Background: The chronic kidney disease (CKD) epidemic continues to grow, and cardiovascular disease (CVD) is the leading cause of death. To modify CVD risk, CKD patients are asked to engage in health promoting behaviors. However, older patients with CKD likely face challenges to engage in healthy behaviors due to social and health factors. This study examined the relationship of social and health factors to health promoting behaviors among younger and older CKD patients and the association of these behaviors with CVD events, death, and CKD progression.
Methods: Data from the Chronic Renal Insufficiency Cohort (CRIC) Study were analyzed using latent class analysis (LCA) to identify health promoting behavior clusters, stratified by <65 and ≥65 years of age. LCA was based on: BMI of >20 and ≤25kg/m2 vs. other, healthy diet vs. not, physical activity ≥150min/week vs. not, blood pressure ≤140/90mmHg vs. greater, never/past smoker vs. current, and <7.0% hemoglobin A1c vs. greater. Social factors (self-efficacy, social support, education, income, insurance) and health factors (depressive symptoms, cognition, co-morbidities) were measured by validated surveys and self-report. Logistic regression assessed the association of social and health factors to the behavior clusters. Cox proportional hazards models estimated risk of clusters to CVD events (myocardial infarction/revascularization, peripheral arterial disease, or stroke), CKD progression (incident end-stage renal disease or 50% decline in eGFR), and death from any cause.
Results: All social and health factors significantly differed between age groups. Three clusters with varying levels of engagement in health promoting behaviors were identified separately among <65 and ≥65 years of age. Among <65 years, the cluster with the highest level of engagement in healthy behaviors was associated with more self-efficacy and lower depressive symptoms. In this age group, in multivariable adjusted models, the clusters with less healthy behavior engagement had a statistically significant increased risk of CVD events (32-81%), death (29-78%), and CKD progression (32-38%). Among ≥65 years, the cluster with the highest level of engagement in healthy behaviors was associated with higher self-efficacy, social support, cognition, and less depressive symptoms. In this age group, in multivariable adjusted models, the clusters with less healthy behaviors had a statistically significant 49% increased risk of death.
Conclusion: This study demonstrated three clusters of health promoting behaviors that distinguish risk for CVD and other outcomes among older and younger CKD patients. These clusters could identify high-risk groups and be targeted for aggressive management. Clusters with less health promoting behaviors were associated with self-efficacy and depressive symptoms, which could serve as potential targets for intervention.