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Low Social Support is Associated with Increased All-cause Mortality in African Americans with Hypertensive CKD

Fischer M, Patel A, Brooks D, Bruce M, Charleston J, Cleveland W, Dowie D, Faulkner M, Gassman J, Greene T, Hiremath L, Kendrick C, Kusek J, Thomley-Brown D, Wang X, Norris K, Lash J. Low Social Support is Associated with Increased All-cause Mortality in African Americans with Hypertensive CKD. Poster session presented at: National Kidney Foundation Clinical Spring Meeting; 2011 Apr 27; Las Vegas, NV.

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Low levels of social support have been found to predict worse outcomes and higher mortality in patients with ESRD. Less is known about the association of social support and clinical outcomes in earlier stages of CKD. We examined the relationship between social support measured at baseline and doubling of serum creatinine (scr)/incident ESRD, cardiovascular (CV) events, and all-cause mortality over an x year period in African Americans with hypertensive CKD from the African American Study of Kidney Disease and Hypertension (AASK) Cohort Study. Social support was assessed using the Interpersonal Support Evaluation List-16 (ISEL- 16). The mean ISEL-16 score was 36 (out of a maximum score of 48) in 659 participants. Lower income, less education, unemployment, lack of marriage, higher body mass index, history of psychiatric disease, and increasing number of comorbidities were associated with lower ISEL-16 scores (p < 0.05). Relative risks (RR) and 95% confidence intervals (CI) for each outcome with ISEL-16 scores below the cohort mean (ref: above cohort mean) are as follows: Unadjusted Adjusted Outcome RR, CI p RR, CI p CV Events 1.25 (0.84, 1.88) 0.27 1.28 (0.85, 1.93) 0.23 Doubling scr/ESRD 0.89 (0.64, 1.24) 0.48 0.92 (0.65, 1.30) 0.63 All-cause mortality 1.41 (0.95, 2.10) 0.09 1.52 (1.01, 2.30) 0.05 The model is adjusted for age, gender, eGFR, and proteinuria. Low levels of social support was associated with lower socioeconomic status and greater burden of comorbid illness. Low social support was independently associated with an increased risk for all-cause mortality but not CV events or CKD progression. Future work will need to focus on mechanisms underlying this relationship.

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