CKD and Health-Related Quality of Life: The Korea National Health and Nutrition Examination Survey

Abstract

Background: Quality of life is increasingly viewed as an important health outcome. However, the association of chronic kidney disease (CKD) and its severity with health-related quality of life is uncertain.

Study design: Nationwide population-based cross-sectional study.

Setting & participants: 46,676 adults participating in the Korea National Health and Nutrition Examination Survey (KNHANES) 2005 to 2013.

Predictor: CKD ascertained as dipstick-positive proteinuria or estimated glomerular filtration rate (eGFR)<60mL/min/1.73m(2). 5 eGFR categories of CKD were compared: ≥90 (with proteinuria), 60 to 89 (with proteinuria), 45 to 59, 30 to 44, and <30mL/min/1.73m(2).

Outcomes: The EQ-5D index for health status (range, 0 [death] to 1 [optimal health]).

Results: The total crude CKD prevalence estimate for adults 20 years or older in Korea was 5.5%. After adjustments for age, sex, risk factors, and comorbid conditions, the EQ-5D index was lower in those with versus without CKD, with mean differences of -0.004 (95% CI, -0.015 to 0.007), -0.016 (95% CI, -0.032 to -0.000), -0.020 (95% CI, -0.029 to -0.011), -0.052 (95% CI, -0.072 to -0.032), and -0.067 (95% CI, -0.101 to -0.032), respectively, for CKD eGFR categories of ≥90, 60 to 89, 45 to 59, 30 to 44, and <30mL/min/1.73m(2). In the subgroup of older (≥60 years) individuals, the adjusted mean difference in the EQ-5D index was lower in the CKD eGFR category of 60 to 89mL/min/1.73m(2), but not in the eGFR category of 45 to 59mL/min/1.73m(2), compared to non-CKD.

Limitations: The survey was conducted on noninstitutionalized civilians, and the chronicity of kidney disease was not verified. Caution is required if our results are applied to special settings and specific populations.

Conclusions: There was a graded but complex association between CKD and poor health-related quality of life in this large community-based population.

Keywords: Health-related quality of life (HRQoL); Korea; chronic; chronic kidney disease (CKD); estimated glomerular filtration rate (eGFR); health status; health surveys; kidney failure; proteinuria; renal function.