Relationship Between Baseline and Longitudinal Self-Reported Physical Function and Cardiorenal Outcomes in CKD: Findings From the CRIC Study

Source Article

Rationale & Objective

Physical function is essential for independent living and good health. The trajectory of physical function and its association with important clinical outcomes is understudied in chronic kidney disease (CKD). We describe the associations of baseline and longitudinal self-reported physical function with cardiorenal outcomes among individuals with CKD.

Study Design

Prospective cohort study.

Setting & Participants

Participants of the multicenter Chronic Renal Insufficiency Cohort (CRIC) Study.

Exposure

Physical Component Summary (PCS) score and PCS slope.

Outcome

Incident heart failure (HF), incident end-stage kidney disease (ESKD), and all-cause mortality.

Analytical Approach

Multivariable adjusted Cox regression models examined associations of baseline PCS score with outcomes and in separate models assessed associations of PCS slope with outcomes. Effect modification was assessed by age, sex, race, and estimated glomerular fitration rate groups.

Results

Lower baseline PCS scores (per 10 points) were independently associated with higher risks of incident HF (HR, 1.21 [95% CI, 1.11-1.32]) and all-cause mortality (HR 1.21 [95% CI, 1.16-1.26]) but not with incident ESKD (HR, 0.98 [95% CI, 0.93-1.04]). PCS change (per 4 points annually) was also independently associated with higher risks for all 3 outcomes: incident HF (HR, 1.22 [95% CI, 1.05-1.42]), all-cause mortality (HR, 1.22 [95% CI, 1.13-1.32]), and incident ESKD (HR, 1.11 [95% CI, 1.01-1.22]).

Limitations

Residual confounding, selection bias, and linearity assumption.

Conclusions

Among individuals with CKD, baseline self-reported physical function was significantly associated with increased risk of incident HF and mortality after full adjustment. In addition, longitudinal changes in self-reported physical function were associated with incident HF, incident ESKD, and mortality, even after accounting for baseline self-reported physical function. These findings support monitoring for and testing of early interventions to preserve physical function and potentially prevent or delay adverse outcomes.

Plain-Language Summary

People with chronic kidney disease (CKD) often experience a decline in physical function, but it is unclear how the decline impacts important outcomes in CKD. This study explored how both initial physical function and changes over time relate to important outcomes in CKD, including heart failure, kidney failure, and death. We found that people who rated their physical function lower or whose physical function declined over time were more likely to experience heart failure, kidney failure, and death. These patterns held true even after accounting for other heatlh conditions. These findings suggest that early interventions to preserve physical function could potentially prevent or delay these outcomes in patients but should be tested.

Graphical Abstract

This study consisted of a prospective cohort of participants from phase 1 (enrolled 2003-2008) through phase 3 (enrolled 2013-2015) of the Chronic Renal Insufficiency Cohort (CRIC) Study. Briefly, the CRIC Study is a multicenter, prospective, observational cohort study of participants with CKD in the United States established to examine risk factors for kidney and cardiovascular disease (CVD) progression. Details on the study design have been previously published.18,19 Briefly, eligibility for

Baseline Participant Characteristics

Among 5,495 CRIC participants, the mean age was 60 years, 44% were female, 43% self-identified as non-Hispanic Black, and 52% had a history of diabetes. The mean eGFR was 48.1 ± 16.7 mL/min/1.73 m2, with a median (Q1-Q3) proteinuria of 0.2 (0.1-0.9) mg/dL / mg/dL. The overall mean PCS-12 score was 41 ± 12 (SD) (Table S1). A notable proportion of participants reported scores substantially below the population norm of 50, with some values extending more than 3 SD below it (Fig S2).

We summarized

Discussion

In this study of people living with moderate to severe CKD, worse self-reported physical function at baseline was associated with greater risks of both incident HF and all-cause mortality after adjusting for important clinical risk factors, including eGFR and proteinuria. When assessing self-reported physical function longitudinally, participants who had worsening self-reported physical function over time had a significantly higher risk of all 3 cardiorenal outcomes independent of their

Article Information

Authors’ Full Names and Academic Degrees

Vanessa-Giselle Peschard, MD, MSc, MAS, Wei Yang, PhD, Xiaoming Zhang, MS, Michael G. Shlipak, MD, MPH, Rebecca T. Brown, MD, MPH, Navdeep Tangri, MD, PhD, Alfonso Cabrera Lagunes, MD, Mark L. Unruh, MD, MS, Jonathan J. Taliercio, DO, Matthew R. Weir, MD, Hernan Rincon-Choles, MD, MBA, Jiang He, MD, MS, PhD, Jing Chen, MD, Manjula Kurella Tamura, MD, MPH, James P. Lash, MD, and Sarah J. Schrauben, MD, MS.

Authors’ Contributions

Research idea and study design: WY, SJS; data acquisition: ACL, MU, JT, MW, HR-C, JH, JC,

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