Psychosocial stress and changes in estimated glomerular filtration rate among adults with diabetes mellitus.
BACKGROUND
Psychosocial stress has been hypothesized to impact renal changes, but this hypothesis has not been adequately tested. The aim of this study was to examine the relationship between psychosocial stress and estimated glomerular filtration rate (eGFR) and to examine other predictors of eGFR changes among persons with diabetes mellitus (DM).


METHODS
Data from a survey conducted in 2005 by a major health maintenance organization located in the southeastern part of the United States, linked to patients' clinical and pharmacy records (n=575) from 2005 to 2008, was used. Study participants were working adults aged 25-59 years, diagnosed with DM but without advanced microvascular or macrovascular complications. eGFR was estimated using the Modification of Diet in Renal Disease equation. A latent psychosocial stress variable was created from five psychosocial stress subscales. Using a growth factor model in a structural equation framework, we estimated the association between psychosocial stress and eGFR while controlling for important covariates.


RESULTS
The psychosocial stress variable was not directly associated with eGFR in the final model. Factors found to be associated with changes in eGFR were age, race, insulin use, and mean arterial pressure.


CONCLUSIONS
Among fairly healthy DM patients, we did not find any evidence of a direct association between psychosocial stress and eGFR changes after controlling for important covariates. Predictors of eGFR change in our population included age, race, insulin use, and mean arterial pressure.
School of Public Health, Georgia State University, Atlanta, GA, USA.
Francis B
FB
Annor
School of Public Health, Georgia State University, Atlanta, GA, USA.
Katherine E
KE
Masyn
School of Public Health, Georgia State University, Atlanta, GA, USA.
Ike S
IS
Okosun
School of Public Health, Georgia State University, Atlanta, GA, USA ; Center for Health Research, Kaiser Permanente Georgia, Atlanta, GA, USA.
Douglas W
DW
Roblin
Department of Epidemiology, Emory University, Atlanta, GA, USA.
Michael
M
Goodman
Diabetes mellitus; Estimated glomerular filtration rate; Psychosocial stress; Renal decline