Limits...
Psychosocial stress and changes in estimated glomerular filtration rate among adults with diabetes mellitus.

Annor FB, Masyn KE, Okosun IS, Roblin DW, Goodman M - Kidney Res Clin Pract (2015)

Bottom Line: The psychosocial stress variable was not directly associated with eGFR in the final model.Factors found to be associated with changes in eGFR were age, race, insulin use, and mean arterial pressure.Among fairly healthy DM patients, we did not find any evidence of a direct association between psychosocial stress and eGFR changes after controlling for important covariates.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, Georgia State University, Atlanta, GA, USA.

ABSTRACT

Background: Psychosocial stress has been hypothesized to impact renal changes, but this hypothesis has not been adequately tested. The aim of this study was to examine the relationship between psychosocial stress and estimated glomerular filtration rate (eGFR) and to examine other predictors of eGFR changes among persons with diabetes mellitus (DM).

Methods: Data from a survey conducted in 2005 by a major health maintenance organization located in the southeastern part of the United States, linked to patients' clinical and pharmacy records (n=575) from 2005 to 2008, was used. Study participants were working adults aged 25-59 years, diagnosed with DM but without advanced microvascular or macrovascular complications. eGFR was estimated using the Modification of Diet in Renal Disease equation. A latent psychosocial stress variable was created from five psychosocial stress subscales. Using a growth factor model in a structural equation framework, we estimated the association between psychosocial stress and eGFR while controlling for important covariates.

Results: The psychosocial stress variable was not directly associated with eGFR in the final model. Factors found to be associated with changes in eGFR were age, race, insulin use, and mean arterial pressure.

Conclusion: Among fairly healthy DM patients, we did not find any evidence of a direct association between psychosocial stress and eGFR changes after controlling for important covariates. Predictors of eGFR change in our population included age, race, insulin use, and mean arterial pressure.

No MeSH data available.


Related in: MedlinePlus

Changes in the estimated glomerular filtration rate at different values of mean arterial pressure, controlling for other covariates.* Adjusted for age, sex, race, education, body mass index, smoke, medication coverage, insulin use, psychosocial stress, and glycemic control.eGFR, estimated glomerular filtration rate; MAP, mean arterial pressure.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4608872&req=5

f0010: Changes in the estimated glomerular filtration rate at different values of mean arterial pressure, controlling for other covariates.* Adjusted for age, sex, race, education, body mass index, smoke, medication coverage, insulin use, psychosocial stress, and glycemic control.eGFR, estimated glomerular filtration rate; MAP, mean arterial pressure.

Mentions: Even though no direct association was observed between psychosocial stress and changes in eGFR, some of the study covariates were significantly associated with eGFR in the expected direction. This observed association validates the data and identifies factors that are important to changes in eGFR among the study population, providing information that could guide prevention efforts, especially for factors that can be modified. At baseline, race, age, insulin use, and MAP was each significantly related to eGFR. Blacks had lower eGFR values compared to their white counterparts. Racial differences in decline of renal function have been reported, with blacks experiencing the greatest disparity compared to whites [55,56]. Increasing age has been associated with eGFR decline among adults with DM. Use of insulin was associated with decline in eGFR which is consistent with the literature [30]. Insulin use may be related to having had DM for a long time, and/or poor glycemic control, particularly, among type 2 DM patients both factors of which have been associated with decline of renal function among DM patients [8,57–59]. Consistent with prior studies, increasing MAP was found to be associated with eGFR at both study baseline and over time [60–62]. Some interventional studies have demonstrated that antihypertensive treatment among DM patients may reduce the incidence or slow the progression of decline of renal function [63,64]. As presented in Fig. 2, the effect of MAP on eGFR trajectory during the study period indicated that not only were people with higher MAP started with lower eGFR value but their rate of decline was also faster.


Psychosocial stress and changes in estimated glomerular filtration rate among adults with diabetes mellitus.

Annor FB, Masyn KE, Okosun IS, Roblin DW, Goodman M - Kidney Res Clin Pract (2015)

Changes in the estimated glomerular filtration rate at different values of mean arterial pressure, controlling for other covariates.* Adjusted for age, sex, race, education, body mass index, smoke, medication coverage, insulin use, psychosocial stress, and glycemic control.eGFR, estimated glomerular filtration rate; MAP, mean arterial pressure.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608872&req=5

f0010: Changes in the estimated glomerular filtration rate at different values of mean arterial pressure, controlling for other covariates.* Adjusted for age, sex, race, education, body mass index, smoke, medication coverage, insulin use, psychosocial stress, and glycemic control.eGFR, estimated glomerular filtration rate; MAP, mean arterial pressure.
Mentions: Even though no direct association was observed between psychosocial stress and changes in eGFR, some of the study covariates were significantly associated with eGFR in the expected direction. This observed association validates the data and identifies factors that are important to changes in eGFR among the study population, providing information that could guide prevention efforts, especially for factors that can be modified. At baseline, race, age, insulin use, and MAP was each significantly related to eGFR. Blacks had lower eGFR values compared to their white counterparts. Racial differences in decline of renal function have been reported, with blacks experiencing the greatest disparity compared to whites [55,56]. Increasing age has been associated with eGFR decline among adults with DM. Use of insulin was associated with decline in eGFR which is consistent with the literature [30]. Insulin use may be related to having had DM for a long time, and/or poor glycemic control, particularly, among type 2 DM patients both factors of which have been associated with decline of renal function among DM patients [8,57–59]. Consistent with prior studies, increasing MAP was found to be associated with eGFR at both study baseline and over time [60–62]. Some interventional studies have demonstrated that antihypertensive treatment among DM patients may reduce the incidence or slow the progression of decline of renal function [63,64]. As presented in Fig. 2, the effect of MAP on eGFR trajectory during the study period indicated that not only were people with higher MAP started with lower eGFR value but their rate of decline was also faster.

Bottom Line: The psychosocial stress variable was not directly associated with eGFR in the final model.Factors found to be associated with changes in eGFR were age, race, insulin use, and mean arterial pressure.Among fairly healthy DM patients, we did not find any evidence of a direct association between psychosocial stress and eGFR changes after controlling for important covariates.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, Georgia State University, Atlanta, GA, USA.

ABSTRACT

Background: Psychosocial stress has been hypothesized to impact renal changes, but this hypothesis has not been adequately tested. The aim of this study was to examine the relationship between psychosocial stress and estimated glomerular filtration rate (eGFR) and to examine other predictors of eGFR changes among persons with diabetes mellitus (DM).

Methods: Data from a survey conducted in 2005 by a major health maintenance organization located in the southeastern part of the United States, linked to patients' clinical and pharmacy records (n=575) from 2005 to 2008, was used. Study participants were working adults aged 25-59 years, diagnosed with DM but without advanced microvascular or macrovascular complications. eGFR was estimated using the Modification of Diet in Renal Disease equation. A latent psychosocial stress variable was created from five psychosocial stress subscales. Using a growth factor model in a structural equation framework, we estimated the association between psychosocial stress and eGFR while controlling for important covariates.

Results: The psychosocial stress variable was not directly associated with eGFR in the final model. Factors found to be associated with changes in eGFR were age, race, insulin use, and mean arterial pressure.

Conclusion: Among fairly healthy DM patients, we did not find any evidence of a direct association between psychosocial stress and eGFR changes after controlling for important covariates. Predictors of eGFR change in our population included age, race, insulin use, and mean arterial pressure.

No MeSH data available.


Related in: MedlinePlus