Nonmedical Factors and Health-Related Quality of Life in CKD in India

Abstract

Background and objectives: Patient-reported outcomes have gained prominence in the management of chronic noncommunicable diseases. Measurement of health-related quality of life is being increasingly incorporated into medical decision making and health care delivery processes.

Design, setting, participants, & measurements: The Indian Chronic Kidney Disease Study is a prospective cohort of participants with mild to moderate CKD. Baseline health-related quality of life scores, determined by the standardized Kidney Disease Quality of Life 36 item instrument, are presented for the inception cohort (n=2919). Scores are presented on five subscales: mental component summary, physical component summary, burden, effect of kidney disease, and symptom and problems; each is scored 0-100. The associations of socioeconomic and clinical parameters with the five subscale scores and lower quality of life (defined as subscale score <1 SD of the sample mean) were examined. The main socioeconomic factors studied were sex, education, occupation, and income. The key medical factors studied were age, eGFR, diabetes, hypertension, and albuminuria.

Results: The mean (SD) subscale scores were physical component summary score, 43±9; mental component summary score, 48±10; burden, 61±33; effects, 87±13; and symptoms, 90±20. Among the socioeconomic variables, women, lower education, and lower income were negatively associated with reduced scores across all subscales. For instance, the respective β-coefficients (SD) for association with the physical component summary subscale were -2.6 (-3.4 to -1.8), -1.5 (-2.2 to -0.7), and -1.6 (-2.7 to -0.5). Medical factors had inconsistent or no association with subscale scores. The quality of life scores also displayed regional variations.

Conclusions: In this first of its kind analysis from India, predominantly socioeconomic factors were associated with quality of life scores in patients with CKD.

Keywords: India; KDQOL; albuminuria; chronic kidney disease; chronic renal insufficiency; clinical decision making; diabetes mellitus; factor V, prospective studies; female; glomerular filtration rate; humans; hypertension; noncommunicable diseases; occupations; patient reported outcome measures; quality of life; socioeconomic factors.

Graphical abstract

Figure 1.

Distribution of Kidney Disease Quality of Life scores and lower quality of life subscale scores across different centers. Lower quality of life defined as score 1 SD below the mean. MCS, mental component summary; PCS, physical component summary.

Figure 2.

Forest plot showing the association of lower quality of life with socioeconomic and clinical characteristics. The odds ratios are from a multivariable logistic regression including the factors center (except for impaired symptoms score), place of residence, sex, age, educational attainment, annual household income, occupation, occupational exposure (to sand, dust, working barefoot in field, animals, chemicals, etc.), current diet, tobacco use, body mass index (BMI), history of hypertension, diabetes status, history of cardiovascular disease (CVD), alternative drug use, albuminuria, and eGFR.