Association of anemia and mineral and bone disorder with health-related quality of life in Asian pre-dialysis patients

Abstract

BackgroundPatients with chronic kidney disease (CKD) have poor health-related quality of life (HRQoL). The association of CKD-related complications such as anemia and mineral and bone disorders (MBD) with HRQoL in pre-dialysis patients is not well-studied. As such, this study aimed to determine the association of anemia and MBD with HRQoL in pre-dialysis patients.MethodsThis was a cross-sectional study involving 311 adult pre-dialysis patients with stage 3–5 CKD from an acute-care hospital in Singapore. Patients’ HRQoL were assessed using Kidney Disease Quality of Life Short Form (KDQOL-SF™) and EuroQol 5 Dimensions–3 levels (EQ5D-3L). HRQoL between patients with and without anemia or MBD were compared by separate hierarchical multiple linear regression analyses using various HRQoL scales as dependent variables, adjusted for sociodemographic, clinical and psychosocial variables.ResultsAfter adjusting for MBD, anemia was associated with lower HRQoL scores on work status (WS), physical functioning (PF) and role physical [β (SE): −10.9 (4.18), p = 0.010; −3.0 (1.28), p = 0.018; and −4.2 (1.40), p = 0.003, respectively]. However, significance was lost after adjustments for sociodemographic variables. Patients with MBD had poorer HRQoL with respect to burden of kidney disease, WS, PF and general health [(β (SE): −7.9 (3.88), p = 0.042; −9.5 (3.99), p = 0.018; −3.0 (1.22) p = 0.014; −3.6 (1.48), p = 0.015, respectively]. Although these remained significant after adjusting for sociodemographic variables, significance was lost after adjusting for clinical variables, particularly pill burden. This is of clinical importance due to the high pill burden of CKD patients, especially from medications for the management of multiple comorbidities such as cardiovascular and mineral and bone diseases.ConclusionsNeither anemia nor MBD was associated with HRQoL in our pre-dialysis patients. Instead, higher total daily pill burden was associated with worse HRQoL. Medication reconciliation should therefore be routinely performed by clinicians and pharmacists to reduce total daily pill burden where possible.

Medication Adherence, Burden and Health-Related Quality of Life in Adults with Predialysis Chronic Kidney Disease: A Prospective Cohort Study

“…This may also strengthen our prior hypothesis, i.e., that regimen complexity could serve as a proxy measure of overall health in patients with CKD [38]. Also, an inverse relationship between medication burden and HRQOL has been previously reported in predialysis patients with CKD [13].…”

“…Nevertheless, there is limited data on patient-centred outcomes in people with advanced CKD [9][10][11], particularly in those not receiving renal replacement therapy [12]. More importantly, the relationship between HRQOL and medication-related factors, such as medication burden and adherence, is relatively under-examined in this patient group [13].…”

Chronic Kidney Disease: Exploring Value-Based Healthcare as a Potential Viable Solution

“…The typical CKD (stage 3-5) patient today is 65 years or older, presents with multiple co-morbid conditions such as hypertension and/or diabetes, having a pill burden of on average 11 medications per day and is hospitalized for 6-11 days per year [17][18][19][20][21][22][23]. Therefore, the treatment of CKD patients represents a substantial economic burden to health systems, especially when patients acquire the end-stage kidney disease (ESKD) [24,25].…”

“…As mentioned in the introduction, CKD has 5 stages, with a higher care requirement from stage 3 onwards [44,45]. In particular, hospitalization and medication utilization increase significantly due to a higher incidence of cardiovascular events associated with renal progression [15,23].…”

“…In particular, for chronic diseases, this is essential, where evidence clearly shows that continuity and patient engagement are 2 main sources for improved therapy adherence [57]. Specifically for CKD patients the integrative aspect is essential, as a variety of caregivers are involved: (1) due to the health system set up (a CKD patient is first usually seen by a general practitioner before co-treatment with a nephrologist is established), (2) the high pill burden for a patient and (3) the majority of CKD patients have co-morbidities and are being treated by other care providers than nephrologists [20,23,58]. Additionally, as a CKD patient will be on different treatment options in their life, it is therefore crucial to determine the right modality for the right patient at the right time in the right location [46].…”