Baseline Physical Activity Guideline Attainment and Mortality Across Cardiovascular-Kidney-Metabolic Syndrome Stages

Background The 2023 American Heart Association cardiovascular-kidney-metabolic (CKM) staging framework supports risk stratification, but evidence on guideline-level physical activity across stages remains limited. Methods We emulated a target-trial protocol using NHANES 2007-2018 and National Death Index linkage through December 31, 2019. Adults aged 20 to 79 years with CKM stages 1 to 4, estimated glomerular filtration rate of at least 15 mL/min/1.73 m2, complete activity data, no cancer history, and eligible follow-up were included. Baseline activity was classified as meeting or not meeting

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