Schrauben Sarah J, Hsu Jesse Y, Wright Nunes Julie, Fischer Michael J, Srivastava Anand, Chen Jing, Charleston Jeanne, Steigerwalt Susan, Tan Thida C, Fink Jeffrey C, Ricardo Ana C, Lash James P, Wolf Myles, Feldman Harold I, Anderson Amanda H
Division of Renal, Electrolyte, and Hypertension, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Kidney Int Rep. 2018 Sep 17;4(1):80-93. doi: 10.1016/j.ekir.2018.09.003. eCollection 2019 Jan.
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.
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.
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.
Identifying health behavior patterns and barriers may help target high-risk groups for strategies to increase participation in health behaviors.
参与指南推荐的健康行为是肾脏疾病管理的基石。然而，在患有慢性肾脏病的年轻人和老年人中，这些健康行为与疾病转归的关系以及参与健康行为的障碍尚未得到描述。
来自一项对5499例慢性肾脏病患者的队列研究的数据，用于通过年龄<65岁和≥65岁分层的潜在类别分析确定健康行为模式。Cox模型按糖尿病分层，评估健康行为模式与慢性肾脏病（CKD）进展、动脉粥样硬化事件和死亡的关联。采用逻辑回归评估参与健康行为的障碍。
确定了三种健康行为模式：1种“健康”模式和2种“不太健康”模式，其中一种模式肥胖和久坐活动较多，另一种模式吸烟较多且肥胖较少。不太健康的模式与不良结局风险增加相关。在年龄<65岁的参与者中，不太健康的模式（与健康模式相比）与糖尿病患者死亡风险增加相关（风险比[HR]=2.17，95%置信区间[CI]=1.09-4.29；HR=2.50，95%CI=1.39-4.50），以及非糖尿病患者心血管事件风险增加相关（HR=1.49，95%CI=1.04-2.43；HR=2.97，95%CI=1.49-5.90）。肥胖/久坐模式较多的个体在糖尿病患者中CKD进展风险增加（HR=1.34，95%CI=1.13-1.59）。在老年人中，不太健康的模式与非糖尿病患者死亡风险增加相关（HR=2.97，95%CI=1.43-6.19；HR=3.47，95%CI=1.48-8.11）。推荐健康行为的潜在障碍包括健康素养和自我效能较低。
识别健康行为模式和障碍可能有助于针对高危人群制定策略，以增加对健康行为的参与度。
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