@article{b184ff7f0d5146d5946711c70f55c399,
title = "CKD Self-management: Phenotypes and Associations With Clinical Outcomes",
abstract = "Background: To slow chronic kidney disease (CKD) progression and its complications, patients need to engage in self-management behaviors. The objective of this study was to classify CKD self-management behaviors into phenotypes and assess the association of these phenotypes with clinical outcomes. Study Design: Prospective cohort study. Setting & Participants: Adults with mild to moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. 3,939 participants in the CRIC Study recruited between 2003 and 2008 served as the derivation cohort and 1,560 participants recruited between 2013 and 2015 served as the validation cohort. Predictors: CKD self-management behavior phenotypes. Outcomes: CKD progression, atherosclerotic events, heart failure events, death from any cause. Measurements: Latent class analysis stratified by diabetes was used to identify CKD self-management phenotypes based on measures of body mass index, diet, physical activity, blood pressure, smoking status, and hemoglobin A1c concentration (if diabetic); Cox proportional hazards models. Results: 3 identified phenotypes varied according to the extent of implementation of recommended CKD self-management behaviors: phenotype I characterized study participants with the most recommended behaviors; phenotype II, participants with a mixture of recommended and not recommended behaviors; and phenotype III, participants with minimal recommended behaviors. In multivariable-adjusted models for those with and without diabetes, phenotype III was strongly associated with CKD progression (HRs of 1.82 and 1.49), death (HRs of 1.95 and 4.14), and atherosclerotic events (HRs of 2.54 and 1.90; each P < 0.05). Phenotype II was associated with atherosclerotic events and death among those with and without diabetes. Limitations: No consensus definition of CKD self-management; limited to baseline behavior data. Conclusions: There are potentially 3 CKD self-management behavior phenotypes that distinguish risk for clinical outcomes. These phenotypes may inform the development of studies and guidelines regarding optimal self-management.",
keywords = "CKD progression: cardiovascular outcomes, Chronic renal failure, all-cause death, atherosclerotic events, blood pressure control, chronic kidney disease (CKD), diabetes, healthy behaviors, heart failure, modifiable risk factors, patient engagement, self-care, self-management, smoking",
author = "{CRIC Study Investigators} and Schrauben, {Sarah J.} and Hsu, {Jesse Y.} and Rosas, {Sylvia E.} and Jaar, {Bernard G.} and Xiaoming Zhang and Rajat Deo and Georges Saab and Jing Chen and Swati Lederer and Radhika Kanthety and Hamm, {L. Lee} and Ricardo, {Ana C.} and Lash, {James P.} and Feldman, {Harold I.} and Anderson, {Amanda H.} and Appel, {Lawrence J.} and Go, {Alan S.} and Jiang He and Kusek, {John W.} and Rao, {Panduranga S.} and Mahboob Rahman and Townsend, {Raymond R.}",
note = "Funding Information: Support: Dr Schrauben was supported by training grants from the National Institutes of Health (NIH): T32-DK07785 and F32-DK113681-01A1. Funding for the CRIC Study was obtained under a cooperative agreement from the 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 Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award (CTSA) NIH/National Center for Advancing Translational Sciences (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 NCATS component of the NIH 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, and Kaiser Permanente NIH/National Center for Research Resources UCSF-CTSI UL1 RR-024131. The funding for the CRIC Study supported the collection of the data that were analyzed for this study. The funders of this study had no role in the study design, analysis and interpretation of the data, writing the manuscript, or the decision to submit for publication. Funding Information: Support: Dr Schrauben was supported by training grants from the National Institutes of Health (NIH): T32-DK07785 and F32-DK113681-01A1 . Funding for the CRIC Study was obtained under a cooperative agreement from the 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 Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award (CTSA) NIH/National Center for Advancing Translational Sciences (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 NCATS component of the NIH 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, and Kaiser Permanente NIH/National Center for Research Resources UCSF-CTSI UL1 RR-024131. The funding for the CRIC Study supported the collection of the data that were analyzed for this study. The funders of this study had no role in the study design, analysis and interpretation of the data, writing the manuscript, or the decision to submit for publication. Publisher Copyright: {\textcopyright} 2018 National Kidney Foundation, Inc.",
year = "2018",
month = sep,
doi = "10.1053/j.ajkd.2018.01.047",
language = "English (US)",
volume = "72",
pages = "360--370",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "3",
}