#3213 PATIENT ACTIVATION STATUS AND PATIENT PERCEIVED FUNCTION IMPAIRMENT IN CKD: A ROUTE TO OPTIMISING LIFE PARTICIPATION THROUGH ENHANCED SELF-MANAGEMENT?
Authors: Lightfoot Courtney J , Wilkinson Thomas , Smith Alice 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD), even at earlier stages where kidney replacement therapy is not required, is associated with significant health and symptom burdens which negatively impact on an individual's functional status and ability to fully engage with work, leisure, and social activities. Life participation can be maximized with optimal day-to-day management of CKD. A strong partnership between the healthcare team and patient is required to support effective self-management. Central to this partnership is patient activation, defined as the knowledge, skills, and confidence to manage one's own health. Individuals who are highly activated take an active role in their health, whilst those with low activated have a more passive role. Higher activation is associated with better clinical outcomes. As part of a wider survey in people living with non-dialysis CKD (ND-CKD), we explored the relationship between patient activation and perceived functional impairment as a result of CKD.

Method
14 hospital sites across England invited patients with ND-CKD to complete a survey on health and lifestyle factors including demographic and clinical information, the SF-12 health-related quality of life (QoL) questionnaire, Chalder Fatigue Scale, Patient Activation Measure (PAM-13), and Work and Social Adjustment Scale (WSAS). Participants were classified as having ‘low’ or ‘high’ activation based on their PAM-13 level (Levels 1&2 ‘low’; 3&4 ‘high’). Higher WSAS scores indicated greater perceived functional impairment due to CKD. To compare perceived impairment in WSAS domains between low and high activated participants, Mann-Whitney tests were conducted. To determine the relationship between participant characteristics (i.e., age, gender, ethnicity, eGFR, patient activation, fatigue, physical and mental QoL) and WSAS score, linear regression was performed.

Results
828 ND-CKD patients completed the survey [mean age 67.9 (±13.8) years, 60% (n = 501) male, 92% White British (n = 771), eGFR 33.1 (±19.7) ml/min/1.732, total number of additional comorbidities 2.0 (±1.5)]. 64% (n = 529) of participants were classified as having ‘low’ activation. The mean WSAS score was 7.8 (±9.9) indicating mild functional impairment. Both high and low PAM groups perceived social and leisure activities (with other people e.g., outings/dating/parties) to be their most impaired functional activities, and close relationships with others as least impaired. Low activated participants perceived greater impairment on work (P = 0.035), home management (P&lt;0.001), social leisure activities (P&lt;0.001), private leisure activities (P&lt;0.001) and close relationships (P&lt;0.001) as a result of their CKD compared to those with higher activation. Individuals who perceived greater functional impairments were younger (P&lt;0.001), had lower levels of activation (P = 0.036), poorer physical (P&lt;0.001) and mental (P = 0.043) QoL, and greater levels of fatigue (P = 0.001).

Conclusion
People with lower patient activation perceived greater functional impairment to work, leisure, and social activities as a result of their CKD. Younger people may have greater expectations as to what they can functionally achieve and the marked impact in comparison to their peers without CKD may be greater and more prominent. Conversely, older individuals may be more likely to attribute functional impairments to other age-associated comorbidities or to the effects of aging itself than to CKD. Interventions designed to increase patient activation and improve psychosocial adjustment have the potential to help individuals manage their CKD and reduce the perceived impairment on life participation.