In 2016, to help achieve the goal of avoiding heart failure and preserving cardiac structure and function, the American Heart Association (AHA) designated Life’s Simple 7 as risk factors that can be addressed through lifestyle changes: smoking, weight, physical activity, diet, cholesterol, blood pressure (BP) , and blood glucose. Although most of these factors are also risk factors for the progression of kidney disease, the association between Life’s Simple 7 and risk of dialysis is unknown. We investigated the impact of 6 factors on the initiation of dialysis based on the AHA’s 7 factors using a nationwide claims database involving 294,647 participants during 2008-16. Multivariate Cox regression model identified risks of starting dialysis. Hazard ratios (HRs) were compared among 7 groups who had 0 to 6 of the following risk factors adjusted by age and sex: BMI ≥25, systolic BP (SBP) ≥140 mmHg, LDL-cholesterol ≥140 mg/dl, diabetes mellitus (DM) , no regular exercise, and smoking. Compared with SBP <140 mmHg, HR for starting dialysis in those with SBP ≥140 mmHg was 3.30 (2.49-4.34) . Compared with DM-, HR for starting dialysis in those with DM+ was 6.50 (4.89-8.65) . In comparison with no risk factors, HRs for starting dialysis for those who had 3, 4, 5, or 6 risk factors were 2.20 (1.17-4.09) , 5.30 (2.80-10.0) , 11.2 (5.47-23.1) , and 32.5 (11.4-92.6) , respectively.

In summary, the risk of dialysis increased with worsening of risk factors derived from AHA’s Life’s Simple 7. These results indicated that factors similar to those used to predict cardiovascular disease might also be useful to predict initiation of dialysis. Use of these approaches might be helpful in clinical practice, especially in patient education.


T.Osawa: None. K.Fujihara: None. M.H.Yamada: None. Y.Yaguchi: None. T.Sato: None. M.Kitazawa: None. Y.Matsubayashi: None. T.Yamada: None. H.Sone: Research Support; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited.


Japan Society for the Promotion of Science (18K17897) .

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at