Physical, cognitive and emotional factors contributing to quality of life, functional health and participation in community dwelling in chronic kidney disease

Abstract

Background: Quality of life (QoL) impairment is a well-known consequence of chronic kidney disease (CKD). The factors influencing QoL and late life functional health are poorly examined.

Methods: Using questionnaires combined with neuropsychological examinations, we prospectively evaluated physical, cognitive, and emotional factors influencing QoL, functional health and participation in community dwelling in 119 patients with CKD stages 3-5 including hemodialysis (61.5±15.7years; 63% men) and 54 control patients of the same age without CKD but with similar cardiovascular risk profile.

Results: Compared with control patients, CKD patients showed impairment of the physical component of QoL and overall function, assessed by the SF-36 and LLFDI, whereas disability, assessed by LLFDI, was selectively impaired in CKD patients on hemodialysis. Multivariable linear regressions (forced entry) confirmed earlier findings that CKD stage (β = -0.24; p = 0.012) and depression (β = -0.30; p = 0.009) predicted the QoL physical component. Hitherto unknown, CKD stage (β = -0.23; p = 0.007), cognition (β = 0.20; p = 0.018), and depression (β = -0.51; <0.001) predicted disability assessed by the LLFDI, while age (β = -0.20; p = 0.023), male gender (B = 5.01; p = 0.004), CKD stage (β = -0.23; p = 0.005), stroke history (B = -9.00; p = 0.034), and depression (β = -0.41; p<0.001) predicted overall function. Interestingly, functional health deficits, cognitive disturbances, depression, and anxiety were evident almost only in CKD patients with coronary heart disease (found in 34.2% of CKD patients). The physical component of QoL and functional health decreased with age and depressive symptoms, and increased with cognitive abilities.

Conclusions: In CKD, QoL, functional health, and participation in community dwelling are influenced by physical, cognitive, and emotional factors, most prominently in coronary heart disease patients.

Figure 1. Quality of life, functional health and participation in community dwelling, cognition, depression and anxiety: Role of age, cognition and depressive symptoms.

Note that (A) QoL, functional health and participation in community dwelling, and cognitive performance decrease with age. (B) Patients with higher cognitive performance show better physical abilities. Patients with (C) higher depression scores show impairment in QoL and functional health. Data are means and standard deviations. Significance was evaluated by one-way ANOVA followed by Bonferroni (equal variances) or Games-Howell (non-equal variances) tests (in case of normally distributed data) or Kruskall-Wallis followed by Mann-Whitney tests with Bonferroni corrections (in case of non-normally distributed data). *p<0.05/**p<0.01. Cognitive compound score represents z-scores (calculated based on norm values generated in the control cohort), which cover ten neuropsychological tests. First tercile: <−0.620 z-scores, second tercile: −0.620≤×<−0.016 z-scores, third tercile: ≥−0.016 z-scores. CKD, chronic kidney disease; HADS, Hospital Anxiety and Depression Scale; LLFDI, Late-Life Function and Disability Instrument; SF-36, 36-Item Short Form Health Survey.

Figure 2. Quality of life, functional health and participation in community dwelling, cognition, depression and anxiety: Role of CKD and CHD.

Note that compared with control patients, CKD patients with CHD show impairment in all domains except the physical component of the SF-36. Such impairment is almost absent in patients without CHD. Data are means and standard deviations. Significance was evaluated by one-way ANOVA followed by Bonferroni (equal variances) or Games-Howell (non-equal variances) tests (in case of normally distributed data) or Kruskall-Wallis followed by Mann-Whitney tests with Bonferroni corrections (in case of non-normally distributed data). *p<0.05/**p<0.01. Cognitive compound score represents z-scores (calculated based on norm values generated in the control cohort), which cover ten neuropsychological tests. CHD, coronary heart disease; CKD, chronic kidney disease; HADS, Hospital Anxiety and Depression Scale; LLFDI, Late-Life Function and Disability Instrument; SF-36, 36-Item Short Form Health Survey.