Abstract Body (Do not enter title and authors here):
Background: Adults with chronic kidney disease (CKD) face a higher risk of hospitalization than the general population. Self-efficacy, an individual’s belief in their ability to manage their health, is a potentially modifiable factor that may reduce this risk.

Research Question/Hypothesis: We examined the association between self-efficacy and hospitalization risk in adults with CKD, hypothesizing that higher self-efficacy would be linked to lower hospitalization risk.

Methods: We analyzed data from the Chronic Renal Insufficiency Cohort study. Self-efficacy was assessed using the 5-item Manage Disease in General Scale, between 2013–2018. This scale evaluates participants’ confidence in managing tasks and activities related to their condition, seeking medical care, and coping with health-related emotional stress. Participants were followed until death, study withdrawal, or October 2024. Poisson regression was used to examine the association between self-efficacy and hospitalization risk, with stratification by sex and race/ethnicity. Models were adjusted for clinical center, age, sex, race/ethnicity, education, income, hypertension, diabetes, cardiovascular disease, estimated glomerular filtration rate, proteinuria, and frailty.

Results: Among 3,862 participants who completed the self-efficacy assessment (mean age [SD]: 65 [10] years; 44% female; 41% White, 42% Black, 13% Hispanic), 44% reported high self-efficacy (score ≥9 out of 10). Those with high self-efficacy were less likely to have low income, diabetes, or frailty. Over a mean follow-up of 7.2 years, 18,939 hospitalizations occurred (21% cardiovascular-related, 79% non-cardiovascular). In fully adjusted models, higher self-efficacy was associated with a lower risk of hospitalization in the full cohort (Incidence Rate Ratio [IRR]: 0.87; 95% CI: 0.84–0.91), as well as in men (IRR: 0.77; 95% CI: 0.74–0.81), and in Black (IRR: 0.90; 95% CI: 0.86–0.94), Hispanic (IRR: 0.82; 95% CI: 0.71–0.96), and White (IRR: 0.84; 95% CI: 0.79–0.89) subgroups.

Conclusion: In this large, diverse cohort of adults with CKD, higher self-efficacy was independently associated with a lower risk of hospitalization, even after adjusting for confounders. While these findings suggest a potential protective role of self-efficacy, residual confounding cannot be ruled out. Further research is needed to determine whether enhancing self-efficacy can causally reduce hospitalization risk in this high-risk population.