Associations Between Life's Essential 8 and Chronic Kidney Disease

Abstract

Background: Chronic kidney disease (CKD) is closely associated with cardiovascular disease. We aimed to examine the association of Life's Essential 8 (LE8), the recently updated measurement of cardiovascular health, with the prevalence of CKD among US adults.

Methods and results: This population-based cross-sectional study used data from the National Health and Nutrition Examination Survey from 2007 to 2018 and included adults aged ≥20 years. Multivariable logistic and restricted cubic spline models were used to assess the associations between LE8 and CKD. Among 24 960 participants, 4437 were determined to have CKD (weighted percentage, 14.11%). After the adjustment of potential confounders, higher LE8 scores were associated with reduced odds of CKD (odds ratio for each 10-point increase, 0.79 [95% CI, 0.76-0.83]), and a nonlinear dose-response relationship was observed. Similar patterns were also identified in the associations of health behavior and health factor scores with CKD. Meanwhile, higher scores for blood glucose (odds ratio, for each 10-point increase, 0.88 [95% CI, 0.87-0.90]) and blood pressure (odds ratio, for each 10-point increase, 0.92 [95% CI, 0.91-0.94]) in the LE8 component are significantly associated with a lower prevalence of CKD. The inversed association of LE8 score and CKD was significantly stronger among middle-aged, male, and coupled participants.

Conclusions: LE8 was negatively associated with the prevalence of CKD in a nonlinear fashion. Promoting adherence to optimal cardiovascular health levels may be beneficial to reduce the burden of CKD.

Keywords: Life's essential 8; NHANES; cardiovascular health; chronic kidney disease.

Figure 1. Age‐adjusted prevalence of CKD in different levels of LE8 scores.

Numbers at the top of the bars represent the weighted percentage. Bar whiskers represent the SE. CKD indicates chronic kidney disease; and LE8, Life's Essential 8.

Figure 2. The nonlinear associations between LE8 and its subscales with CKD.

Dose–response relationships between LE 8 score (A), health behaviors score (B), health factors score (C), and CKD. ORs (solid lines) and 95% CIs (shaded areas) were adjusted for age (as a continuous variable), sex, race and ethnicity, poverty ratio (as a continuous variable), education levels, and marital status. Vertical dotted lines indicate the minimal threshold for the beneficial association with estimated OR of 1. CKD indicates chronic kidney disease; LE8, Life's Essential 8; and OR, odds ratio.

Figure 3. Subgroup analysis of the association of LE8 scores and the presence of CKD.

OR was calculated as per 10‐point increase in LE8 score. Each stratification was adjusted for age (as a continuous variable), sex, race and ethnicity, poverty ratio (as a continuous variable), education levels, and marital status. CKD indicates chronic kidney disease; LE8, Life's Essential 8; and OR, odds ratio.