Supplementary Material for: Trends in Adherence to Recommended Physical Activity and Its Association with Mortality and Disease Progression among US Adults with Chronic Kidney Disease

Introduction: This study aimed to examine the trends in adherence to the Physical Activity Guidelines (PAG) for aerobic activity and sedentary time and their effects on mortality and disease progression among US adults with chronic kidney disease (CKD). Methods: We studied individuals from the National Health and Nutrition Examination Survey 2007–08 to 2017–18 with a mortality file in 2015. Multivariate regression models were used to evaluate the association between adherence to PAG and sedentary time with mortality, estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio. Results: For the CKD population, adherence rate increased from 48.2% in 2007–08 to 55.0% in 2017–18, and sedentary time peaked in 2013–14 (7.5 h/day) and then decreased afterward. There was no difference in the trends across the non-CKD and CKD population. For the CKD population, adherence to the PAG was significantly associated with all-cause mortality (HR, 0.49; 95% CI: 0.38–0.63), malignant neoplasm mortality (HR, 0.30; 95% CI: 0.17–0.52), and albumin-creatinine ratio (OR, −0.27; 95% CI: −0.39 to −0.15). Sedentary time was significantly associated with all-cause mortality (HR, 1.12; 95% CI: 1.08–1.15), heart disease mortality (HR, 1.13; 95% CI: 1.08–1.19), and eGFR (OR, −0.49; 95% CI: −0.72 to −0.26). Conclusions: Favorable trends were observed in adherence to the PAG and sedentary time. Adherence to the PAG and reduction in sedentary time reduced all-cause and cause-specific mortality and prevented disease progression differently. Efforts are needed to decrease sedentary time rather than adhering to the PAG for aerobic activity alone.

研究背景：本研究旨在分析美国成人慢性肾脏病（chronic kidney disease, CKD）群体中，有氧运动相关身体活动指南（Physical Activity Guidelines, PAG）依从性与久坐时长的变化趋势，及其对死亡率与疾病进展的影响。
研究方法：本研究纳入2007–2008年至2017–2018年美国国家健康与营养调查（National Health and Nutrition Examination Survey）中关联2015年死亡随访数据的受试者。采用多变量回归模型，评估PAG依从性、久坐时长与死亡率、估算肾小球滤过率（estimated glomerular filtration rate, eGFR）、尿白蛋白-肌酐比之间的关联。
研究结果：针对慢性肾脏病群体，PAG依从率从2007–2008年的48.2%升至2017–2018年的55.0%；久坐时长在2013–2014年达到峰值（7.5小时/天），随后逐步下降。非慢性肾脏病群体与慢性肾脏病群体的变化趋势无显著差异。在慢性肾脏病群体中，PAG依从性与全因死亡率（风险比，Hazard Ratio, HR=0.49；95%置信区间，Confidence Interval, CI: 0.38–0.63）、恶性肿瘤死亡率（HR=0.30；95%CI: 0.17–0.52）及尿白蛋白-肌酐比（比值比，Odds Ratio, OR=-0.27；95%CI: -0.39至-0.15）显著相关。久坐时长则与全因死亡率（HR=1.12；95%CI:1.08–1.15）、心脏病死亡率（HR=1.13；95%CI:1.08–1.19）及估算肾小球滤过率（OR=-0.49；95%CI: -0.72至-0.26）显著相关。
研究结论：慢性肾脏病群体的PAG依从性与久坐时长均呈现向好的变化趋势。遵循PAG与减少久坐时长可降低全因死亡率与特定病因死亡率，并以不同模式延缓疾病进展。未来仍需着力减少久坐时长，而非仅关注有氧运动的PAG依从性。