Cardiovascular-kidney-metabolic syndrome (CKM) and chronic kidney disease (CKD) exhibit bidirectional associations. Limited research has explored the relationship between physical activity patterns and CKD risk among middle-aged and older adult participants with stage 1 CKM.

This longitudinal analysis used China Health and Retirement Longitudinal Study (CHARLS) data from 2015, 2018, and 2020, including 2569 participants with stage 1 CKM. Physical activity was assessed using the International Physical Activity Questionnaire with Metabolic Equivalent of Task (MET) calculations. A Latent Class Growth Model was constructed to examine patterns in physical activity across follow-up points. Restricted Cubic Spline analysis examined nonlinear associations between MET and CKD risk, while a Generalized Linear Model evaluated associations between physical activity patterns and CKD incidence.

The CKM stage 1 participants’ mean [SD] age was 59 [ 8Department of Medical Administration National Health Commission of the People's Republic of China. Chinese clinical practice guideline for obesity (2024 edition) PUMCH Journal 2025 ;  16 (1) : 90-10810.12290/xhyxzz.2024-0918

Cliccare qui per andare alla sezione Riferimenti ] years, 69% (1766/2569) were female, and 59% (1518/2569) had low educational attainment. During the 5-year follow-up, 55% (1415/2569) of participants progressed to CKD. Two physical activity patterns were identified: a high-level parabolic physical activity pattern (HPPA; n = 428) and a low-level continuously decreasing physical activity pattern (LCDPA; n = 2,167). Significant nonlinear associations existed between physical activity levels and CKD risk. CKD risk was significantly reduced when weekly physical activity reached 2613 MET at baseline, 3066 MET at 3 years, and 5907 MET at 5 years (all P < 0.001). Compared with LCDPA, HPPA significantly reduced CKD risk (OR = 0.18; 95% CI, 0.13-0.24; P < 0.001), with consistent protective effects across all subgroups.

Physical activity in stage 1 CKM participants is nonlinearly associated with CKD risk. Maintaining specific MET thresholds at diagnosis, 3 years, and 5 years post-diagnosis significantly reduced CKD incidence. HPPA significantly reduced CKD risk compared to LCDPA, and suggests that encouraging higher sustained physical activity could be valuable for CKD prevention in this population.

This study used data from the China Health and Retirement Longitudinal Study (CHARLS), publicly available at charls.pku.edu.cn (registration required). The processed datasets and analysis code are openly available in the Zenodo repository: 17840857 (10.5281/zenodo.17840857).