Uraemic symptom burden and clinical condition in women and men of ≥65 years of age with advanced chronic kidney disease: results from the EQUAL study

Investigators, Equal Study; Luijtgaarden, Moniek W.M. van de; Caskey, Fergus; Wanner, Christoph; Chesnaye, Nicholas C.; Postorino, Maurizio; Janmaat, Cynthia; Rao, Anirudh; Torino, Claudia; Klinger, Marian; Drechsler, Christiane; Heimbürger, Olof; Szymczak, Maciej; Evans, Marie; Dekker, Friedo W.; Jager, Kitty J.

doi:10.1093/ndt/gfy155

Cited by 24 publications

(24 citation statements)

References 47 publications

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“…It has been shown in multiple studies of hemodialysis patients that older age is associated with fatigue [2,10], so our sample weighted toward older patients may have overestimated fatigue presence in CKD-ND patients. Female sex has also been associated with fatigue [10], with women most frequently reporting fatigue and bone/joint pain as severe symptoms in one study of CKD-ND patients with an incident eGFR ≤20 mL/ min/1.73 m 2 [40]. We were unable to evaluate sex-based differences in our study comprised predominantly of men.…”

Section: Discussionmentioning

confidence: 80%

Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

et al. 2019

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Background: Fatigue, although common and associated with outcomes in dialysis-dependent chronic kidney disease (CKD), has not been studied in nondialysis chronic kidney disease (CKD-ND) patients. Methods: In this longitudinal cohort of 266 outpatients with CKD-ND stages 2–5, we measured self-reported fatigue on 3 scales-Quick Inventory of Depression Symptomatology-Self Report (QIDS-SR₁₆), Beck Depression Inventory-I (BDI-I), and short form 12 health survey (SF-12) questionnaires and evaluated the prespecified composite of progression to dialysis initiation, death, or hospitalization after 12 months. Logistic and linear regression assessed characteristics associated with fatigue. Survival analysis measured associations of fatigue with outcomes. Results: Mean age was 64.4 ± 12.0 years, and mean estimated glomerular filtration rate (eGFR) was 31.6 ± 16.7 mL/min/1.73 m². Fatigue was common, with 69.2% reporting fatigue on QIDS-SR₁₆ and 77.7% on BDI-I. Unemployment, comorbidities, use of antidepressant medications, and lower hemoglobin correlated with fatigue. There were 126 outcome events. Participants that reported any versus no fatigue on QIDS-SR₁₆ were more likely to reach the composite, hazard ratio (HR) 1.70 (95% CI 1.11–2.59), which persisted after adjusting for demographics, comorbidities, substance abuse, hemoglobin, albumin, eGFR, and calcium-phosphorus product, HR 1.63 (1.05–2.55). Fatigue severity by the SF-12 was also associated with outcomes independent of demographics, comorbidities, and substance abuse, HR per unit increase 1.18 (1.03–1.35). No association was observed with fatigue on the BDI-I. Conclusion: Fatigue affected about 2/3 of CKD-ND patients and associated with unemployment, comorbidities, antidepressant medication use, and anemia. Fatigue measured by the QIDS-SR₁₆ and SF-12 independently predicted outcomes in CKD patients. Eliciting the presence of fatigue may be a clinically significant prognostic assessment in CKD patients.

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Section: Discussionmentioning

confidence: 80%

Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

et al. 2019

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“…Small, single-center studies in patients with nondialysis CKD have shown wide variation in the prevalence of pruritus, ranging from 12% to 74% (10)(11)(12)(13)(14)(15). In a larger international study, over 50% of patients with advanced CKD suffered from itching, which was reported as severe among 11% and 18% of men and women, respectively (16).…”

Section: Introductionmentioning

confidence: 99%

Pruritus and Patient Reported Outcomes in Non-Dialysis CKD

Sukul¹,

Speyer

et al. 2019

CJASN

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Background and objectivesAmong patients on hemodialysis, pruritus has been associated with poorer mental and physical quality of life, sleep quality, depression, and mortality. We evaluated patients with nondialysis CKD to describe the prevalence of pruritus, identify associated factors, and investigate associations with patient-reported outcomes.Design, setting, participants, & measurementsUsing cross-sectional data from patient questionnaires in the CKD Outcomes and Practice Patterns Study (CKDopps), we asked patients with CKD stages 3–5 (nondialysis) from the United States, Brazil, and France to identify how much they were bothered by pruritus. Response options ranged from “not at all” to “extremely.” Log-Poisson regression, yielding prevalence ratios, was used to evaluate associations of moderate-to-extreme pruritus with patient characteristics, CKD stage, self-reported depression symptoms, and restless sleep. Mixed linear regression was used to examine associations between pruritus and physical and mental component summary scores, with lower scores indicating poorer quality of life.ResultsOf the 5658 CKDopps patients enrolled in the United States, Brazil, and France, 3780 (67%) answered the pruritus question. The prevalence of moderate-to-extreme pruritus was 24%, and more likely in older patients, women, and those with stage 5 CKD, lung disease, diabetes, and physician-diagnosed depression. In adjusted models, patients with moderate pruritus had physical and mental component summary scores 3.5 (95% confidence interval [95% CI], −4.6 to −2.3) and 2.3 (95% CI, −3.2 to −1.5) points lower, respectively, than patients without pruritus, and they also had a higher adjusted prevalence of patient-reported depression (prevalence ratio, 1.83; 95% CI, 1.58 to 2.11) and restless sleep (prevalence ratio, 1.69; 95% CI, 1.49 to 1.91) compared with patients without pruritus. These patient-reported outcomes were progressively worse with increasing severity of pruritus.ConclusionsOur findings demonstrate high prevalence of pruritus in nondialysis CKD, as well as strong associations of pruritus with poor health-related quality of life, self-reported depression symptoms, and self-reported poor sleep.

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“…Although it was the most common symptom in the non-KD group, ‘feeling tired’ was two to five times more likely to be reported in those with KD, suggesting that having KD increases the occurrence of this symptom. Feeling tired is often used interchangeably with the term ‘fatigue’ in research and this symptom, and its variations, is often reported as the most common symptom in KD [ 6 , 9 , 10 , 15 , 19 ]. Almutary et al [ 3 ] suggested that ‘fatigue or lack of energy’ has a weighted prevalence of 81% (49–100%) across all stages.…”

Section: Discussionmentioning

confidence: 99%

Differences in physical symptoms between those with and without kidney disease: a comparative study across disease stages in a UK population

et al. 2021

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Background Those living with kidney disease (KD) report extensive symptom burden. However, research into how symptoms change across stages is limited. The aims of this study were to 1) describe symptom burden across disease trajectory, and 2) to explore whether symptom burden is unique to KD when compared to a non-KD population. Methods Participants aged > 18 years with a known diagnosis of KD (including haemodialysis (HD) and peritoneal dialysis (PD)) and with a kidney transplant) completed the Leicester Kidney Symptom Questionnaire (KSQ). A non-KD group was recruited as a comparative group. Multinominal logistic regression modelling was used to test the difference in likelihood of those with KD reporting each symptom. Results In total, 2279 participants were included in the final analysis (age 56.0 (17.8) years, 48% male). The main findings can be summarised as: 1) the number of symptoms increases as KD severity progresses; 2) those with early stage KD have a comparable number of symptoms to those without KD; 3) apart from those receiving PD, the most frequently reported symptom across every other group, including the non-KD group, was ‘feeling tired’; and 4) being female independently increased the likelihood of reporting more symptoms. Conclusions Our findings have important implications for patients with KD. We have shown that high symptom burden is prevalent across the spectrum of disease, and present novel data on symptoms experienced in those without KD. Symptoms requiring the most immediate attention given their high prevalence may include pain and fatigue. Trial registration The study was registered prospectively as ISRCTN11596292.

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Uraemic symptom burden and clinical condition in women and men of ≥65 years of age with advanced chronic kidney disease: results from the EQUAL study

Abstract: Women in secondary care with an incident eGFR ≤20 mL/min/1.73 m2 reported a higher symptom burden, while their clinical state was considered similar or even more favourable as compared with men.

Cited by 24 publications

References 47 publications

Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

Pruritus and Patient Reported Outcomes in Non-Dialysis CKD

Differences in physical symptoms between those with and without kidney disease: a comparative study across disease stages in a UK population

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