Lifestyle changes and kidney function: A 10-year follow-up study in patients with manifest cardiovascular disease

Helena Bleken Østergaard, Imre Demirhan, Jan Westerink, Marianne C. Verhaar, Folkert W. Asselbergs, Gert J. de Borst, L. Jaap Kappelle, Frank L. J. Visseren, Joep van der Leeuw, the UCC-SMART studygroup

Published: 2022



Patients with cardiovascular disease (CVD) are at higher risk of kidney function decline. The current study aimed to examine the association of lifestyle changes with kidney function decline in patients with manifest CVD.


A total of 2260 patients from the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease cohort with manifest CVD who returned for a follow-up visit after a median of 9.9 years were included. The relation between change in lifestyle factors (smoking, alcohol consumption, physical activity and obesity) and change in kidney function (eGFR and uACR) was assessed using linear regression models.


An increase in body mass index (β −2.81; 95% CI −3.98; −1.63 per 5 kg/m2) and for men also an increase in waist circumference (β −0.87; 95% CI −1.28; −0.47 per 5 cm) were significantly associated with a steeper decline in eGFR over 10 years. Continuing smoking (β −2.44, 95% CI −4.43; −0.45) and recent smoking cessation during follow-up (β −3.27; 95% CI −5.20; −1.34) were both associated with a steeper eGFR decline compared to patients who remained as non- or previous smokers from baseline. No significant association was observed between physical exercise or alcohol consumption and kidney function decline. No significant relation between any lifestyle factor and change in uACR was observed.


In patients with CVD, continuing smoking, recent smoking cessation and an increase in obesity markers were related to a steeper kidney function decline. Although no definite conclusions from this study can be drawn, the results support the importance of encouraging weight loss and smoking cessation in high-risk patients as a means of slowing down kidney function decline.

Full Access Link: European Journal of Clinical Investigation