Physical activity attenuates mortality risk associated with elevated resting heart rate in chronic kidney disease

The independent and combined associations of resting heart rate (RHR) and physical activity (PA) with mortality in diverse chronic kidney disease (CKD) populations remain unclear. We analyzed 12,042 patients from three cohorts using Cox regression, restricted cubic splines, joint-effect, mediation, and meta-analytic approaches. Elevated RHR was associated with increased risks of all-cause and cardiovascular mortality, whereas higher PA levels showed consistent protective associations across cohorts. Combined analyses demonstrated that high RHR with low PA was associated with the greatest mortality risk, while high PA attenuated the adverse association of elevated RHR with mortality. Mediation analyses suggested that RHR partially contributed to the association between PA and mortality. RHR and PA are independent and modifiable risk markers for mortality in patients with CKD. Promoting PA and monitoring RHR should be integrated into CKD management to improve survival.