Health-Related Quality of Life in People Across the Spectrum of CKD

Abstract

Introduction People with chronic kidney disease (CKD) experience reduced quality of life (QoL) because of the high symptom and treatment burden. Limited data exist on the factors associated with overall and domain-specific QoL across all CKD stages. Methods Using data from a prospective, multinational study (Australia, New Zealand, Canada, and Spain) in 1696 participants with CKD, we measured overall and domain-specific QoL (pain, self-care, activity, mobility, anxiety/depression) using the EuroQoL, 5 dimension, 3 level. Multivariable linear regression and logistic modeling were used to determine factors associated with overall and domain-specific QoL. Results QoL for patients with CKD stages 3 to 5 (n = 787; mean, 0.81; SD, 0.20) was higher than in patients on dialysis (n = 415; mean, 0.76; SD, 0.24) but lower than in kidney transplant recipients (n = 494; mean, 0.84; SD, 0.21). Factors associated with reduced overall QoL (β [95% confidence intervals]) included being on dialysis (compared with CKD stages 3–5: –0.06 [–0.08 to –0.03]), female sex (–0.03 [–0.05 to –0.006]), lower educational attainment (– 0.04 [–0.06 to –0.02), lacking a partner (–0.04 [–0.06 to –0.02]), having diabetes (–0.05 [–0.07 to –0.02]), history of stroke (–0.09 [–0.13 to –0.05]), cardiovascular disease (–0.06 [–0.08 to –0.03]), and cancer (–0.03 [–0.06 to –0.009]). Pain (43%) and anxiety/depression (30%) were the most commonly affected domains, with dialysis patients reporting decrements in all 5 domains. Predictors for domain-specific QoL included being on dialysis, presence of comorbidities, lower education, female sex, and lack of a partner. Conclusions Being on dialysis, women with CKD, those with multiple comorbidities, lack of a partner, and lower educational attainment were associated with lower QoL across all stages of CKD.

Alterations in symptoms and health‐related quality of life as kidney function deteriorates: A cross‐sectional study

“…Across CKD G3b to G5, both physical and mental HRQoL scores were lower than that of healthy population norms and both of these also decreased as kidney function declined. In contrast to other studies (Alam et al, 2019;Kalfoss et al, 2019;Krishnan et al, 2020), participants in this study who were receiving dialysis (either HD or PD) experienced slightly better physical HRQoL than those with CKD G5. This relatively higher total PCS score could be due to the younger age and higher percentage of men in the G5D group.…”

“…These impairments could be due to the increasing burden of symptoms, older age, advanced CKD grade, presence of comorbidities, prolonged duration of receiving dialysis as well as the functional limitations associated with kidney failure (Almutary et al, 2017;Brkovic et al, 2016;Raj et al, 2017). Several studies that investigated HRQoL at different CKD grades have found that there was a declining trend in HRQoL across the disease trajectory (Aggarwal et al, 2016;Kefale et al, 2019;Krishnan et al, 2020;Peng et al, 2017). Understanding the pattern of HRQoL across the disease trajectory would help clinicians to better support people who are at risk of experiencing impairments in HRQoL so that care to improve their wellbeing can be commenced proactively.…”

Quality of Life, Depression, and Anxiety in Patients Undergoing Renal Replacement Therapies in Saudi Arabia

“…Similarly, in Poland, a prospective study on a single-center evaluating QOL before Tx and one year after found that QOL improved after Tx for patients who were previously receiving PD or HD [ 37 ]. Additionally, a four-year multicountry cohort study with 1,685 patients comprising patients with CKD (not on dialysis), patients on dialysis (HD or PD), and transplanted patients found that QOL was highest among Tx and then CKD patients, and was worst among receivers of dialysis [ 38 ]. However, a systematic review reported that most studies found no significant differences in QOL among patients with ESRD receiving HD or PD treatment modalities [ 39 ].…”

Health-related quality of life in T1DM patients after high-dose cholecalciferol supplementation: data from a pilot clinical trial

“…Studies have shown that, among patients with CKD, HRQoL gradually declines as the disease progresses, with the worst HRQoL scores obtained when an advanced stage of kidney disease is reached [ 38 , 39 ]. When CKD coexists with diabetes an accentuated deterioration in HRQoL is expected [ 40 ]. However, few studies have examined this relationship in the early stages of CKD or attempted to incorporate albuminuria in this assessment.…”