Multiple Risk Factors Controlled and Mortality Risks in Chronic Kidney Disease

Introduction: Chronic kidney disease (CKD) is associated with elevated mortality risk. The study aimed to investigate the extent to which multiple risk factors controlled could attenuate CKD-related excess mortality. Methods: The study included 2,394 CKD patients and 15,962 non-CKD individuals from the National Health and Nutrition Examination Survey (NHANES) 2007–2018. Seven modifiable risk factors included blood pressure, body mass index, hemoglobin A1c, non-high-density lipoprotein cholesterol, smoking, physical activity, and diet. CKD patients were categorized by the number of controlled risk factors. Cox models were used to estimate associations between risk factors controlled and risks of all-cause and cause-specific mortality. Results: Among CKD patients, each additional risk factor control was significantly associated with a 19% lower risk of all-cause mortality (HR [hazard ratio]: 0.81; 95% CI [confidence interval]: 0.71–0.93), with the optimal control of 6–7 risk factors associated with a 59% lower risk of all-cause mortality (HR: 0.41; 95% CI: 0.19–0.90). Furthermore, compared with non-CKD individuals (death rate per 1,000 person-years: 2.69 [95% CI: 1.77–4.09]), CKD patients with 6–7 risk factors controlled had no significantly different risks of all-cause mortality (absolute rate difference per 1,000 person-years: 0.79 [95% CI: −2.65, 6.63]; HR: 1.29 [95% CI: 0.62–2.66]), cardiovascular disease mortality (absolute rate difference: 0.27 [95% CI: −0.80, 3.00]; HR: 1.51 [95% CI: 0.43–5.34]), and cancer mortality (absolute rate difference: 0.27 [95% CI: −0.80, 3.00]; HR: 1.06 [95% CI: 0.28–3.96]). Conclusions: Multiple risk factors controlled were associated with reduced CKD-related excess mortality. Optimal control of 6–7 factors was associated with the elimination of increased mortality risks relative to non-CKD individuals. These findings highlight the need for integrated management strategies targeting biological and lifestyle risk factors in CKD populations.