Social Network Affects Diabetic Kidney Disease Risk

Lifestyle factors other than diet—including a high “social network score” (SNS)—are associated with a lower risk of chronic kidney disease (CKD) in patients with type 2 diabetes, reports a study in Kidney International.

The study included 6972 patients with type 2 diabetes but without macroalbuminuria, representing all such patients enrolled in the “Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial” (ONTARGET). During 5.5 years of follow-up, CKD progression was assessed in terms of more than a 5 percent annual decline in GFR, development of ESRD, microalbuminuria, or macroalbuminuria.

Various lifestyle and social factors were evaluated for association with CKD progression, including tobacco and alcohol use, physical activity, stress, financial worries, and the SNS as an indicator of the size of the social network. The analysis was adjusted for known risk factors and considered competing causes of death.

At follow-up, 31 percent of patients had incident or progressive CKD, and 15 percent had died. A higher SNS was independently associated with a lower risk of CKD and death: when the third tertile was compared with the first tertile of SNS, the odds ratios were 0.89 and 0.78, respectively.

Stress and financial worries were not related to CKD, but education was. The risk of CKD was lower for patients with moderate alcohol consumption and those with regular physical activity.

Information on modifiable risk factors is needed to lower the risk of progressive diabetic CKD, especially in the early stages. This study identifies lifestyle and social factors associated with a lower risk of CKD in high-risk diabetic patients—notably including a larger social network. This, along with physical activity and moderate alcohol intake, may be a useful target for disease prevention studies [Dunkler D, et al. Modifiable lifestyle and social factors affect chronic kidney disease in high-risk individuals with type 2 diabetes mellitus. Kidney Int 2015; 87:784–791].