards regression models were used to explore the associations of estimated glomerular filtration rate (eGFR) and PA with all-cause mortality, as well as to test for potential interactions between eGFR and PA. Results: A total of 6266 participants with complete data were included in the analysis, with a median age of 52 years and 44% being male. Of these participants, 1034 (16.5%) had an eGFR <60 ml/min/1.73 m 2 . During a median follow-up 9.1 years (interquartile range [IQR]: 7.7–9.9), 196(3.1%) participants died. Participants with eGFR <60 ml/min/1.73 m 2 had a significantly higher risk of death (hazard ratio [HR] = 1.93; 95% confidence interval [CI]: 1.39–2.68) compared with eGFR ≥60 ml/min/1.73 m 2 . A significant interaction was observed between PA and eGFR in relation to all-cause mortality risk (p for interaction = 0.004). Notably, participant with eGFR <60 ml/min/1.73 m 2 and low PA had a highest risk of all-cause mortality, compared with those with eGFR ≥60 ml/min/1.73 m 2 and high PA (HR: 4.06; 95% CI: 2.34–7.03). Conclusion: PA, a key lifestyle factor, is a potentially modifiable risk factor for both individuals with normal renal function and those with impaired kidney function. Consistent with existing literature, participants with decreased renal function exhibited a significantly higher risk of all-cause mortality. Notably, our analysis further revealed that the risk of all-cause mortality was the highest among participants with impaired renal function and low PA.