Does adherence to Canadian 24-Hour Movement Guidelines reduce all-cause mortality in patients with chronic kidney disease?

Patients with chronic kidney disease (CKD) are at an increased risk of mortality. Whether adherence to the Canadian 24-Hour Movement Guidelines, which integrate moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB), and sleep time (ST), is associated with improved survival in this population remains unclear. We analyzed 5578 adults with CKD from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 linked to National Death Index mortality data through 2019. Adherence to guideline components was assessed using self-reported measures. Multivariable Cox proportional hazards models were used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI) for all-cause mortality. Meeting the MVPA or SB recommendations individually was associated with lower all-cause mortality (MVPA: HR = 0.48; SB: HR = 0.75), whereas meeting the sleep recommendation alone was not significantly associated with mortality. Greater benefits were observed for combined adherence to guideline components (MVPA + SB: HR = 0.47; MVPA + ST: HR = 0.42; SB + ST: HR = 0.67; all 3 components: HR = 0.45). Sex-stratified analyses demonstrated significant survival benefits in both men and women. Age-stratified analyses showed a more pronounced survival advantage among participants aged ≥65 years, whereas associations were weaker and generally not statistically significant among those aged <65 years. Among adults with CKD, adherence to the Canadian 24-Hour Movement Guidelines was associated with lower all-cause mortality, particularly among older adults (≥65 years). Promoting a combination of adequate physical activity, reduced sedentary behavior, and healthy sleep may have important implications for improving survival in this high-risk population.