Recent study findings add to evidence favoring healthy lifestyle behaviors for patients with chronic kidney disease (CKD), but also raise some new questions. A healthy lifestyle has been linked to lower risks of heart attack, stroke, and other ailments in the general population, but less is known about how it influences outcomes in CKD patients.

Ana C. Ricardo, MD, of the University of Illinois at Chicago, and colleagues assessed adherence to 4 healthy lifestyle factors—regular physical activity, body mass index (BMI) 20.0 to  24.9 kg/m2 (normal weight), smoking abstinence, and a healthy diet—using baseline data for 3,006 adults with mild to moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. The investigators compared these lifestyle factors to outcomes 4 years later.

According to results published online ahead of print in the American Journal of Kidney Diseases, adhering to all 4 healthy behaviors was associated with a 68% lower risk of early death from all causes.

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Regular physical activity and smoking abstinence were also specifically linked with reduced odds of early death. In addition, not smoking was associated with decreased risks of kidney disease progression and cardiovascular events such as heart attack and stroke.

Paradoxically, higher BMI was linked to better outcomes.  Investigators found reduced risks of renal and cardiovascular events for BMI 25 kg/m2 and above ( overweight) and early death for BMI 30 kg/m2 and above. In contrast, a BMI below 20 kg/m2 ( underweight) was linked to double the risk of premature death from all causes.

“The current findings emphasize the need for further research to evaluate the relationship between BMI and outcomes in patients with CKD and determine what represents an ideal BMI for this population,” the researchers wrote.

Notably, no results specifically favored a healthy diet possibly due to the criteria used. Future studies could examine diet in greater detail, the researchers suggested. 


  1. Ricardo, et al. Am J Kidney Dis. 2014; doi: 10.1053/j.ajkd.2014.0916