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

Area of Science:

• Nephrology
• Public Health
• Internal Medicine

Background:

• Self-management programs (SMP) involve multidimensional interventions for chronic kidney disease (CKD).
• Previous research indicates SMP's short-term efficacy on indicators like urinary protein excretion and blood pressure.
• Long-term effects of SMP on CKD progression and surrogate markers remain under investigation.

Purpose of the Study:

• To evaluate the long-term impact of SMP on CKD progression and surrogate markers in patients with stages 3-4 CKD.
• To assess the association between SMP participation and composite outcomes including mortality, end-stage kidney disease (ESKD), and estimated glomerular filtration rate (eGFR) decline.
• To analyze changes in surrogate markers such as eGFR and serum albumin (Alb) in response to SMP.

Main Methods:

• A cohort of 1160 patients with CKD stages 3-4 was divided into SMP and non-SMP groups.
• 1:1 nearest-neighbor propensity score matching (PSM) was employed to balance group characteristics.
• Cox regression and linear mixed-effects (LME) models were utilized to analyze long-term outcomes and surrogate markers, respectively.

Main Results:

• SMP participation was linked to a 30.9% reduction in CKD progression risk (HR: 0.691, p=0.002).
• Patients in the SMP group exhibited significantly higher mean eGFR (1.791 mL/min/1.73 m²; p=0.001) and serum albumin (0.654 g/L; p=0.005) compared to the non-SMP group.
• Marginal means analysis confirmed improved eGFR (2.560 mL/min/1.73 m²; p<0.0001) and serum albumin (0.460 g/L; p=0.002) in the SMP group.

Conclusions:

• SMP programs demonstrate a significant association with reduced CKD progression risk.
• SMP interventions lead to improvements in kidney function (eGFR) and nutritional status (serum albumin) in CKD patients.
• These findings highlight the long-term benefits of SMP for individuals with stages 3-4 CKD.