Health-related quality of life in different stages of chronic kidney disease and at initiation of dialysis treatment

Abstract

Objectives: To evaluate health-related quality of life (HRQoL) in patients in different stages of chronic kidney disease (CKD) up to initiation of dialysis treatment and to explore possible correlating and influencing factors.

Methods: Cross-sectional design with 535 patients in CKD stages 2-5 and 55 controls assessed for HRQoL through SF-36 together with biomarkers.

Results: All HRQoL dimensions deteriorated significantly with CKD stages with the lowest scores in CKD 5. The largest differences between the patient groups were seen in 'physical functioning', 'role physical', 'general health' and in physical summary scores (PCS). The smallest disparities were seen in mental health and pain. Patients in CKD stages 2-3 showed significantly decreased HRQoL compared to matched controls, with differences of large magnitude - effect size (ES) ≥ .80 - in 'general health' and PCS. Patients in CDK 4 demonstrated deteriorated scores with a large magnitude in 'physical function', 'general health' and PCS compared to the patients in CKD 2-3. Patients in CKD 5 demonstrated deteriorated scores with a medium sized magnitude (ES 0.5 - 0.79) in 'role emotional' and mental summary scores compared to the patients in CKD 4. Glomerular filtration rate <45 ml/min/1.73 m², age ≥ 61 years, cardiovascular disease (CVD), diabetes, C-reactive protein (CRP) ≥5 mg/L, haemoglobin ≤110 g/L, p-albumin ≤ 35 g/L and overweight were associated with impaired HRQoL. CRP and CVD were the most important predictors of impaired HRQoL, followed by reduced GFR and diabetes.

Conclusions: Having CKD implies impaired HRQoL, also in earlier stages of the disease. At the time for dialysis initiation HRQoL is substantially deteriorated. Co-existing conditions, such as inflammation and cardiovascular disease seem to be powerful predictors of impaired HRQoL in patients with CKD. Within routine renal care, strategies to improve function and well-being considering the management of co-existing conditions like inflammation and CVD need to be developed.

Figure 1

HRQoL domains and summary scores (M) in different stages of Chronic Kidney Disease (CKD). PF = Physical functioning, RP = Role physical, BP = Bodily pain, GH = General health, VT = Vitality, SF = Social functioning, RE = Role emotional, MH = Mental health, PCS = Physical summary scores, MCS = Mental summary scores.

Figure 2

Mean Physical Composite summary (PCS) and Mental Composite Summay (MCS) scores related to declining levels of kidney function/Glomerular Filtration Rate (GFR), ml/min/1.73 m². GFR span <50 > 30 not shown, since it was covered by only one patient.

Figure 3

Effect Sizes in HRQoL domains and summary scores (M) in different stages of Chronic Kidney Disease (CKD) and in controls. PF = Physical functioning, RP = Role physical, BP = Bodily pain, GH = General health, VT = Vitality, SF = Social functioning, RE = Role emotional, MH = Mental health, PCS = Physical summary scores, MCS = Mental summary scores.