Abstract
BackgroundThe transtheoretical model (TTM) is composed of the multiple stages according to patient’s consciousness and is believed to lead people to realize the importance of healthier behaviors. We examined the association of TTM stages with the decline of estimated glomerular filtration rate (eGFR).MethodsWe used the annual health checkup data and health insurance claims data of the Japan Health Insurance Association in Kyoto Prefecture between April 2012 and March 2016. TTM stages of change obtained from questionnaires at the first health checkup and categorized into six groups. The primary outcome was defined as a more than 30% decline in eGFR from the first health checkup. We fitted multivariable Cox proportional-hazards model for time-to-event analyses adjusting for age, sex, eGFR, body mass index, blood pressure, blood sugar, dyslipidemia, uric acid, urinary protein, and existence of kidney diseases at first health checkup.ResultsWe analyzed 239,755 employees and the mean follow-up was 2.9 (standard deviation, 1.2) years. As compared with the stage 1 group, the risk of eGFR decline was significantly low in the stage 3 group (hazard ratio [HR] 0.77; 95% confidence interval [CI], 0.65–0.91); stage 4 group (HR 0.80; 95% CI, 0.65–0.98); and stage 5 group (HR 0.79; 95% CI, 0.66–0.95).ConclusionCompared with the precontemplation stage (stage 1), the preparation, action and maintenance stages (stages 3, 4, and 5), were associated with a lower risk of eGFR decline.
Highlights
Chronic kidney disease (CKD) has been a global health problem for many years, and its prevalence has reached approximately 10–15% worldwide among 500 million people.[1]
Dietary and lifestyle modifications were found to affect renal function, so the Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommends that CKD patients should monitor and change their behaviors, including smoking cigarettes, their healthy weights, and daily physical activity.[2]
Compared with the stage 1 group, the risk of decreasing renal function was significantly lower in the stage 3 group (HR 0.77; 95% confidence interval (CI), 0.65–0.91); in the stage 4 group (HR 0.80; 95% CI, 0.65–0.98); and in the stage 5 group (HR 0.79; 95% CI, 0.66– 0.95), after adjusting for age, sex, estimated glomerular filtration rate (eGFR), body mass index, blood pressure, blood sugar, dyslipidemia, uric acid, urinary protein (Table 2)
Summary
Chronic kidney disease (CKD) has been a global health problem for many years, and its prevalence has reached approximately 10–15% worldwide among 500 million people.[1] CKD progression is caused by many pathophysiological risks such as diabetes, hypertension, and systemic immune disorders.[1] Recently, dietary and lifestyle modifications were found to affect renal function, so the Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommends that CKD patients should monitor and change their behaviors, including smoking cigarettes, their healthy weights, and daily physical activity.[2] the evidence that being a past smoker compared with current smoker was associated with a decreased risk of CKD progression[3] indicates that behavior change might slow the disease progression. An issue would be that changing such healthy behaviors does not seem easy in clinical settings. The transtheoretical model (TTM) is composed of the multiple stages according to patient’s consciousness and is believed to lead people to realize the importance of healthier behaviors. We examined the association of TTM stages with the decline of estimated glomerular filtration rate (eGFR)
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