Supplementary Material for: Life's Essential 8 and Mortality in US Adults with Chronic Kidney Disease

Introduction: The current prevalence of chronic kidney disease (CKD) is substantial, and CKD individuals face a heightened risk of mortality, encompassing both all-cause and cause-specific outcomes. The current study aims to investigate the potential impact of adhering to Life Essential 8 (LE8) on reducing mortality among CKD individuals. Methods: Using the National Health and Nutrition Survey (NHANES) data from 2005 to 2018, we analyzed 22,420 United States adults (≥20 years old). CKD is defined by urinary albumin-to-creatinine ratio (≥30 mg/g or 3 mg/mmol) and estimated glomerular filtration rate (<60 ml/min/1.73m2). The components of LE8, including diet, physical activity (PA), nicotine exposure, sleep, Body Mass Index, blood lipids, blood glucose, and blood pressure (BP) were measured and given a score of 0-100. The total LE8 score was the unweighted average of all components and was divided into low cardiovascular health (CVH) (0-49), moderate CVH (50-79), and high CVH (80-100). Cox proportional hazards regression model was used to explore the associations of LE8 with all-cause, cardiovascular disease (CVD), and cancer mortality, which were followed prospectively by the National Center for Health Statistics until December 31, 2019. Results: In the overall population, individuals with moderate CVH had a 47% lower risk of CKD, while high CVH was linked to a 55% lower risk compared to low CVH. During a median follow-up of 7.58 years, CKD individuals had a 93% higher all-cause mortality rate and a 149% higher CVD mortality rate compared to those without CKD. Among the CKD individuals, every 10-point increase in LE8 score was associated with reduced risks of 17% for all-cause mortality (especially PA, nicotine exposure, blood glucose, and BP), 18% for CVD mortality (especially PA), and 12% for cancer mortality (especially PA and sleep health). In additional and sensitivity analysis, the results remained significant after further consideration of potential confounding of renal function. Additionally, LE8 demonstrated superior risk stratification for CVD mortality among CKD patients compared with LS7. Interaction was observed between LE8 and age, education level, marital status, and drinking status. Conclusions: The current study demonstrates that adherence to higher LE8 levels within CKD individuals is associated with a reduced risk of both all-cause and cause-specific mortality.

引言：当前慢性肾脏病（chronic kidney disease, CKD）的患病率居高不下，此类患者的全因死亡及特异性病因死亡风险均显著升高。本研究旨在探讨坚持生命核心8项指标（Life Essential 8, LE8）对降低慢性肾脏病患者死亡风险的潜在作用。
方法：本研究采用2005-2018年美国国家健康与营养调查（National Health and Nutrition Survey, NHANES）的数据，共纳入22420名20岁及以上的美国成年人。慢性肾脏病的定义为尿白蛋白肌酐比值（urinary albumin-to-creatinine ratio）≥30 mg/g或3 mg/mmol，且估算肾小球滤过率（estimated glomerular filtration rate）<60 ml/min/1.73m²。生命核心8项指标的组成包括饮食、身体活动（physical activity, PA）、尼古丁暴露、睡眠、体重指数（Body Mass Index）、血脂、血糖及血压（blood pressure, BP），各项指标均按0-100分进行评分。总LE8得分为各分项得分的未加权平均值，并据此分为低心血管健康（cardiovascular health, CVH）组（0-49分）、中心血管健康组（50-79分）及高心血管健康组（80-100分）。本研究采用考克斯比例风险回归模型（Cox proportional hazards regression model），分析LE8与全因死亡、心血管疾病（cardiovascular disease, CVD）及癌症死亡的关联；随访工作由美国国家卫生统计中心（National Center for Health Statistics）开展，截至2019年12月31日。
结果：在全人群中，与低心血管健康组相比，中心血管健康组患者的慢性肾脏病发病风险降低47%，高心血管健康组则降低55%。中位随访7.58年期间，慢性肾脏病患者的全因死亡率较非CKD人群升高93%，心血管疾病死亡率升高149%。在慢性肾脏病患者中，LE8评分每升高10分，全因死亡风险降低17%（尤以身体活动、尼古丁暴露、血糖及血压为著），心血管疾病死亡风险降低18%（尤以身体活动为著），癌症死亡风险降低12%（尤以身体活动及睡眠健康为著）。在补充分析及敏感性分析中，在进一步校正肾功能的潜在混杂因素后，上述结果仍具有统计学意义。此外，与LS7相比，LE8对慢性肾脏病患者的心血管疾病死亡风险分层效果更优。研究还观察到LE8与年龄、教育水平、婚姻状况及饮酒状态存在交互作用。
结论：本研究表明，慢性肾脏病患者坚持更高水平的生命核心8项指标，与全因死亡及特异性病因死亡风险降低显著相关。