Quality of life and psychosocial factors in African Americans with hypertensive chronic kidney disease

Abstract

Health-related quality of life (HRQOL) is poorly understood in patients with chronic kidney disease (CKD) prior to end-stage renal disease. The association between psychosocial measures and HRQOL has not been fully explored in CKD, especially in African Americans. We performed a cross-sectional analysis of HRQOL and its association with sociodemographic and psychosocial factors in African Americans with hypertensive CKD. There were 639 participants in the African American Study of Kidney Disease and Hypertension Cohort Study. The Short Form-36 was used to measure HRQOL. The Diener Satisfaction with Life Scale measured life satisfaction, the Beck Depression Inventory-II assessed depression, the Coping Skills Inventory-Short Form measured coping, and the Interpersonal Support Evaluation List-16 was used to measure social support. The mean participant age was 60 years at enrollment, and men comprised 61% of participants. Forty-two percent reported a household income less than $15,000/year. Higher levels of social support, coping skills, and life satisfaction were associated with higher HRQOL, whereas unemployment and depression were associated with lower HRQOL (P < 0.05). A significant positive association between higher estimated glomerular filtration rate (eGFR) was observed with the Physical Health Composite (PHC) score (P = 0.004) but not in the Mental Health Composite (MHC) score (P = 0.24). Unemployment was associated with lower HRQOL, and lower eGFR was associated with lower PHC. African Americans with hypertensive CKD with better social support and coping skills had higher HRQOL. This study demonstrates an association between CKD and low HRQOL, and it highlights the need for longitudinal studies to examine this association in the future.

Figure 1

a (top panel): Mean aggregate BDI-II (Beck Depression Inventory-II, open circles) and SWLS (Satisfaction with Life, closed circles) mean item scores (y axis) and standard deviations per quartile of MHC score. b (bottom panel): Mean aggregate BDI-II (Beck Depression Inventory-II, open circles) and SWLS (Satisfaction with Life, closed circles) mean item scores (y axis) and standard deviations per quartile of PHC score.

Figure 2

a (top panel): Mean aggregate ISEL (social support, open circles) and CSI-SF subscale (coping skills, closed circles=overall disengagement, X’s=overall engagement) scores (y axis) and standard deviations per quartile of MHC score. b (bottom panel): Mean aggregate ISEL (social support, open circles) and CSI-SF subscale (coping skills, closed circles=overall disengagement, X’s=overall engagement)) scores (y axis) and standard deviations per quartile of PHC score.