Self-Management Improves Long-Term CKD Prognosis: A 10-Year Retrospective Cohort Study From China

Abstract

Background: Self-management (SMP) is a novel treatment comprised of multidimensional interventions. Researchers have reported its reliable effects on short-term improvements in surrogate indicators like 24-h urinary protein excretion and systolic blood pressure. However, whether it has any effect on long-term changes in other surrogate indicators and chronic kidney disease (CKD) endpoints remains unclear. Methods: Patients with CKD stages 3-4 were grouped into either a SMP group or a nonself-management (non-SMP) group whether they had complied any of five characterized elements: regular visits, medication adjustment, nutritional intervention, lifestyle modification, education, and behavior guide. We used 1:1 nearest-neighbor propensity score matching (PSM) to balance between-group differences. Cox regression was used to explore the long-term association between SMP and composite outcomes (all-cause mortality, end-stage kidney disease (ESKD), ≥ 50% decline in estimated glomerular filtration rate (eGFR), or doubling of serum creatinine (SCr) from baseline). Linear mixed-effects (LME) model and marginal means comparisons were used to surrogate indicators analysis. Results: The study included 1160 patients with a median follow-up of 27.20 months. Among them, 580 individuals were in the SMP group and 580 were in the non-SMP group. In the non-SMP group, the median follow-up was 24.48 (12.21, 43.39) months with 174 (30.00%) events, whereas the SMP group had a median follow-up of 29.34 (14.75, 42.00) months with 134 (23.10%) composite outcomes. Participation in a SMP program was associated with a 30.9% reduction in CKD progression risk (hazard ratio (HR) of composite outcome: 0.691, 95% CI: 0.549–0.869, and p = 0.002). LME and marginal means comparison indicated that patients with SMP had higher mean difference of eGFR and serum albumin (Alb) than the non-SMP individuals (mean difference of eGFR: 1.791 (0.721, 2.861) mL/min/1.73 m2, p = 0.001; marginal mean difference of eGFR: 2.560 (1.660, 3.470) mL/min/1.73 m2, p < 0.0001; mean difference of Alb: 0.654 (0.202, 1.105) g/L, p = 0.005; and marginal mean difference of Alb: 0.460 (0.166, 0.753) g/L, p = 0.002). Conclusion: SMP programs are associated with a 30.9% reduction in CKD progression risk and improvements in kidney function and nutrition-related surrogate markers, benefiting CKD patients in stages 3-4.