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Kidney Week

Abstract: PO2021

Predictors of Healthy Behavior Engagement in CKD

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Schrauben, Sarah J., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Hsu, Jesse Yenchih, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Wright Nunes, Julie A., University of Michigan, Ann Arbor, Michigan, United States
  • Ricardo, Ana C., University of Illinois at Chicago College of Medicine, Chicago, Illinois, United States
  • Fischer, Michael J., University of Illinois at Chicago College of Medicine, Chicago, Illinois, United States
  • Greer, Raquel C., Johns Hopkins University, Baltimore, Maryland, United States
  • Anderson, Cheryl A., University of California San Diego School of Medicine, San Diego, California, United States
  • Mohanty, Madhumita J., Wayne State University School of Medicine, Detroit, Michigan, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Chen, Jing, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Anderson, Amanda Hyre, Tulane University, New Orleans, Louisiana, United States
  • Dember, Laura M., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Feldman, Harold I., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
Background

Guidelines for chronic kidney disease (CKD) management recommend healthy behaviors to mitigate disease progression, but behavior engagement is low. Identifying predictors of behavior engagement could inform strategies to increase healthy behaviors.

Methods

Using data from the Chronic Renal Insufficiency Cohort Study, potential predictors of behavior engagement included demographics, clinical and psychosocial factors, and behaviors at baseline. We dichotomized behaviors (recommended vs. not): smoking (no vs. current), body mass index (BMI <18.5 or >30 kg/m2), physical activity (>150 vs <150 minutes/week), diet (score of >2 vs 0-1), and hemoglobin A1c (<7 vs >7) if diabetes. Relationships between predictors and behaviors at 2 years were estimated by multivariable adjusted logistic regression models.

Results

Among 5,209 participants at baseline, mean age was 60 years, mean eGFR was 48 ml/min/ml2, and 51% had diabetes. In multivariable analyses, baseline behaviors were most strongly associated with behaviors at 2 years (Table). Higher SF-12 physical component scores, which relate to better physical function and pain control, associated with recommended behaviors at 2 years. In models that did not adjust for baseline behaviors, no smoking was associated with older age, female sex, and non-White race, but the other behavior associations were not notably changed.

Conclusion

Interventions to increase healthy behavior engagement should be implemented and tested to evaluate whether they improve physical function and pain control, and possibly mitigate CKD progression.

Associations with Recommended Behaviors at 2 years. ORs and 95% CI reported.
Predictors^Diet score 2-4 (vs 0-1)BMI 18.5 to <30 kg/m^2 (vs <18.5 or ≥30 kg/m^2)Physical Activity ≥150 minutes/week (vs <150)Non-smoking (vs. current smoking)Hemoglobin A1c <7 (vs. ≥7)
Age (per 10 years)1.16 (1.00-1.34)1.07 (0.92-1.25)1.07 (0.97-1.19)1.05 (0.81-1.36)1.21 (1.02-1.43)
Non-Hispanic Black (vs Non-Hispanic White)1.65 (1.26-2.15)0.71 (0.54-0.94)0.96 (0.81-1.14)0.85 (0.55-1.31)1.01 (0.78-1.31)
Medicaid (vs no insurance)1.08 (0.64-1.82)1.10 (0.60-2.04)0.69 (0.47-1.02)0.39 (0.17-0.90)1.52 (0.86-2.68)
Medicare (vs no insurance)0.67 (0.41-1.10)1.21 (0.68-2.16)0.70 (0.48-1.00)0.77 (0.34-1.75)1.94 (1.13-3.33)
High school or higher (vs less than high school)0.99 (0.68-1.42)0.93 (0.64-1.37)1.35 (1.05-1.74)1.23 (0.73-2.10)0.79 (0.56-1.08)
Diabetes (vs. no diabetes)0.68 (0.52-0.89)0.67 (0.51-0.88)0.86 (0.73-1.03)1.25 (0.81-1.93)---
CKD stage 4-5 (vs stage 1-2)0.83 (0.52-1.33)1.57 (0.96-1.02)0.80 (0.58-1.10)0.96 (0.44-2.09)3.10 (1.94-4.94)
SF-12 Mental Component Summary (per SD)1.03 (0.88-1.20)1.19 (1.02-1.40)1.00 (0.90-1.10)1.33 (1.05-1.68)0.95 (0.82-1.09)
SF-12 Physical Component Summary (per SD)1.06 (0.92-1.21)1.29 (1.12-1.48)1.16 (1.06-1.28)1.30 (1.04-1.63)1.03 (0.91-1.17)
Adequate health literacy (vs inadequate)*0.69 (0.48-0.99)0.86 (0.59-1.25)1.12 (0.87-1.43)0.85 (0.48-1.52)0.99 (0.73-1.36)
Recommended behavior of interest at baseline (vs not recommended)2.76 (2.20-3.46)75.88 (60.50-95.17)3.89 (3.37-4.49)228.30 (154.42-337.53)5.52 (4.44-6.85)
Models adjusted for age, sex, race/ethnicity, education, health insurance, diabetes, Charlson comorbidity index, total medications, CKD stage (1-2, 3, 4-5), duration of CKD awareness, Mini-metal status exam score, SF-12 mental component summary score, SF-12 physical component summary score, Beck’s depressive index, health literacy, and baseline behavior of interest.
*Adequate determined by score of >22 on the Short Test of Functional Health Literacy.
^Predictors not significantly associated: sex, Comorbidity index, total medications, CKD stage 3, duration of CKD awareness, MMSE score, Beck’s depressive index

Funding

  • NIDDK Support