Social isolation is a marker of increased mortality and cardiovascular risk in patients with chronic kidney disease

1. In this prospective cohort study, social isolation is associated with decreased survival time and accelerated onset of cardiovascular disease (CVD) in individuals with chronic kidney disease (CKD). 

Evidence Rating Level: 1 (Excellent) 

Chronic kidney disease (CKD) is a condition in which the kidneys have abnormalities in structure or function that last for 3 months or longer. The incidence of chronic kidney disease (CKD) is rising globally and is expected to continue increasing over the next 15 years. As CKD progresses to end-stage, it requires extensive medical care and increases the risk of serious health complications. Managing CKD focuses on identifying risk factors, slowing disease progression and preventing cardiovascular mortality. Social isolation is a recognized but often overlooked factor that can negatively impact health, increasing the risk of health issues, including cardiovascular disease (CVD) and death. While social isolation has been linked to faster kidney function decline in the general population, its impact on outcomes in people already living with CKD is unclear. To address this research gap, this prospective cohort study sought to evaluate the relationship between social isolation and CVD and mortality among patients with CKD. Participants with CKD at baseline between the ages of 40 and 69 years were recruited through the UK Biobank. Social isolation was assessed through self-reported questionnaires. The total sample included 13,090 participants (mean age 65 [IQR 61-68] years), with 62% having a decreased estimated glomerular filtration rate (eGFR). Individuals experiencing moderate and high levels of social isolation showed accelerated all-cause mortality (time ratio 0.87 [95% CI, 0.82-0.93; P<0.001] and 0.76 [95% CI, 0.70-0.82; P<0.001] respectively) compared to those experiencing the least isolation. Moderate and high levels of social isolation were minimally associated with accelerated CVD mortality, with time ratios of 0.93 (95% CI, 0.87-0.99; P=0.039) and 0.87 (95% CI, 0.79-0.96; P=0.005), respectively. However, this association was observed for stroke but not for coronary artery disease. In summary, social isolation was significantly associated with decreased survival time and accelerated onset of CVD, specifically stroke, in individuals with CKD. 

Click to read the study in JAHA

Image: PD

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