Study on the physical activity levels and all-cause mortality risk in diabetic kidney disease patients and mediating effect of inflammation
10.3760/cma.j.cn112338-20240816-00504
- VernacularTitle:糖尿病肾脏病患者体力活动水平与全因死亡风险研究及炎症的中介效应
- Author:
Shuangshuang TIAN
1
;
Fang ZHANG
;
Huiqiang HAO
;
Xiaoshuang ZHOU
Author Information
1. 山西省人民医院肾脏病大数据中心，太原 030012
- Publication Type:Journal Article
- Keywords:
Diabetic kidney disease;
Physical activity;
Inflammation;
Mortality;
Mediation analysis
- From:
Chinese Journal of Epidemiology
2025;46(4):717-723
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the association between physical activity levels and all-cause mortality risk in patients with diabetic kidney disease (DKD) and to investigate the mediating effect of inflammation.Methods:Based on National Health and Nutrition Examination Survey of America data matched with the National Death Index of America, a prospective cohort was formed, including 59 482 participants from six cycles between 2007 and 2018. After applying inclusion and exclusion criteria, 2 214 DKD patients were selected for the study. Cox proportional hazard regression models were used to analyze the impact of physical activity levels on all-cause mortality risk. The mediating effect of inflammatory markers in the association between physical activity and all-cause mortality risk was explored.Results:There were statistically significant differences in survival curves among different physical activity level groups ( P<0.001). As physical activity levels increased, the risk of mortality decreased. Patients in the high physical activity group had a lower mortality risk compared to those in the inactive group ( HR=0.64, 95% CI: 0.53-0.78), with a statistically significant difference ( P<0.001). Patients with higher physical activity levels had lower levels of inflammation (white blood cell, neutrophil, and C-reactive protein) ( P<0.001). White blood cell, neutrophil, C-reactive protein, the neutrophil-to-lymphocyte ratio (NLR), and the systemic inflammation index (SII) were independent risk factors for mortality in DKD patients ( HR>1.00), with higher risk effects observed for the combined indicator lgNLR ( HR=2.06, 95% CI: 1.76-2.41) and lgSII ( HR=1.44, 95% CI: 1.26-1.64). Mediation analysis showed that physical activity had an indirect effect on all-cause mortality risk through neutrophil, with an effect size of -0.033 (95% CI: -0.052 - -0.002), which was statistically significant ( P<0.05), with a mediation effect proportion of 9.75%. Conclusion:Physical activity is a protective factor against all-cause mortality risk in DKD patients, partly through reducing neutrophil levels.
