Health Behaviors in Younger and Older Adults With CKD: Results From the CRIC Study

CRIC Study Investigators

doi:10.1016/j.ekir.2018.09.003

Health Behaviors in Younger and Older Adults With CKD: Results From the CRIC Study

CRIC Study Investigators

Medicine, Nephrology Division

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

Abstract

Introduction: A cornerstone of kidney disease management is participation in guideline-recommended health behaviors. However, the relationship of these health behaviors with outcomes, and the identification of barriers to health behavior engagement, have not been described among younger and older adults with chronic kidney disease. Methods: Data from a cohort study of 5499 individuals with chronic kidney disease was used to identify health behavior patterns with latent class analysis stratified by age <65 and ≥65 years. Cox models, stratified by diabetes, assessed the association of health behavior patterns with chronic kidney disease (CKD) progression, atherosclerotic events, and death. Logistic regression was used to assess for barriers to health behavior engagement. Results: Three health behavior patterns were identified: 1 “healthy” pattern, and 2 “less healthy” patterns comprising 1 pattern with more obesity and sedentary activity and 1 with more smoking and less obesity. Less healthy patterns were associated with an increased hazard of poor outcomes. Among participants <65 years of age, the less healthy patterns (vs. healthy pattern) was associated with an increased hazard of death in diabetic individuals (hazard ratio [HR] = 2.17, 95% confidence interval [CI] = 1.09–4.29; and HR = 2.50, 95% CI = 1.39–4.50) and cardiovascular events among nondiabetic individuals (HR = 1.49, 95% CI = 1.04–2.43; and HR = 2.97, 95% CI = 1.49–5.90). Individuals with the more obese/sedentary pattern had an increased risk of CKD progression in those who were diabetic (HR = 1.34, 95% CI = 1.13–1.59). Among older adults, the less healthy patterns were associated with increased risk of death (HR = 2.97, 95% CI = 1.43–6.19; and HR = 3.47, 95% CI = 1.48–8.11) in those who were nondiabetic. Potential barriers to recommended health behaviors include lower health literacy and self-efficacy. Conclusion: Identifying health behavior patterns and barriers may help target high-risk groups for strategies to increase participation in health behaviors.

Original language	English (US)
Pages (from-to)	80-93
Number of pages	14
Journal	Kidney International Reports
Volume	4
Issue number	1
DOIs	https://doi.org/10.1016/j.ekir.2018.09.003
State	Published - Jan 2019

Funding

SJS was supported by a training grant from the National Institutes of Health (NIH): F32-DK113681-01A1 . ACR was supported by NIH/NIDDK K23DK094829 . JWN was supported by NIH/NIDDK K23 DK097183, R01 DK115844 . AHA was supported by NIH/NIDDK R01DK107566 and R01 DK104730 . Funding for the CRIC Study was obtained under a cooperative agreement from National Institute of Diabetes and Digestive and Kidney Diseases (U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902). In addition, this work was supported in part by the following: the Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award NIH/NCATS UL1TR000003, Johns Hopkins University UL1 TR-000424, University of Maryland GCRC M01 RR-16500, Clinical and Translational Science Collaborative of Cleveland, UL1TR000439 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research, Michigan Institute for Clinical and Health Research (MICHR) UL1TR000433, University of Illinois at Chicago CTSA UL1RR029879, Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases P20 GM109036, Kaiser Permanente NIH/NCRR UCSF-CTSI UL1 RR-024131. The funding for the CRIC Study supported the collection of the data that was analyzed for this study. The funders had no role in the study design, analysis and interpretation of the data, writing the manuscript, or the decision to submit for publication. AHA declares lecture fees from Kyowa Hakko Kirin. MW declares consulting fees from Akebia, Amag, Amgen, Ardelyx, Diasorin, Keryx, and grant support from Shire. All the other authors declared no competing interests.

Keywords

CKD progression
all-cause death cardiovascular outcomes
chronic renal failure
chronic renal insufficiency
health behavior
self-management

ASJC Scopus subject areas

Nephrology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ekir.2018.09.003

Cite this

@article{fcee6b4403d746acab5f85a217a60b2e,

title = "Health Behaviors in Younger and Older Adults With CKD: Results From the CRIC Study",

abstract = "Introduction: A cornerstone of kidney disease management is participation in guideline-recommended health behaviors. However, the relationship of these health behaviors with outcomes, and the identification of barriers to health behavior engagement, have not been described among younger and older adults with chronic kidney disease. Methods: Data from a cohort study of 5499 individuals with chronic kidney disease was used to identify health behavior patterns with latent class analysis stratified by age <65 and ≥65 years. Cox models, stratified by diabetes, assessed the association of health behavior patterns with chronic kidney disease (CKD) progression, atherosclerotic events, and death. Logistic regression was used to assess for barriers to health behavior engagement. Results: Three health behavior patterns were identified: 1 “healthy” pattern, and 2 “less healthy” patterns comprising 1 pattern with more obesity and sedentary activity and 1 with more smoking and less obesity. Less healthy patterns were associated with an increased hazard of poor outcomes. Among participants <65 years of age, the less healthy patterns (vs. healthy pattern) was associated with an increased hazard of death in diabetic individuals (hazard ratio [HR] = 2.17, 95% confidence interval [CI] = 1.09–4.29; and HR = 2.50, 95% CI = 1.39–4.50) and cardiovascular events among nondiabetic individuals (HR = 1.49, 95% CI = 1.04–2.43; and HR = 2.97, 95% CI = 1.49–5.90). Individuals with the more obese/sedentary pattern had an increased risk of CKD progression in those who were diabetic (HR = 1.34, 95% CI = 1.13–1.59). Among older adults, the less healthy patterns were associated with increased risk of death (HR = 2.97, 95% CI = 1.43–6.19; and HR = 3.47, 95% CI = 1.48–8.11) in those who were nondiabetic. Potential barriers to recommended health behaviors include lower health literacy and self-efficacy. Conclusion: Identifying health behavior patterns and barriers may help target high-risk groups for strategies to increase participation in health behaviors.",

keywords = "CKD progression, all-cause death cardiovascular outcomes, chronic renal failure, chronic renal insufficiency, health behavior, self-management",

author = "{CRIC Study Investigators} and Schrauben, {Sarah J.} and Hsu, {Jesse Y.} and {Wright Nunes}, Julie and Fischer, {Michael J.} and Anand Srivastava and Jing Chen and Jeanne Charleston and Susan Steigerwalt and Tan, {Thida C.} and Fink, {Jeffrey C.} and Ricardo, {Ana C.} and Lash, {James P.} and Myles Wolf and Feldman, {Harold I.} and Anderson, {Amanda H.} and Appel, {Lawrence J.} and Go, {Alan S.} and Jian He and Kusek, {John W.} and Rao, {Panduranga S.} and Mahboob Rahman and Townsend, {Raymond R.}",

note = "Publisher Copyright: {\textcopyright} 2018 International Society of Nephrology",

year = "2019",

month = jan,

doi = "10.1016/j.ekir.2018.09.003",

language = "English (US)",

volume = "4",

pages = "80--93",

journal = "Kidney International Reports",

issn = "2468-0249",

publisher = "Elsevier Inc.",

number = "1",

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TY - JOUR

T1 - Health Behaviors in Younger and Older Adults With CKD

T2 - Results From the CRIC Study

AU - CRIC Study Investigators

AU - Schrauben, Sarah J.

AU - Hsu, Jesse Y.

AU - Wright Nunes, Julie

AU - Fischer, Michael J.

AU - Srivastava, Anand

AU - Chen, Jing

AU - Charleston, Jeanne

AU - Steigerwalt, Susan

AU - Tan, Thida C.

AU - Fink, Jeffrey C.

AU - Ricardo, Ana C.

AU - Lash, James P.

AU - Wolf, Myles

AU - Feldman, Harold I.

AU - Anderson, Amanda H.

AU - Appel, Lawrence J.

AU - Go, Alan S.

AU - He, Jian

AU - Kusek, John W.

AU - Rao, Panduranga S.

AU - Rahman, Mahboob

AU - Townsend, Raymond R.

PY - 2019/1

Y1 - 2019/1

N2 - Introduction: A cornerstone of kidney disease management is participation in guideline-recommended health behaviors. However, the relationship of these health behaviors with outcomes, and the identification of barriers to health behavior engagement, have not been described among younger and older adults with chronic kidney disease. Methods: Data from a cohort study of 5499 individuals with chronic kidney disease was used to identify health behavior patterns with latent class analysis stratified by age <65 and ≥65 years. Cox models, stratified by diabetes, assessed the association of health behavior patterns with chronic kidney disease (CKD) progression, atherosclerotic events, and death. Logistic regression was used to assess for barriers to health behavior engagement. Results: Three health behavior patterns were identified: 1 “healthy” pattern, and 2 “less healthy” patterns comprising 1 pattern with more obesity and sedentary activity and 1 with more smoking and less obesity. Less healthy patterns were associated with an increased hazard of poor outcomes. Among participants <65 years of age, the less healthy patterns (vs. healthy pattern) was associated with an increased hazard of death in diabetic individuals (hazard ratio [HR] = 2.17, 95% confidence interval [CI] = 1.09–4.29; and HR = 2.50, 95% CI = 1.39–4.50) and cardiovascular events among nondiabetic individuals (HR = 1.49, 95% CI = 1.04–2.43; and HR = 2.97, 95% CI = 1.49–5.90). Individuals with the more obese/sedentary pattern had an increased risk of CKD progression in those who were diabetic (HR = 1.34, 95% CI = 1.13–1.59). Among older adults, the less healthy patterns were associated with increased risk of death (HR = 2.97, 95% CI = 1.43–6.19; and HR = 3.47, 95% CI = 1.48–8.11) in those who were nondiabetic. Potential barriers to recommended health behaviors include lower health literacy and self-efficacy. Conclusion: Identifying health behavior patterns and barriers may help target high-risk groups for strategies to increase participation in health behaviors.

AB - Introduction: A cornerstone of kidney disease management is participation in guideline-recommended health behaviors. However, the relationship of these health behaviors with outcomes, and the identification of barriers to health behavior engagement, have not been described among younger and older adults with chronic kidney disease. Methods: Data from a cohort study of 5499 individuals with chronic kidney disease was used to identify health behavior patterns with latent class analysis stratified by age <65 and ≥65 years. Cox models, stratified by diabetes, assessed the association of health behavior patterns with chronic kidney disease (CKD) progression, atherosclerotic events, and death. Logistic regression was used to assess for barriers to health behavior engagement. Results: Three health behavior patterns were identified: 1 “healthy” pattern, and 2 “less healthy” patterns comprising 1 pattern with more obesity and sedentary activity and 1 with more smoking and less obesity. Less healthy patterns were associated with an increased hazard of poor outcomes. Among participants <65 years of age, the less healthy patterns (vs. healthy pattern) was associated with an increased hazard of death in diabetic individuals (hazard ratio [HR] = 2.17, 95% confidence interval [CI] = 1.09–4.29; and HR = 2.50, 95% CI = 1.39–4.50) and cardiovascular events among nondiabetic individuals (HR = 1.49, 95% CI = 1.04–2.43; and HR = 2.97, 95% CI = 1.49–5.90). Individuals with the more obese/sedentary pattern had an increased risk of CKD progression in those who were diabetic (HR = 1.34, 95% CI = 1.13–1.59). Among older adults, the less healthy patterns were associated with increased risk of death (HR = 2.97, 95% CI = 1.43–6.19; and HR = 3.47, 95% CI = 1.48–8.11) in those who were nondiabetic. Potential barriers to recommended health behaviors include lower health literacy and self-efficacy. Conclusion: Identifying health behavior patterns and barriers may help target high-risk groups for strategies to increase participation in health behaviors.

KW - CKD progression

KW - all-cause death cardiovascular outcomes

KW - chronic renal failure

KW - chronic renal insufficiency

KW - health behavior

KW - self-management

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Health Behaviors in Younger and Older Adults With CKD: Results From the CRIC Study

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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