Associations of accelerometer-derived physical activity with chronic kidney disease risk in a population with hypertension: a prospective cohort study

BACKGROUND: Hypertension is a key risk factor for chronic kidney disease (CKD), but evidence on whether physical activity (PA) reduces CKD risk in patients with hypertension remains limited. This study investigates the association between PA intensity and CKD prevention in this high-risk group. METHODS: This prospective cohort study analyzed 37,908 patients with hypertension from the UK Biobank without pre-existing CKD who underwent accelerometer-based PA monitoring between 2013 and 2015. PA was classified into light (LPA), moderate (MPA), and vigorous (VPA) intensities, with weekly duration calculated for each. CKD incidents were determined via hospital admissions and death records. Polygenic risk scores were used to evaluate genetic susceptibility. Cox proportional hazards models and restricted cubic splines were applied to examine associations between PA levels and CKD, adjusting for socioeconomic status, comorbidities, and genetic risk. RESULTS: During the median follow-up period of 7.71 years, 1,131 participants (2.98%) developed CKD. Higher MVPA levels were significantly associated with reduced CKD risk (highest vs. lowest quartile: Hazard Ratio(HR) 0.62, 95% Confidence Interval(CI) 0.50–0.77). Independently, MPA and VPA showed protective associations (highest vs. lowest quartile: HR 0.76, 95% CI 0.50–0.98 and HR 0.68, 95% CI 0.54–0.85, respectively). Of particular note, we found that MPA levels surpassing current guideline recommendations lowered the risk of CKD by 65%(HR 0.35, 95% CI 0.21–0.58) compared with the most inactive group. LPA alone showed no preventive effect on CKD risk. CONCLUSIONS: In patients with hypertension, more MVPA duration rather than LPA could benefit more renal protection. These findings highlight the value of objective PA monitoring and support precise, intensity-specific exercise prescriptions for CKD prevention in populations with hypertension.