Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: analysis of multinational real-world data

Abstract

Background: Reductions in health-related quality of life (HRQoL) in patients with chronic kidney disease (CKD) are thought to be exacerbated by the low hemoglobin (Hb) levels that define anemia, a common complication of CKD. The current analysis evaluated the impact of anemia on HRQoL and work productivity in patients with non-dialysis dependent and dialysis-dependent CKD using real-world data.

Methods: Data were collected in France, Germany, Italy, Spain, the UK, the USA and China in 2012-2018 in the Adelphi Real World Disease Specific Programme™ for CKD, a large, cross-sectional, survey of physicians and their patients. Patients completed three patient-reported outcomes (PRO) instruments: the EuroQol 5-Dimension 3-level (EQ-5D-3 L), the Kidney Disease Quality of Life (KDQOL-36) instrument and the Work Productivity and Activity Impairment questionnaire. PROs were assessed by CKD stage and Hb levels, and regression analyses were performed with CKD stage and Hb level as independent variables and PROs as outcome variables, while adjusting for age, sex, CKD stage, comorbidities and cardiovascular risk.

Results: Overall, 5276 patients participated in the survey, including 28% stage 4 and 36% dialysis patients. Patients with lower Hb levels more often reported problems/issues on all EQ-5D-3 L domains (p < 0.0001). Regression analyses showed significant associations between lower Hb levels and the probability of low (< 0.8) EQ-5D-3 L utility scores (p < 0.0001) and low visual analog scale scores (p < 0.05), indicating poorer health status. Associations were seen even when adjusting for CKD stage and other potential confounding factors. Significant associations were observed between Hb level and the 12-Item Short-Form Health Survey (SF-12) Physical Component Summary, SF-12 Mental Component Summary and the three KDQOL-36 subscales (all p < 0.0001), and were confirmed using linear regression analyses adjusting for CKD stage and other potential confounders. Numerically greater work productivity losses and greater activity impairment were observed with lower Hb levels.

Conclusions: Lower Hb levels worsen the impact of CKD on HRQoL, and are associated with lower work productivity in patients with CKD. Assessment and treatment of anemia should be recognized as a key component of integral CKD management throughout all stages of the disease.

Keywords: Anemia; Chronic kidney disease; EQ-5D-3 L; Health-related quality of life; KDQOL-36; Patient-reported outcomes; Real-world.

Fig. 1

EQ-5D-3 L by Hb level and CKD stage. CI, confidence interval; CKD, chronic kidney disease; DD, dialysis-dependent; Hb, hemoglobin; NDD, non-dialysis dependent; VAS, visual analog scale

Fig. 2

Regression analyses^a. ^aThese figures use regression models to show how the outcome changes with changing Hb with all other covariates set to their mean values.^bPredictive margins with 95% CIs – shown separately for DD and NDD.^cPredictive margins of current stage with 95% CIs – shown separately for each CKD stage. CI, confidence interval; CKD, chronic kidney disease; Hb, hemoglobin; NDD, non-dialysis dependent; VAS, visual analog scale

Fig. 3

Regression analyses^a. ^aThese figures use regression models to show how the outcome changes with changing Hb with all other covariates set to their mean values. Predictive margins with 95% CIs are shown separately for DD and NDD^bSymptoms and problems with kidney disease subscale.^cEffects of kidney disease on daily life subscale.^dBurden of kidney disease subscale. CI, confidence interval; Hb, hemoglobin; NDD, non-dialysis dependent

Fig. 4

Regression analyses^a. ^aThese figures use regression models to show how the outcome changes with changing Hb with all other covariates set to their mean values. Predictive margins of current stage with 95% CIs are shown separately for each CKD stage^bSymptoms and problems with kidney disease subscale.^cEffects of kidney disease on daily life subscale.^dBurden of kidney disease subscale. CI, confidence interval; Hb, hemoglobin; NDD, non-dialysis dependent