Slaven Anne, Hsu Jesse, Schelling Jeffrey R, Navaneethan Sankar D, Rincon-Choles Hernan, McAdams-DeMarco Mara A, Schachere Marlene, O'Malley Noreen, Deluca Jennifer, Lustigova Eva, Wang Xue, Kusek John, Porter Anna C, Lash James P, Rahman Mahboob, Horwitz Edward
Division of Nephrology and Hypertension, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
Kidney Med. 2021 Jul 19;3(5):776-784.e1. doi: 10.1016/j.xkme.2021.04.025. eCollection 2021 Sep-Oct.
RATIONALE & OBJECTIVE: Social support in older adults with chronic kidney disease (CKD) is a potentially modifiable factor that may affect important clinical outcomes such as health-related quality of life, cognitive function, and frailty. However, limited data about the effects of social support in older patients with non-dialysis-dependent CKD exist. Our objective was to evaluate the association of social support with health-related quality of life, cognitive function, and frailty in older adults with CKD.
Cross-sectional analysis of a prospective cohort study.
SETTING & POPULATION: 1,851 participants older than 65 years with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study.
Social support (Lubben Social Network Scale [LSNS]).
Health-related quality of life (Kidney Disease Quality of Life-36), cognitive function (Modified Mini-Mental State Examination, Trail Making Test A & B, and Buschke Selective Reminder Tests), and frailty (modified Fried frailty criteria).
Multivariable, linear, and logistic regression to determine the association between social support and health-related quality of life, cognitive function, and frailty.
Low social support, defined as LSNS score < 12, was present in 22% of participants. On multivariable analysis, higher social support was associated with higher health-related quality of life (β coefficient per 1-SD increase in LSNS score; burden subscale, 2.57 (95% CI, 1.57-3.56); effects subscale, 2.21 (95% CI, 1.52-2.9); symptoms subscale, 1.64 (95% CI, 0.88-2.41); mental health composite subscale, 1.91 (95% CI, 1.40-2.43); and physical health composite score, 0.64 (95% CI, 0.03-1.24)). Higher social support was associated with better cognitive function (β coefficient per 1-SD increase in LSNS score; Modified Mini-Mental State Examination, 0.81 (95% CI, 0.44 to 1.19); Trail Making Test A & B, -2.53 (95% CI, -4.29 to -0.76) and -6.53 (95% CI, -10.07 to -2.99), respectively; Buschke Selective Reminder Test 1, 2, and 3, 0.19 (95% CI, 0.07 to 0.30); 1.59 (95% CI, 0.96 to 2.22); and 0.40 (95% CI, 0.23 to 0.56), respectively. Higher social support was associated with higher likelihood of being nonfrail (OR, 1.77; 95% CI per 1-SD higher LSNS score, 1.24-2.53).
Conclusions about causality cannot be drawn from an observational cross-sectional study.
In older patients with CKD, higher social support was associated with higher health-related quality of life and cognitive function and less frailty.
慢性肾脏病（CKD）老年患者的社会支持是一个潜在的可改变因素，可能会影响诸如健康相关生活质量、认知功能和衰弱等重要临床结局。然而，关于社会支持对非透析依赖型CKD老年患者影响的数据有限。我们的目的是评估社会支持与CKD老年患者健康相关生活质量、认知功能和衰弱之间的关联。
一项前瞻性队列研究的横断面分析。
1851名年龄大于65岁的CKD患者纳入慢性肾功能不全队列（CRIC）研究。
社会支持（鲁本社会网络量表[LSNS]）。
健康相关生活质量（肾脏病生活质量-36量表）、认知功能（改良简易精神状态检查表、连线测验A和B以及布施克选择性提醒测验）和衰弱（改良弗里德衰弱标准）。
多变量、线性和逻辑回归分析，以确定社会支持与健康相关生活质量、认知功能和衰弱之间的关联。
22%的参与者社会支持水平较低，定义为LSNS得分<12。多变量分析显示，社会支持水平越高，健康相关生活质量越高（LSNS得分每增加1个标准差的β系数；负担子量表，2.57（95%CI，1.57 - 3.56）；影响子量表，2.21（95%CI，1.52 - 2.9）；症状子量表，1.64（95%CI，0.88 - 2.41）；心理健康综合子量表，1.91（95%CI，1.40 - 2.43）；身体健康综合得分，0.64（95%CI，0.03 - 1.24））。社会支持水平越高，认知功能越好（LSNS得分每增加1个标准差的β系数；改良简易精神状态检查表，0.81（95%CI，0.44至1.19）；连线测验A和B，分别为-2.53（95%CI，-4.29至-0.76）和-6.53（95%CI，-10.07至-2.99）；布施克选择性提醒测验1、2和3，分别为0.19（95%CI，0.07至0.30）；1.59（95%CI，0.96至2.22）；和0.40（95%CI，0.23至0.56））。社会支持水平越高，非衰弱的可能性越大（OR，1.77；LSNS得分每增加1个标准差的95%CI，1.24 - 2.53）。
观察性横断面研究无法得出因果关系结论。
在CKD老年患者中，较高的社会支持与较高的健康相关生活质量、较好的认知功能以及较低的衰弱程度相关。
