P1851INCREASING CO-MORBIDITY REDUCES A PATIENT'S ABILITY TO SELF-MANAGE: AN OBSERVATIONAL STUDY IN NON-DIALYSIS CKD PATIENTS
Authors: Memory Katherine , Wilkinson Thomas , Palmer Jared , Smith Alice 
Published: June 2020

Abstract

Background and Aims
Co-morbidity is high in CKD patients and associated with greater mortality and disease burden. Increased burden from other health conditions, as well as CKD, may impact the successful self-management of a patient’s health. A patient’s perceived ability to self-manage their condition can be assessed through the concept of ‘Patient Activation (PA)’ which encompasses a patient’s knowledge, skills, and confidence to undertake self-management tasks. Low PA is associated with poor self-reported health, greater renal impairment, and increased hospitalisation rates. Understanding PA may help the development and initiation of self-management interventions (e.g., low ‘activated’ individuals may require further education on their condition(s) whilst high ‘activated’ patients may require better support in maintaining their current lifestyle). This study aimed to assess how co-morbidity may influence PA and sought to identify which conditions, in exception to CKD, impact PA the most. This may help identify how co-morbidities affect patient’s ability self-manage successfully and aid the development of individualised intervention.

Method
The Patient Activation Measure (PAM), a validated 13 item questionnaire, assessed patient activation by measuring patients perceived ability to self-manage their condition. Results categorise participants into four activation categories (1 to 4; low to high). 152 non-dialysis CKD patients (52.6% female, age 67.9 (SD:12.7) years, eGFR 42.2 (SD:18.6) ml/min) provided self-reported information about their co-morbidities, and completed the PAM. Data was analysed by general linear modelling adjusting for age, sex and eGFR.

Results
134/152 (88.2%) of patients were multi-morbid, defined as 2 or more conditions including CKD, with a mean of 2.1 (SD:1.4) comorbidities. Increasing co-morbidities were associated with reduced PAM score (p=0.009). PAM scores decreased from 67.96 (SE:3.68) in patients with no other co-morbidities to 55.57 (SE:2.81) with 4+ co-morbidities; a reduction from PA level 4 (high) to 2 (low) respectively. The co-morbidities which explained the largest variance in PAM score were diabetes (β=-.193, p=.021), respiratory conditions (β=-.184, p=.37), and MSK conditions (β=-.154, p=.081). No other conditions were predictive of PAM score.

Conclusion
Co-morbidity in non-dialysis CKD patients is high and is associated with reduced PA (i.e. the perceived ability of patients to self-manage their condition(s)). We identified that CKD patients with diabetes, respiratory, and musculoskeletal conditions found it more difficult to self-manage their co-existing conditions. Individuals with musculoskeletal or respiratory conditions may perceive poor self-management ability due to this conditions impact on function (e.g. physical activity limitations) and/or quality of life (e.g. symptoms or sleep). Diabetes could challenge perceived self-management ability due to its chronicity, management complexity (e.g. medication regimens and side effects) and demoralising health sequelae (e.g. cardiovascular risk).