{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:31:56Z","timestamp":1786480316321,"version":"build-2736575974"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Living arrangements did not significantly modify the overall association between diabetes and mortality among hemodialysis patients in Japan.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>In women aged 65\u201389 years, hemodialysis patients living with others had significantly higher mortality risks than those living with a spouse.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Frequent clinic visits and lifestyle support by medical staff may facilitate diabetes management and mitigate social isolation.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Living arrangements, such as living alone or with a spouse, may affect mortality risk in hemodialysis patients with diabetes. This study investigated whether living arrangements modify the association between diabetes and mortality in community-dwelling hemodialysis patients in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from 27 outpatient dialysis units, this retrospective cohort study analyzed 2799 community-dwelling hemodialysis patients (women: 33.7%) aged 40\u201389 years between April 2016 and March 2021. Each patient was placed into one of three categories according to living arrangements: living alone, with a spouse, or with others (excluding spouses). Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. Interaction analyses were performed to assess the potential effect measure modification of the association between diabetes and mortality by living arrangements. The analyses were also conducted according to sex and age groups (40\u201364 and 65\u201389 years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 835 deaths were observed during a mean follow-up period of 3.9 years. Diabetes showed a significantly higher mortality risk (HR, 1.63; 95% CI, 1.42 to 1.89) in all patients. However, patients living alone did not have a significantly higher mortality risk than those living with a spouse (HR, 1.04; 95% CI, 0.87 to 1.24). There was no significant interaction between diabetes and living arrangements (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.73). Women aged 65\u201389 years who were living with others had a significantly higher mortality risk than those living with a spouse (HR, 1.41; 95% CI, 1.04 to 1.92).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Living arrangements did not modify the association between diabetes and mortality in community-dwelling hemodialysis patients. Frequent clinic visits and lifestyle support by medical staff related to hemodialysis treatment may have facilitated diabetes management and mitigated the negative influence of social isolation, thereby reducing mortality risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0000000784","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T12:10:41Z","timestamp":1743682241000},"page":"1357-1363","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Association between Diabetes and Mortality Is Not Modified by Living Arrangements in Hemodialysis Patients in Japan"],"prefix":"10.34067","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9319-3908","authenticated-orcid":false,"given":"Mutsumi","family":"Uesugi","sequence":"first","affiliation":[{"name":"Department of Medical Statistics, Toho University Graduate School of Medicine, Tokyo, Japan"},{"name":"Department of Rehabilitation, Eikokai Kojiya Renal Clinic, Zenjinkai Group, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7696-3717","authenticated-orcid":false,"given":"Anna","family":"Tsutsui","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, Faculty of Medicine, Toho University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitaka","family":"Murakami","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, Faculty of Medicine, Toho University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"issue":"6","key":"B1-20250828","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1038\/s41581-022-00542-7","article-title":"Epidemiology of haemodialysis outcomes","volume":"18","author":"Bello","year":"2022","journal-title":"Nat Rev Nephrol."},{"issue":"18","key":"B2-20250828","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1001\/jama.2017.4046","article-title":"Assessment of global kidney health care status","volume":"317","author":"Bello","year":"2017","journal-title":"JAMA."},{"issue":"3","key":"B3-20250828","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1053\/j.ajkd.2020.05.030","article-title":"Hemodialysis use and practice patterns: an international survey study","volume":"77","author":"Htay","year":"2021","journal-title":"Am J Kidney Dis."},{"issue":"3","key":"B4-20250828","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1159\/000441816","article-title":"Hemodialysis in Asia","volume":"1","author":"Prasad","year":"2015","journal-title":"Kidney Dis."},{"issue":"2","key":"B5-20250828","doi-asserted-by":"crossref","first-page":"54","DOI":"10.3121\/cmr.2020.1541","article-title":"Age, gender and diabetes as risk factors for early mortality in dialysis patients: a systematic review","volume":"19","author":"Hazara","year":"2021","journal-title":"Clin Med Res."},{"key":"B6-20250828","doi-asserted-by":"crossref","first-page":"e930152","DOI":"10.12659\/MSM.930152","article-title":"Risk factors associated with all-cause death among dialysis patients with diabetes","volume":"27","author":"Grzywacz","year":"2021","journal-title":"Med Sci Monit."},{"issue":"9","key":"B7-20250828","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1097\/01.ASN.0000081662.64171.9B","article-title":"Different impact of biomarkers as mortality predictors among diabetic and nondiabetic patients undergoing hemodialysis","volume":"14","author":"Hocher","year":"2003","journal-title":"J Am Soc Nephrol."},{"issue":"5S","key":"B8-20250828","first-page":"S1","article-title":"KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease","volume":"102","year":"2022","journal-title":"Kidney Int."},{"issue":"suppl 1","key":"B9-20250828","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/1744-9987.12299","article-title":"Best practice for diabetic patients on hemodialysis 2012","volume":"19","author":"Nakao","year":"2015","journal-title":"Ther Apher Dial."},{"issue":"12","key":"B10-20250828","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.2337\/dci22-0027","article-title":"Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"45","author":"de Boer","year":"2022","journal-title":"Diabetes Care."},{"issue":"7","key":"B11-20250828","doi-asserted-by":"crossref","first-page":"e1000316","DOI":"10.1371\/journal.pmed.1000316","article-title":"Social relationships and mortality risk: a meta-analytic review","volume":"7","author":"Holt-Lunstad","year":"2010","journal-title":"PLoS Med."},{"issue":"2","key":"B12-20250828","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1177\/1745691614568352","article-title":"Loneliness and social isolation as risk factors for mortality: a meta-analytic review","volume":"10","author":"Holt-Lunstad","year":"2015","journal-title":"Perspect Psychol Sci."},{"issue":"1","key":"B13-20250828","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1749-6632.2011.06028.x","article-title":"Social isolation","volume":"1231","author":"Cacioppo","year":"2011","journal-title":"Ann N Y Acad Sci."},{"key":"B14-20250828","doi-asserted-by":"crossref","first-page":"101677","DOI":"10.1016\/j.eclinm.2022.101677","article-title":"Living alone and all-cause mortality in community-dwelling adults: a systematic review and meta-analysis","volume":"54","author":"Zhao","year":"2022","journal-title":"EClinicalMedicine."},{"issue":"14","key":"B15-20250828","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1001\/archinternmed.2012.2782","article-title":"Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis","volume":"172","author":"Udell","year":"2012","journal-title":"Arch Intern Med."},{"key":"B16-20250828","doi-asserted-by":"crossref","first-page":"100826","DOI":"10.1016\/j.ssmph.2021.100826","article-title":"Living alone as a risk factor for cancer incidence, case-fatality and all-cause mortality: a nationwide registry study","volume":"15","author":"Elovainio","year":"2021","journal-title":"SSM Popul Health."},{"issue":"5","key":"B17-20250828","doi-asserted-by":"crossref","first-page":"e2214181","DOI":"10.1001\/jamanetworkopen.2022.14181","article-title":"Association of marital status with total and cause-specific mortality in Asia","volume":"5","author":"Leung","year":"2022","journal-title":"JAMA Netw Open."},{"key":"B18-20250828","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/1471-2458-7-73","article-title":"Marital status and mortality among Japanese men and women: the Japan Collaborative Cohort Study","volume":"7","author":"Ikeda","year":"2007","journal-title":"BMC Public Health."},{"issue":"5","key":"B19-20250828","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s00038-020-01371-w","article-title":"Marital status, living arrangements, and mortality in middle and older age in Europe","volume":"65","author":"Zueras","year":"2020","journal-title":"Int J Public Health."},{"key":"B20-20250828","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s41256-020-00133-8","article-title":"Sex differences in the association between marital status and the risk of cardiovascular, cancer, and all-cause mortality: a systematic review and meta-analysis of 7,881,040 individuals","volume":"5","author":"Wang","year":"2020","journal-title":"Glob Health Res Policy."},{"issue":"1","key":"B21-20250828","doi-asserted-by":"crossref","first-page":"142","DOI":"10.2215\/CJN.02340310","article-title":"The associations of social support and other psychosocial factors with mortality and quality of life in the dialysis outcomes and practice patterns study","volume":"6","author":"Untas","year":"2011","journal-title":"Clin J Am Soc Nephrol."},{"issue":"3","key":"B22-20250828","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1093\/ndt\/gfl700","article-title":"Social support predicts survival in dialysis patients","volume":"22","author":"Thong","year":"2007","journal-title":"Nephrol Dial Transplant."},{"issue":"4","key":"B23-20250828","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1093\/ndt\/gfs547","article-title":"Associations of marital status with mortality from all causes and mortality from cardiovascular disease in Japanese haemodialysis patients","volume":"28","author":"Tanno","year":"2013","journal-title":"Nephrol Dial Transplant."},{"issue":"6","key":"B24-20250828","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.semnephrol.2021.10.009","article-title":"Social support, caregivers, and chronic kidney disease","volume":"41","author":"Fuertes","year":"2021","journal-title":"Semin Nephrol."},{"issue":"6","key":"B25-20250828","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1037\/amp0000066","article-title":"Close relationships and the management of chronic illness: associations and interventions","volume":"72","author":"Martire","year":"2017","journal-title":"Am Psychol."},{"key":"B26-20250828","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1186\/1471-2458-7-335","article-title":"Living alone is a risk factor for mortality in men but not women from the general population: a prospective cohort study","volume":"7","author":"Kandler","year":"2007","journal-title":"BMC Public Health."},{"issue":"2","key":"B27-20250828","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1111\/spc3.12087","article-title":"Social relationships and health: the toxic effects of perceived social isolation","volume":"8","author":"Cacioppo","year":"2014","journal-title":"Soc Personal Psychol Compass."},{"issue":"4","key":"B28-20250828","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1681\/ASN.V441028","article-title":"Social support and subsequent mortality among patients with end-stage renal disease","volume":"4","author":"McClellan","year":"1993","journal-title":"J Am Soc Nephrol."},{"issue":"10","key":"B29-20250828","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/S0277-9536(98)00437-7","article-title":"Family structure and patient survival in an African-American end-stage renal disease population: a preliminary investigation","volume":"48","author":"Turner-Musa","year":"1999","journal-title":"Soc Sci Med."},{"issue":"6","key":"B30-20250828","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1037\/0278-6133.13.6.521","article-title":"Predictors of survival among hemodialysis patients: effect of perceived family support","volume":"13","author":"Christensen","year":"1994","journal-title":"Health Psychol."},{"issue":"3","key":"B31-20250828","doi-asserted-by":"crossref","first-page":"539","DOI":"10.2337\/dc09-1298","article-title":"Relationship styles and mortality in patients with diabetes","volume":"33","author":"Ciechanowski","year":"2010","journal-title":"Diabetes Care."},{"issue":"2","key":"B32-20250828","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1177\/0145721707299265","article-title":"Social support and mortality among older persons with diabetes","volume":"33","author":"Zhang","year":"2007","journal-title":"Diabetes Educ."},{"issue":"2","key":"B33-20250828","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/j.1525-139X.2005.18203.x","article-title":"The impact of social support on end-stage renal disease","volume":"18","author":"Patel","year":"2005","journal-title":"Semin Dial."},{"issue":"4","key":"B34-20250828","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1046\/j.1523-1755.2001.0590041599.x","article-title":"Psychosocial factors in dialysis patients","volume":"59","author":"Kimmel","year":"2001","journal-title":"Kidney Int."},{"issue":"10302","key":"B35-20250828","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/S0140-6736(21)00519-5","article-title":"Chronic kidney disease","volume":"398","author":"Kalantar-Zadeh","year":"2021","journal-title":"Lancet."},{"issue":"6","key":"B36-20250828","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1111\/1744-9987.12418","article-title":"Influence of staff encouragement on perceived burden of dietary restriction among patients living alone","volume":"20","author":"Ikenoue","year":"2016","journal-title":"Ther Apher Dial."},{"issue":"1","key":"B37-20250828","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1186\/s12882-021-02543-3","article-title":"Changes in practice patterns in Japan from before to after JSDT 2013 guidelines on hemodialysis prescriptions: results from the JDOPPS","volume":"22","author":"Tomo","year":"2021","journal-title":"BMC Nephrol."},{"issue":"2","key":"B38-20250828","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1093\/intqhc\/mzi010","article-title":"Frequency of patient-physician contact in chronic kidney disease care and achievement of clinical performance targets","volume":"17","author":"Plantinga","year":"2005","journal-title":"Int J Qual Health Care."},{"issue":"2","key":"B39-20250828","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.kint.2017.02.008","article-title":"Unique hemoglobin A1c level distribution and its relationship with mortality in diabetic hemodialysis patients","volume":"92","author":"Hoshino","year":"2017","journal-title":"Kidney Int."},{"issue":"4","key":"B40-20250828","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.pec.2015.10.029","article-title":"Social support and self-management capabilities in diabetes patients: an international observational study","volume":"99","author":"Koetsenruijter","year":"2016","journal-title":"Patient Educ Couns."},{"issue":"6","key":"B41-20250828","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s11892-012-0317-0","article-title":"The impact of social support on outcomes in adult patients with type 2 diabetes: a systematic review","volume":"12","author":"Strom","year":"2012","journal-title":"Curr Diab Rep."},{"key":"B42-20250828","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.socscimed.2016.12.004","article-title":"Neighbourly support of people with chronic illness is related to neighbourhood social capital?","volume":"173","author":"Waverijn","year":"2017","journal-title":"Soc Sci Med."},{"key":"B43-20250828","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1146\/annurev-soc-073014-112428","article-title":"Marriage and family in East Asia: continuity and change","volume":"41","author":"Raymo","year":"2015","journal-title":"Annu Rev Sociol."}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000000784","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:03:06Z","timestamp":1786478586000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000000784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,3]]},"references-count":43,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0000000784","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,3]]},"assertion":[{"value":"2024-11-23","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}