Social isolation tied to detrimental outcomes in CKD

For patients with chronic kidney disease (CKD) who are facing social isolation, survival is shortened while the onset of cardiovascular disease (CVD) is accelerated, as shown in a prospective cohort study.

Researchers used data from the UK Biobank and included 13,090 CKD patients (median age 65 years, 57 percent female, 62 percent had decreased eGFR).

Social isolation was assessed based on questionnaires, which covered the following questions: (1) “Including yourself, how many people are living together in your household?”; (2) “How often do you visit friends or family or have them visit you?”; and (3) “Which of the following (sports club or gym, pub or social club, religious group, adult education class, other group activity, and none) do you attend once a week or more often?” A score of 0 was defined as being least isolated, a score of 1 as moderately isolated, and a score of 2 or 3 as most isolated.

Of the study participants, 45 percent were classified as least isolated, 42 percent as moderately isolated, and 13 percent as most isolated. Compared with being least isolated, being moderately and mostly isolated were associated with accelerated all‐cause death, with a time ratio of 0.87 (95 percent confidence interval [CI], 0.82–0.93; p<0.001) and 0.76 (95 percent CI, 0.70–0.82; p<0.001), respectively.  

Being moderately and most isolated were also associated with restricted mean survival time differences of 49.1 and 71.6 days, respectively, within 10 years as compared with being least isolation.

There was a marginal association between CVD risk and moderate isolation (time ratio, 0.93, 95 percent CI, 0.87–0.99; p=0.039) and most isolation (time ratio, 0.87, 95 percent CI, 0.79–0.96; p=0.005) vs least isolation. However, this association was significant only for stroke and not for coronary artery disease.

Inverse odds ratio–weighted mediation analysis showed that CVD and sarcopenia mediated 21.8 percent of the total effect of social isolation on death.