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