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Tang R, Wang X, Li X, Ma H, Liang Z, Heianza Y, Qi L. Adherence to Life's Essential 8 and incident chronic kidney disease: a prospective study of 147,988 UK Biobank participants. Am J Clin Nutr 2023; 118:804-811. [PMID: 37604298 PMCID: PMC10579043 DOI: 10.1016/j.ajcnut.2023.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The American Heart Association recently updated Life's Essential 8 (LE8) score. This amalgamation of health factors, recognized for their individual associations with chronic kidney disease (CKD) risk, provides a robust tool to assess overall cardiovascular health (CVH), which could potentially be extrapolated to predict CKD risk. OBJECTIVES This study aimed to investigate the association between levels of CVH, as measured by the LE8 score, and risk of CKD in the UK Biobank. METHODS A total of 147,988 participants free of CKD and cardiovascular disease from the UK Biobank were included in this prospective study. CVH levels were categorized as low (0-49), moderate (50-79), and high (80-100) using LE8 score. An adjusted Cox proportional hazard model was used to investigate the association between LE8 and CKD. The population attributable-risk (PAR) was also calculated. RESULTS During a median follow-up of 10 y, 1936 CKD cases were documented. A higher LE8 score was associated with a significant lower risk of CKD (P < 0.001), and a linear dose-response relationship was observed. Similar patterns were also found in the associations of the LE8 behavior and biological subscale scores with CKD. Compared with participants with a low CVH category, participants with a moderate CVH were associated with a 39% lower risk of developing CKD (hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.52, 0.72); and those with a high CVH had a 57% lower risk of CKD incidence (HR: 0.43; 95% CI: 0.35, 0.53) after adjustment for covariates. Among 8 distinct metrics of LE8 score, the BMI metric had the highest PAR (24.6%; 95% CI: 18.8, 30.2). Of the total CKD risk, 3.2% (95% CI: 1.4, 5.0) was attributable to inadequate or excessive sleep duration. CONCLUSIONS High CVH, defined by LE8, is significantly associated with a lower risk of CKD. These results suggest that promoting optimal cardiovascular health may lower the burden of CKD.
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Affiliation(s)
- Rui Tang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Zhaoxia Liang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States; Department of Obstetrical, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
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Hernandez R, Wilund K, Solai K, Tamayo D, Fast D, Venkatesan P, Lash JP, Lora CM, Martinez L, Martin Alemañy G, Martinez A, Kwon S, Romero D, Browning MHEM, Moskowitz JT. Positive Psychological Intervention Delivered Using Virtual Reality in Patients on Hemodialysis With Comorbid Depression: Protocol and Design for the Joviality Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e45100. [PMID: 37327026 DOI: 10.2196/45100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Depression is highly prevalent in individuals on hemodialysis, but it is infrequently identified and remains undertreated. In this paper, we present details of the methodology of a randomized controlled trial (RCT) aimed at testing the feasibility and preliminary efficacy of a 5-week positive psychological intervention in individuals on hemodialysis with comorbid depression delivered using immersive virtual reality (VR) technology. OBJECTIVE We aim to describe the protocol and design of the Joviality trial whose main objectives are 2-fold: determine the feasibility of the Joviality VR software through metrics capturing rates of recruitment, refusal, retention, noncompliance, and adherence, as well as end-user feedback; and assess preliminary efficacy for outcomes measures of depressive symptoms, psychological well-being and distress, quality of life, treatment adherence, clinical biomarkers, and all-cause hospitalizations. METHODS This 2-arm RCT is scheduled to enroll 84 individuals on hemodialysis with comorbid depression from multiple outpatient centers in Chicago, Illinois, United States. Enrollees will be randomized to the following groups: VR-based Joviality positive psychological intervention or sham VR (2D wildlife footage and nature-based settings with inert music presented using a head-mounted display). To be eligible, individuals must be on hemodialysis for at least 3 months, have Beck Depression Inventory-II scores of ≥11 (ie, indicative of mild-to-severe depressive symptoms), be aged ≥21 years, and be fluent in English or Spanish. The Joviality VR software was built using agile design principles and incorporates fully immersive content, digital avatars, and multiplex features of interactability. Targeted skills of the intervention include noticing positive events, positive reappraisal, gratitude, acts of kindness, and mindful or nonjudgmental awareness. The primary outcomes include metrics of feasibility and acceptability, along with preliminary efficacy focused on decreasing symptoms of depression. The secondary and tertiary outcomes include quality of life, treatment adherence, clinical biomarkers, and all-cause hospitalization rates. There are 4 assessment time points: baseline, immediately after the intervention, 3 months after the intervention, and 6 months after the intervention. We hypothesize that depressive symptoms and hemodialysis-related markers of disease will substantially improve in participants randomized to the VR-based Joviality positive psychology treatment arm compared with those in the attention control condition. RESULTS This RCT is funded by the National Institute of Diabetes and Digestive and Kidney Diseases and is scheduled to commence participant recruitment in June 2023. CONCLUSIONS This trial will be the first to test custom-built VR software to deliver a positive psychological intervention, chairside, in individuals on hemodialysis to reduce symptoms of depression. Within the context of an RCT using an active control arm, if proven effective, VR technology may become a potent tool to deliver mental health programming in clinical populations during their outpatient treatment sessions. TRIAL REGISTRATION ClinicalTrials.gov NCT05642364; https://clinicaltrials.gov/ct2/show/NCT05642364. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45100.
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Affiliation(s)
- Rosalba Hernandez
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, United States
| | - Ken Wilund
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Killivalavan Solai
- Center for Innovation in Teaching and Learning, University of Illinois at Urbana Champaign, Urbana, IL, United States
| | - David Tamayo
- Center for Innovation in Teaching and Learning, University of Illinois at Urbana Champaign, Urbana, IL, United States
| | - Drew Fast
- Center for Innovation in Teaching and Learning, University of Illinois at Urbana Champaign, Urbana, IL, United States
| | - Prasakthi Venkatesan
- Center for Innovation in Teaching and Learning, University of Illinois at Urbana Champaign, Urbana, IL, United States
| | - James P Lash
- Division of Nephrology, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Claudia M Lora
- Division of Nephrology, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Lizet Martinez
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, United States
| | - Geovana Martin Alemañy
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Angela Martinez
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, United States
| | - Soonhyung Kwon
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Dana Romero
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, United States
| | - Matthew H E M Browning
- Department of Parks, Recreation and Tourism Management, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Zambrano J, Romero P, Longley R, Huffman JC, Cohen-Bucay A, Celano CM. Well-being and health in kidney failure: A scoping review. J Acad Consult Liaison Psychiatry 2022; 63:384-393. [PMID: 35278740 DOI: 10.1016/j.jaclp.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Kidney Failure (KF) is associated with impaired physical function, reduced health-related quality of life (HRQoL), increased healthcare costs, and high rates of cardiovascular complications and mortality. Among individuals with KF, well-being and related constructs, such as positive affect, optimism, self-efficacy, and resilience, may have both mental and physical health benefits, independent of the effects of negative emotions and affective syndromes. However, there has been minimal review of these characteristics in people with KF. METHODS We conducted a scoping review, using a semi-systematic approach, to summarize the relationships between well-being characteristics and renal health, the potential mechanisms mediating these relationships, and the effects of interventions that promote positive constructs on adherence and health outcomes. We conducted database searches using PubMed and PsycInfo until November 2020. Articles were included if they examined (1) relationships between a well-being construct and health outcome in patients with KF, (2) potential biological or behavioral mediators, or (3) interventions that target positive psychological constructs as outcomes or mediators in KF, and (4) were written in English or Spanish. RESULTS Among patients with KF, well-being constructs are associated with increased health-related quality of life (HRQoL), reduced morbidity and complications, and increased survival. Potential mechanisms mediating these associations include reduced inflammation, improved autonomic and endothelial function, and improved health behavior adherence. Psychological and psychosocial interventions promoting well-being have primarily focused on improving self-efficacy to promote behavior change, with limited study of interventions to promote positive psychological constructs in this population. CONCLUSIONS Further research is needed to better understand the relationship between well-being constructs and health, specific to KF populations. This could inform the development of needed interventions that harness the promotion of other positive characteristics to improve well-being and health.
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Affiliation(s)
- Juliana Zambrano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Perla Romero
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Regina Longley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Abraham Cohen-Bucay
- Harvard Medical School, Boston, MA, USA; Renal Division and Transplant Center, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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