Association between questionnaire-based and accelerometer-based physical activity and the incidence of chronic kidney disease using data from UK Biobank: a prospective cohort study

Abstract

Background: Prior studies on the relationship between chronic kidney disease (CKD) and physical activity (PA) mainly relied on subjective PA data and rarely considered the genetic risk. This study aims to thoroughly investigate this relationship by utilizing both accelerometer-measured and questionnaire-measured PA data.

Methods: This prospective cohort study encompasses two cohorts from the UK Biobank. The questionnaire-based cohort involves 448,444 CKD-free participants who completed an International Physical Activity Questionnaire between 2006 and 2010 and had genetic data. PA was categorized into distinct activities: leisure, housework, job-related, and transportation. The accelerometer-based cohort involves 89,296 CKD-free participants who provided a full week of accelerometer-based physical activity data between 2013 and 2015 and had genetic data. PA was classified as light-intensity, moderate-intensity, vigorous-intensity, moderate to vigorous-intensity PA (LPA, MPA, VPA, MVPA), and total PA. Incident CKD was ascertained from linked hospital inpatient and death records. Genetic risk was assessed using polygenic risk scores. Cox proportional hazard models with restricted cubic splines were used for the analysis.

Findings: In the questionnaire-based cohort, 18,184 (4.05%) participants developed CKD during 13.6 years of follow-up. Engaging in strenuous sports, other exercises, walking for pleasure, stair climbing, and heavy DIY were associated with a reduced risk of CKD. In the accelerometer-based cohort, 2297 (2.57%) participants developed CKD during 7.9 years of follow-up. Higher levels [highest quartile vs lowest quartile] of MPA (HR 0.639, 95% CI 0.554-0.737), VPA (HR 0.639, 95% CI 0.549-0.745), MVPA (HR 0.630, 95% CI 0.545-0.729), and total PA (HR 0.649, 95% CI 0.563-0.750) were associated with a lower CKD risk. There were significant interactions between MPA and genetic risk on the risk of CKD incidence (P for interaction = 0.025). A linear dose-response relationship was observed between MPA, total PA, and the risk of CKD incidence with no minimal or maximal threshold. These associations are robust in different subgroups and a series of sensitivity analyses.

Interpretation: Engaging in multiple types of PA and higher levels of total PA, MPA, VPA, and MVPA may be associated with a lower risk of developing CKD, regardless of genetic risk. This finding holds substantial implications for clinical approaches to CKD prevention and provides evidence to inform future PA guideline development.

Funding: Medical Science Advancement Program of Wuhan University, and the National Science Foundation of China.

Keywords: Accelerometer; Chronic kidney disease; Physical activity; Questionnaire.

Fig. 1

The flow chart of participants through the study.

Fig. 2

HRs for the associations between all questionnaire-based physical activity items and CKD incidence. All adjusted for sex, age at enrollment, genetic ethic group, recruitment centre, cigarette smoking, alcohol consumption, Townsend deprivation index, education level, diet ideal or poor, BMI categories, history of diabetes, history of hypertension, history of CVD, baseline eGFR, genetic risk, genetic ethnic group, and first 10 principal components of ancestry. All P values were corrected using the FDR via the Benjamin-Hochberg method, and a P value of less than 0.05 was regarded as statistically significant. HR, hazard ratio; CI, confidence interval; CKD, chronic kidney disease; Ref, reference; FDR, False Discovery Rate.

Fig. 3

Risk of incident CKD by quarters of accelerometer-measured average total volume, moderate-intensity, vigorous-intensity, and moderate-to vigorous-intensity physical activities in 89,296 UK Biobank participants. All adjusted for sex, age at accelerometer measurement, recruitment centre, season of accelerometer wear, cigarette smoking, alcohol consumption, Townsend deprivation index, education level, diet ideal or poor, BMI categories, history of diabetes, history of hypertension, history of CVD, baseline eGFR, genetic ethnic group, genetic risk, and first 10 principal components of ancestry. All P values were corrected via the FDR by using the Benjamin-Hochberg method. HR: hazard ratio; CI, confidence interval; CKD, chronic kidney disease; MET, metabolic equivalent of task; MPA, moderate-intensity physical activity; MVPA, moderate-to vigorous-intensity physical activity; PA, physical activity; VPA, vigorous-intensity physical activity; Ref, reference; FDR, False Discovery Rate.

Fig. 4

Restricted cubic spline for the association between accelerometer-measured average total volume, moderate-intensity, vigorous-intensity, and moderate-to vigorous-intensity physical activities and the risk of CKD incidence. All adjusted for sex, age at accelerometer measurement, recruitment centre, season of accelerometer wear, cigarette smoking, alcohol consumption, Townsend deprivation index, education level, diet ideal or poor, BMI categories, history of diabetes, history of hypertension, history of CVD, baseline eGFR, genetic risk, genetic ethnic group, and first 10 principal components of ancestry. The solid line is the estimate (HR) and the shaded area is the 95% CI. HR indicates hazard ratio; CI, confidence interval; CKD, chronic kidney disease; MET, metabolic equivalent of task; MPA, moderate-intensity physical activity; VPA, vigorous-intensity physical activity; PA, physical activity; MVPA, moderate-to vigorous-intensity physical activity.

Fig. 5

Risk of incident CKD according to genetic and accelerometer-measured average total volume, moderate-intensity, vigorous-intensity, and moderate-to vigorous-intensity physical activities in 89,296 UK Biobank participants. All adjusted for sex, age at accelerometer measurement, recruitment centre, season of accelerometer wear, cigarette smoking, alcohol consumption, Townsend deprivation index, education level, diet ideal or poor, BMI categories, history of diabetes, history of hypertension, history of CVD, baseline eGFR, genetic ethnic group, and first 10 principal components of ancestry. P values were corrected via the FDR by using the Benjamin-Hochberg method. HR, hazard ratio; CI, confidence interval; Q, quartile; CKD, chronic kidney disease; MET, metabolic equivalent of task; MPA, moderate-intensity physical activity; MVPA, moderate-to vigorous-intensity physical activity; PA, physical activity; and VPA, vigorous-intensity physical activity; Ref, reference; FDR, false discovery rate.