Impaired kidney function is associated with lower quality of life among community-dwelling older adults

Abstract

Background Quality of life (QoL) refers to the physical, psychological, social and medical aspects of life that are influenced by health status and function. The purpose of this study was to measure the self-perceived health status among the elderly population across Europe in different stages of Chronic Kidney Disease (CKD). Methods Our series consisted of 2255 community-dwelling older adults enrolled in the Screening for Chronic Kidney Disease (CKD) among Older People across Europe (SCOPE) study. All patients underwent a comprehensive geriatric assessment (CGA), including included demographics, clinical and physical assessment, number of medications taken, family arrangement, Geriatric Depression Scale (GDS), Cumulative Illness Rating Scale, History of falls, Lower urinary tract symptoms, and Short Physical Performance Battery (SPPB). Estimated glomerular filtration rate (eGFR) was calculated by Berlin Initiative Study (BIS) equation. Quality of life was assessed by Euro Qol questionnaire (Euro-Qol 5D) and EQ-Visual Analogue Scale (EQ-VAS). The association between CKD (eGFR < 60, < 45 ml or < 30 ml/min/1.73m2) and low EQoL-VAS was investigated by multivariable logistic regression models. Results CKD was found to be significantly associated with low EQoL-VAS in crude analysis (OR = 1.47, 95%CI = 1.16–1.85 for eGFR< 60; OR = 1.38, 95%CI = 1.08–1.77 for eGFR< 45; OR = 1.57, 95%CI = 1.01–2.44). Such association was no longer significant only when adjusting for SPPB (OR = 1.20, 95%CI = 0.93–1.56 for eGFR< 60; OR = 0.87, 95%CI = 0.64–1.18 for eGFR< 45; OR = 0.84, 95%CI = 0.50–1.42), CIRS and polypharmacy (OR = 1.16, 95%CI = 0.90–1.50 for eGFR< 60; OR = 0.86, 95%CI = 0.64–1.16 for eGFR< 45; OR = 1.11, 95%CI = 0.69–1.80) or diabetes, hypertension and chronic obstructive pulmonary disease (OR = 1.28, 95%CI = 0.99–1.64 for eGFR< 60; OR = 1.16, 95%CI = 0.88–1.52 for eGFR< 45; OR = 1.47, 95%CI = 0.92–2.34). The association between CKD and low EQoL-VAS was confirmed in all remaining multivariable models. Conclusions CKD may significantly affect QoL in community-dwelling older adults. Physical performance, polypharmacy, diabetes, hypertension and COPD may affect such association, which suggests that the impact of CKD on QoL is likely multifactorial and partly mediated by co-occurrent conditions/risk factors.

Health-Related Quality of Life according to Renal Function: Results from a Nationwide Health Interview and Examination Survey

“…However, we have shown that the distinction between categories G3a and G3b might be important as already in category G3a both physical HRQoL and the perceived general state of health are reduced significantly. In accordance with “the screening for CKD among older people across Europe” (SCOPE) study, we were able to prove that already in category G3a HRQoL is impaired significantly [26]. However, in contrast to the SCOPE Study which analyzed a geriatric cohort (>75 years), we could also detect the negative effect on HRQoL in a population aged 40–79 years.…”

“…The association of the less severe stages of CKD with HRQoL remains largely unclear as the majority of studies are not population-based and have not classified renal function according to KDIGO guidelines into 5 categories (G1–G5) [3, 18-24]. Some studies could detect impairment in HRQoL in the early stages of CKD [3, 11, 18, 25, 26]. Other studies could not confirm this finding [27] or results were not significant after adjusting for confounders [11, 19, 20, 27].…”

“…Panuccio et al [29] showed that merely the general state of health decreases as CKD progresses whereas mental or physical HRQoL are not affected by a declining kidney function. Only few studies assessed all these measures of HRQoL in a population-based sample [26, 30]. Hence, the objective of our study was to analyze both mental and physical HRQoL and perceived general state of health according to glomerular filtration rate (GFR) categories in a large and representative sample of adults aged 40–79 years living in Germany.…”

Quality of life and cognitive assessment in healthy older Asian people with early and moderate chronic kidney disease: The NAHSIT 2013–2016 and validation study

“…For quality of life assessment, our participants showed no obvious deficits in vitality, social functioning, emotional role, and mental health, except for physical role function. Our analysis was mostly consistent with a recent study [ 42 ] employing the EQ-VAS, which showed impaired self-perceived quality of life in patients at CKD stages 3a, 3b, and 4 before and after adjusting for sociodemographic factors. However, the EQ-VAS is a multifactorial scale, which was scored by asking the participants to indicate their health state in a range from 0 (worst) to 100 (best).…”

“…However, few studies have investigated the association between quality of life and the early and moderate stages of CKD. We found that these studies exhibited inconsistent results: (1) a cross-sectional study of ≥60 year-old participants in North California [ 40 ] showed no relationship between eGFR and quality of life scores in physical and mental dimensions after adjustment for medical comorbidities; (2) a cross-sectional study including ≥50 year-old Irish participants [ 41 ] showed that reduced scores in quality of life are associated with eGFR by serum cystatin rather than creatinine; and (3) a recent cross-sectional study [ 42 ] enrolled 2,255 older adults in European countries and found that early CKD at stages 3a and 3b, defined by the BIS equation, is associated with lower quality of life on the EQ-Visual Analogue Scale (EQ-VAS). To our knowledge, there is a lack of relevant research on ethnic Han Chinese as well.…”