Association of low physical performance assessed by five-time chair stand test with new-onset and severity of chronic kidney disease: hybrid evidence from public health and clinical settings

Background This study aimed to investigate the longitudinal association between low physical performance assessed by five-time chair stand test (CST, seconds) and new-onset chronic kidney disease (CKD) in middle-aged and older adults, and to explore their cross-sectional relationship in patients with established CKD. Methods This observational, multicenter cohort study included 4,593 community-dwelling adults without CKD at baseline in 2011. An additional 549 patients with CKD were included for an exploratory cross-sectional analysis. Baseline physical performance was measured using the five-time chair stand test. Participants without CKD were followed from 2011 to 2018, with incident CKD identified via self-reported clinician diagnoses. Restricted cubic spline (RCS) and discrete-time survival model with a complementary log–log link were employed to investigate the associations between CST and new-onset CKD. The cross-sectional association between CST and disease severity in CKD patients was analyzed using Spearman’s correlation and logistic regression. Results There were 2,496 women and 2,097 men (median age = 58.0 years). During the seven-year follow-up, 485 CKD incidents occurred. RCS showed a linear-like association between CST and new-onset CKD in men ( p = 0.018), but no statistically significant association was observed in women. Exploratory OS-derived CST thresholds were 10.38 s for men and 12.77 s for women and were used only for statistical categorization. Multivariable analysis further indicated that prolonged CST times were positively associated with CKD risk (HR = 1.490, 95%CI = 1.227 to 1.810). This relationship was strengthened in subjects with lower blood urea nitrogen levels. In the exploratory analysis, CST was significantly associated with CKD stage, end-stage kidney disease, and estimated glomerular filtration rate (eGFR) in men, but not in women. Conclusion In this hypothesis-generating analysis, low physical performance, as indicated by prolonged CST time, was positively associated with new-onset CKD in middle-aged and older Chinese adults. A similar pattern was observed in male patients with CKD. Future studies are warranted to clarify whether early intervention could play a role in preventing the onset and progression of CKD.