January 18, 2019
3 min read

Health behavior patterns impact clinical outcomes in patients with CKD

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Different health behavior patterns were associated with specific clinical outcomes in patients with CKD, according to a recently published study.

“We identified three similar patterns of engagement in health behaviors among young and older adults with CKD that varied in association with clinical outcomes,” Sarah J. Schrauben, MD, of the Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine and the division of renal, electrolyte and hypertension at the University of Pennsylvania, and colleagues wrote. “In both age groups, individuals with less healthy behavior patterns had an increased hazard of poor clinical outcomes, but differed depending on diabetes status. Identification of the health behavior patterns and barriers to health behavior engagement may help target high-risk groups for strategies to increase participation in health behaviors.”

To explore the relationship between health behavior patterns and clinical outcomes in kidney disease management, researchers used data from the Chronic Renal Insufficiency Cohort Study, which was a multicenter, prospective observational cohort of 5,499 patients with CKD.

Patients were further grouped by age — younger than 65 years (n = 3,552; mean age, 54 years; 55% men) or older than 65 years (n = 1,947; mean age, 70 years; 42% men) — as well as categorized into one of three health behavior patterns. These patterns included one “healthy” pattern and two “less healthy” patterns, which consisted of one pattern with more obesity and sedentary activity and one with more smoking and less obesity.

After using Cox models, stratified by diabetes, to examine the relationship of these health behavior patterns with CKD progression, atherosclerotic events and death, researchers found an association between the less healthy patterns and an increased hazard of poor outcomes.

For patients younger than 65 years, the less healthy patterns were associated with an increased hazard of death in those with diabetes (HR = 2.17; 95% CI, 1.09-4.29; HR = 2.50; 95% CI, 1.39-4.50), as well as increased cardiovascular events in those without diabetes (HR = 1.49; 95% CI, 1.04-2.43; HR = 2.97; 95% CI, 1.49-5.90). In addition, patients who participated in the more obese/sedentary behavior pattern and had diabetes had an increased risk for CKD progression (HR = 1.34; 95% CI, 1.13-1.59).

For those older than 65 years who did not have diabetes, researchers observed that less healthy patterns were associated with increased risk of death (HR = 2.97; 95% CI, 1.43-6.19; HR = 3.47; 95% CI, 1.48-8.11).

“A logical first step to enhance the ability of individuals with CKD to participate in recommended health behaviors is to address the barriers to behavior engagement,” the researchers wrote. “The more readily modifiable barriers include physical functioning, self-efficacy, social support, health literacy and depressive symptoms, which could serve as potential targets for intervention ... In addition, future directions in CKD management could further explore the role of self-efficacy in the patient-provider relationship as well as conducting randomized clinical trials of health behavior promotion programs, exploring the role of supporting health behaviors to address poor outcomes.”

In a related commentary, Charumathi Sabanayagam, MD, MPH, PhD, of the Singapore Eye Research Institute and Duke-NUS Medical School, and Su Chi Lim, MD, of Khoo Tech Puat Hospital, National Health Group, and the Saw Swee Hock School of Public Health at the National University of Singapore, wrote: “The impact of age- and diabetes-specific behavioral engagement pattern and individual behaviors with outcomes in CKD patients provided by Schrauben and colleagues suggest the potential for tailoring behavioral recommendations specific to subgroups with varying patterns of risk behaviors. For example, blood pressure control could be prioritized for both age groups, whereas increasing physical activity could be an intervention target for persons with diabetes, irrespective of age. Behavioral interventions based on more homogeneous subgroups or risk clusters would be more effective than adopting a ‘one-size-fits-all’ approach in chronic disease management.” – by Melissa J. Webb

Disclosures: Schrauben reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Sabanayagam and Lim report no relevant financial disclosures.