Abstract
BackgroundThere is limited evidence on the relationship between social support and renal outcomes in African Americans. We sought to determine the association of social support with prevalent chronic kidney disease (CKD) and kidney function decline in an African American cohort. We also examined whether age modifies the association between social support and kidney function decline.MethodsWe identified Jackson Heart Study (JHS) participants with baseline (Exam in 2000–2004) functional and structural social support data via the Interpersonal Support Evaluation List (ISEL) and social network size questions, respectively. With ISEL as our primary exposure variable, we performed multivariable regression models to evaluate the association between social support and prevalent CKD [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 or urine albumin-creatinine ratio (ACR) ≥30 mg/g], eGFR decline, and rapid renal function decline (RRFD) (> 30% decrease in eGFR over approximately 10 years). All models were adjusted for baseline sociodemographics, diabetes, hypertension, smoking status, and body mass index; models for eGFR decline and RRFD were additionally adjusted for eGFR and ACR. In models for eGFR decline, we assessed for interaction between age and social support. For secondary analyses, we replaced ISEL with its individual domains (appraisal, belonging, self-esteem, and tangible) and social network size in separate models as exposure variables.ResultsOf 5301 JHS participants, 4015 (76%) completed the ISEL at baseline. 843 (21%) had low functional social support (ISEL score < 32). Participants with low (vs. higher) functional social support were more likely to have lower income (47% vs. 28%), be current or former tobacco users (39% vs. 30%), have diabetes (25% vs. 21%) or CKD (14% vs. 12%). After multivariable adjustment, neither ISEL or social network size were independently associated with prevalent CKD, eGFR decline, or RRFD. Of the ISEL domains, only higher self-esteem was associated with lower odds of prevalent CKD [OR 0.94 (95% CI 0.89–0.99)]. The associations between social support measures and eGFR decline were not modified by age.ConclusionsIn this African-American cohort, social support was not associated with prevalent CKD or kidney function decline. Further inquiry of self-esteem’s role in CKD self-management and renal outcomes is warranted.
Highlights
There is limited evidence on the relationship between social support and renal outcomes in African Americans
For analyses of kidney function decline, we limited the cohort to Jackson Heart Study (JHS) participants with diabetes, hypertension and/or chronic kidney disease (CKD) at Exam 1 and excluded JHS participants who reported a history of dialysis or kidney transplant at any visit
We found no association between functional social support and prevalent CKD or estimated glomerular filtration rate (eGFR) decline (β = − 0.01, 95% confidence interval (CI) -0.02, 0.01) (Table 3)
Summary
There is limited evidence on the relationship between social support and renal outcomes in African Americans. We sought to determine the association of social support with prevalent chronic kidney disease (CKD) and kidney function decline in an African American cohort. The presence of adequate social support is associated with lower risk of morbidity and mortality in the general population [5,6,7,8,9,10,11]. This lower risk is explained by social support’s facilitation of health-promoting behaviors [12].
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