Social Support in Older Adults With CKD: A Report From the CRIC (Chronic Renal Insufficiency Cohort) Study

Anne Slaven; Jesse Hsu; Jeffrey R Schelling; Sankar D Navaneethan; Hernan Rincon-Choles; Mara A McAdams-DeMarco; Marlene Schachere; Noreen O'Malley; Jennifer Deluca; Eva Lustigova; Xue Wang; John Kusek; Anna C Porter; James P Lash; Mahboob Rahman; Edward Horwitz; CRIC Study investigators

doi:10.1016/j.xkme.2021.04.025

Social Support in Older Adults With CKD: A Report From the CRIC (Chronic Renal Insufficiency Cohort) Study

Kidney Med. 2021 Jul 19;3(5):776-784.e1. doi: 10.1016/j.xkme.2021.04.025. eCollection 2021 Sep-Oct.

Authors

Anne Slaven¹, Jesse Hsu², Jeffrey R Schelling¹, Sankar D Navaneethan³, Hernan Rincon-Choles⁴, Mara A McAdams-DeMarco⁵, Marlene Schachere⁶, Noreen O'Malley⁶, Jennifer Deluca⁷, Eva Lustigova⁸, Xue Wang², John Kusek⁹, Anna C Porter¹⁰, James P Lash¹⁰, Mahboob Rahman¹¹, Edward Horwitz¹; CRIC Study investigators

Affiliations

¹ Division of Nephrology and Hypertension, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
² Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
³ Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
⁴ Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH.
⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
⁶ MetroHealth Medical Center, Cleveland, OH.
⁷ Renaissance Renal Research Institute; Detroit, MI.
⁸ Department of Epidemiology, Tulane University, New Orleans, LA.
⁹ Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
¹⁰ Department of Medicine, University of Illinois at Chicago, Chicago, IL.
¹¹ Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH.

Abstract

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.

Study design: 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.

Exposure: Social support (Lubben Social Network Scale [LSNS]).

Outcomess: 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).

Analytic approach: Multivariable, linear, and logistic regression to determine the association between social support and health-related quality of life, cognitive function, and frailty.

Results: 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).

Limitations: Conclusions about causality cannot be drawn from an observational cross-sectional study.

Conclusions: In older patients with CKD, higher social support was associated with higher health-related quality of life and cognitive function and less frailty.

Keywords: Social support; chronic kidney disease; cognitive function; frailty; quality of life.

Abstract

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