Self‐Management Improves Long‐Term CKD Prognosis: A 10‐Year Retrospective Cohort Study From China

Background Self‐management (SMP) is a novel treatment comprised of multidimensional interventions. Researchers have reported its reliable effects on short‐term improvements in surrogate indicators like 24‐h urinary protein excretion and systolic blood pressure. However, whether it has any effect on long‐term changes in other surrogate indicators and chronic kidney disease (CKD) endpoints remains unclear. Methods Patients with CKD stages 3‐4 were grouped into either a SMP group or a nonself‐management (non‐SMP) group whether they had complied any of five characterized elements: regular visits, medication adjustment, nutritional intervention, lifestyle modification, education, and behavior guide. We used 1:1 nearest‐neighbor propensity score matching (PSM) to balance between‐group differences. Cox regression was used to explore the long‐term association between SMP and composite outcomes (all‐cause mortality, end‐stage kidney disease (ESKD), ≥ 50% decline in estimated glomerular filtration rate (eGFR), or doubling of serum creatinine (SCr) from baseline). Linear mixed‐effects (LME) model and marginal means comparisons were used to surrogate indicators analysis. Results The study included 1160 patients with a median follow‐up of 27.20 months. Among them, 580 individuals were in the SMP group and 580 were in the non‐SMP group. In the non‐SMP group, the median follow‐up was 24.48 (12.21, 43.39) months with 174 (30.00%) events, whereas the SMP group had a median follow‐up of 29.34 (14.75, 42.00) months with 134 (23.10%) composite outcomes. Participation in a SMP program was associated with a 30.9% reduction in CKD progression risk (hazard ratio (HR) of composite outcome: 0.691, 95% CI: 0.549–0.869, and p = 0.002). LME and marginal means comparison indicated that patients with SMP had higher mean difference of eGFR and serum albumin (Alb) than the non‐SMP individuals (mean difference of eGFR: 1.791 (0.721, 2.861) mL/min/1.73 m 2 , p = 0.001; marginal mean difference of eGFR: 2.560 (1.660, 3.470) mL/min/1.73 m 2 , p < 0.0001; mean difference of Alb: 0.654 (0.202, 1.105) g/L, p = 0.005; and marginal mean difference of Alb: 0.460 (0.166, 0.753) g/L, p = 0.002). Conclusion SMP programs are associated with a 30.9% reduction in CKD progression risk and improvements in kidney function and nutrition‐related surrogate markers, benefiting CKD patients in stages 3‐4.