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09-05-2024 | Chronic Kidney Disease | Original Article

Characterization of CKD illness representation profiles using patient-level factors

Authors: Eleanor Rivera, Nathan Tintle, Raymond R. Townsend, Mahboob Rahman, Sarah J. Schrauben, Maya N. Clark-Cutaia, Mary Hannan, James P. Lash, Katherine Wolfrum, Celestin Missikpode, Karen B. Hirschman

Published in: Journal of Nephrology | Issue 3/2024

Abstract

Background

Illness perceptions are the unique perspective individuals have on their illness, based on their context and experiences, and are associated with patient outcomes including coping and adherence. The purpose of this study was to explore characteristics that may be driving membership in illness perceptions cluster groups for adults with chronic kidney disease (CKD).

Methods

This study was conducted within the multicenter longitudinal Chronic Renal Insufficiency Cohort (CRIC) Study. Cross-sectional data were collected and combined with CRIC data. Illness perceptions were measured using the Revised Illness Perception Questionnaire. Clustering analysis was conducted in R, and bivariate analysis including linear regression was performed in STATA 16.

Results

The sample (n = 197) had a mean age of 68, was 52% women, 53% non-White, and mean estimated glomerular filtration rate (eGFR) 56 ml/min/1.73 m². Three cluster groups were identified, labeled as “Disengaged” (n = 20), “Well-Resourced” (n = 108), and “Distressed” (n = 69). The “Disengaged” group was characterized by low CKD knowledge, many recent hospitalization days, and the lowest perceived CKD burden. The “Well-Resourced” group was characterized by the highest levels of education, CKD knowledge, optimism, and medication adherence. The “Distressed” group was characterized by the highest levels of depression scores, comorbidity burden, CKD burden, CKD symptoms, and lowest optimism. Group membership significantly predicted the number of hospitalization days in adjusted analyses.

Conclusions

Illness perceptions groups are associated with number of hospitalization days but are independent of many patient characteristics. Illness perceptions data could be used to tailor care for specific patients at risk for poor health outcomes.

Graphical Abstract

Available only for authorised users

United States Renal Data System. 2021 USRDS annual data report: epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD2021

Gunarathne T, Tang LY, Lim SK, Nanayakkara N, Damayanthi H, Abdullah KL (2022) Factors associated with symptom burden in adults with chronic kidney disease undergoing hemodialysis: a prospective study. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph19095540CrossRefPubMedPubMedCentral

Engle RL, Mohr DC, Holmes SK, Seibert MN, Afable M, Leyson J et al (2019) Evidence-based practice and patient-centered care: doing both well. Health Care Manag Rev. https://doi.org/10.1097/HMR.0000000000000254CrossRef

Grover S, Fitzpatrick A, Azim FT, Ariza-Vega P, Bellwood P, Burns J et al (2022) Defining and implementing patient-centered care: an umbrella review. Patient Educ Couns 105(7):1679–1688. https://doi.org/10.1016/j.pec.2021.11.004CrossRefPubMed

Leventhal H, Nerenz DR, Steele DJ (1984) Illness representation and coping with health threats. In: Baum A, Taylor SE, Singer JE (eds) Social psychological aspects of health. L. Erlbaum Associates, Hillsdale, pp 219–252

Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D (2002) The Revised Illness Perception Questionnaire (IPQ-R). Psychol Health 17(1):1–16. https://doi.org/10.1080/08870440290001494CrossRef

Nahlen Bose C, Elfstrom ML, Bjorling G, Persson H, Saboonchi F (2016) Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure. Scand J Caring Sci 30(4):704–713. https://doi.org/10.1111/scs.12297CrossRefPubMed

Muscat P, Weinman J, Farrugia E, Camilleri L, Chilcot J (2020) Illness perceptions predict mortality in patients with predialysis chronic kidney disease: a prospective observational study. BMC Nephrol 21(1):537. https://doi.org/10.1186/s12882-020-02189-7CrossRefPubMedPubMedCentral

Rivera E, Corte C, Steffen A, DeVon HA, Collins EG, McCabe P (2018) Illness representation and self-care ability in older adults with chronic disease. Geriatrics 3(3):45. https://doi.org/10.3390/geriatrics3030045CrossRefPubMedPubMedCentral

10.

Denker M, Boyle S, Anderson AH, Appel LJ, Chen J, Fink JC et al (2015) Chronic Renal Insufficiency Cohort Study (CRIC): overview and summary of selected findings. Clin J Am Soc Nephrol 10(11):2073–2083. https://doi.org/10.2215/CJN.04260415CrossRefPubMedPubMedCentral

11.

Teng EL, Chui HC (1987) The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry 48(8):314–318PubMed

12.

Rivera E, Levoy K, Clark-Cutaia MN, Schrauben S, Townsend RR, Rahman M et al (2022) Content Validity Assessment of the Revised Illness Perception Questionnaire in CKD using qualitative methods. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph19148654CrossRefPubMedPubMedCentral

13.

Rivera E, Clark-Cutaia MN, Schrauben SJ, Townsend RR, Lash JP, Hannan M et al (2022) Treatment adherence in CKD and support from health care providers: a qualitative study. Kidney Med. https://doi.org/10.1016/j.xkme.2022.100545CrossRefPubMedPubMedCentral

14.

Devins GM, Binik YM, Mandin H, Letourneau PK, Hollomby DJ, Barre PE et al (1990) The Kidney Disease Questionnaire: a test for measuring patient knowledge about end-stage renal disease. J Clin Epidemiol 43(3):297–307CrossRefPubMed

15.

Scheier MF, Carver CS, Bridges MW (1994) Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. J Pers Soc Psychol 67(6):1063–1078CrossRefPubMed

16.

Cedillo-Couvert EA, Ricardo AC, Chen J, Cohan J, Fischer MJ, Krousel-Wood M et al (2018) Self-reported medication adherence and CKD progression. Kidney Int Rep 3(3):645–651. https://doi.org/10.1016/j.ekir.2018.01.007CrossRefPubMedPubMedCentral

17.

Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004CrossRefPubMed

18.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8CrossRefPubMed

19.

Hays RD et al (1997) Kidney Disease Quality of Life Short Form (KDQOL-SF™), version 1.3: a manual for use and scoring

20.

Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J (1999) Development of a brief test to measure functional health literacy. Patient Educ Couns 38(1):33–42CrossRefPubMed

21.

Scrucca L, Fop M, Murphy TB, Raftery AE (2016) mclust 5: clustering, classification and density estimation using Gaussian finite mixture models. R J 8(1):289–317. https://doi.org/10.32614/RJ-2016-021CrossRefPubMedPubMedCentral

22.

Li J, Qiu X, Yang X, Zhou J, Zhu X, Zhao E et al (2020) Relationship between illness perception and depressive symptoms among type 2 diabetes mellitus patients in China: a mediating role of coping style. J Diabetes Res 2020:3142495. https://doi.org/10.1155/2020/3142495CrossRefPubMedPubMedCentral

23.

Baiardini I, Rogliani P, Santus P, Corsico AG, Contoli M, Scichilone N et al (2019) Disease awareness in patients with COPD: measurement and extent. Int J Chron Obstruct Pulmon Dis 14:1–11. https://doi.org/10.2147/COPD.S179784CrossRefPubMed

24.

Hurt CS, Burn DJ, Hindle J, Samuel M, Wilson K, Brown RG (2014) Thinking positively about chronic illness: an exploration of optimism, illness perceptions and well-being in patients with Parkinson’s disease. Br J Health Psychol 19(2):363–379. https://doi.org/10.1111/bjhp.12043CrossRefPubMed

25.

Meuleman Y, Chilcot J, Dekker FW, Halbesma N, van Dijk S (2017) Health-related quality of life trajectories during predialysis care and associated illness perceptions. Health Psychol 36(11):1083–1091. https://doi.org/10.1037/hea0000504CrossRefPubMed

26.

Wang Y, Veltkamp DMJ, van der Boog PJM, Hemmelder MH, Dekker FW, de Vries APJ et al (2022) Illness perceptions and medication nonadherence to immunosuppressants after successful kidney transplantation: a cross-sectional study. Transpl Int 35:10073. https://doi.org/10.3389/ti.2022.10073CrossRefPubMedPubMedCentral

27.

Massey EK, Tielen M, Laging M, Timman R, Beck DK, Khemai R et al (2015) Discrepancies between beliefs and behavior: a prospective study into immunosuppressive medication adherence after kidney transplantation. Transplantation 99(2):375–380. https://doi.org/10.1097/TP.0000000000000608CrossRefPubMed

28.

Nah R, Robertson N, Niyi-Odumosu FA, Clarke AL, Bishop NC, Smith AC (2019) Relationships between illness representations, physical activity and depression in chronic kidney disease. J Ren Care 45(2):74–82. https://doi.org/10.1111/jorc.12274CrossRefPubMed

29.

Tsai YC, Chiu YW, Hung CC, Hwang SJ, Tsai JC, Wang SL et al (2012) Association of symptoms of depression with progression of CKD. Am J Kidney Dis 60(1):54–61. https://doi.org/10.1053/j.ajkd.2012.02.325CrossRefPubMed

30.

Plantinga LC, Tuot DS, Powe NR (2010) Awareness of chronic kidney disease among patients and providers. Adv Chronic Kidney Dis 17(3):225–236. https://doi.org/10.1053/j.ackd.2010.03.002CrossRefPubMedPubMedCentral

Title: Characterization of CKD illness representation profiles using patient-level factors
Authors: Eleanor Rivera
Nathan Tintle
Raymond R. Townsend
Mahboob Rahman
Sarah J. Schrauben
Maya N. Clark-Cutaia
Mary Hannan
James P. Lash
Katherine Wolfrum
Celestin Missikpode
Karen B. Hirschman
Publication date: 09-05-2024
Publisher: Springer International Publishing
Keyword: Chronic Kidney Disease
Published in: Journal of Nephrology / Issue 3/2024
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI: https://doi.org/10.1007/s40620-024-01955-2

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Characterization of CKD illness representation profiles using patient-level factors

Abstract

Background

Methods

Results

Conclusions

Graphical Abstract

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