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. 2020 Oct 3;5(12):2264-2274.
doi: 10.1016/j.ekir.2020.09.028. eCollection 2020 Dec.

Health-Related Quality of Life in People Across the Spectrum of CKD

Anoushka Krishnan  1   2 , Armando Teixeira-Pinto  1 , Wai H Lim  2 , Kirsten Howard  1 , Jeremy R Chapman  3 , Antoni Castells  4 , Simon D Roger  5 , Michael J Bourke  6 , Petra Macaskill  1 , Gabrielle Williams  1 , Charmaine E Lok  7 , Fritz Diekmann  8 , Nicholas Cross  9 , Shaundeep Sen  1   10 , Richard D M Allen  11 , Steven J Chadban  11 , Carol A Pollock  12 , Robin Turner  1   13 , Allison Tong  1 , Jean Y H Yang  14 , Narelle Williams  1 , Eric Au  1 , Anh Kieu  1 , Laura James  1 , Anna Francis  1 , Germaine Wong  1   3 , Jonathan C Craig  15
Affiliations

Health-Related Quality of Life in People Across the Spectrum of CKD

Anoushka Krishnan et al. Kidney Int Rep. .

Abstract

Introduction: People with chronic kidney disease (CKD) experience reduced quality of life (QoL) because of the high symptom and treatment burden. Limited data exist on the factors associated with overall and domain-specific QoL across all CKD stages.

Methods: Using data from a prospective, multinational study (Australia, New Zealand, Canada, and Spain) in 1696 participants with CKD, we measured overall and domain-specific QoL (pain, self-care, activity, mobility, anxiety/depression) using the EuroQoL, 5 dimension, 3 level. Multivariable linear regression and logistic modeling were used to determine factors associated with overall and domain-specific QoL.

Results: QoL for patients with CKD stages 3 to 5 (n = 787; mean, 0.81; SD, 0.20) was higher than in patients on dialysis (n = 415; mean, 0.76; SD, 0.24) but lower than in kidney transplant recipients (n = 494; mean, 0.84; SD, 0.21). Factors associated with reduced overall QoL (β [95% confidence intervals]) included being on dialysis (compared with CKD stages 3-5: -0.06 [-0.08 to -0.03]), female sex (-0.03 [-0.05 to -0.006]), lower educational attainment (- 0.04 [-0.06 to -0.02), lacking a partner (-0.04 [-0.06 to -0.02]), having diabetes (-0.05 [-0.07 to -0.02]), history of stroke (-0.09 [-0.13 to -0.05]), cardiovascular disease (-0.06 [-0.08 to -0.03]), and cancer (-0.03 [-0.06 to -0.009]). Pain (43%) and anxiety/depression (30%) were the most commonly affected domains, with dialysis patients reporting decrements in all 5 domains. Predictors for domain-specific QoL included being on dialysis, presence of comorbidities, lower education, female sex, and lack of a partner.

Conclusions: Being on dialysis, women with CKD, those with multiple comorbidities, lack of a partner, and lower educational attainment were associated with lower QoL across all stages of CKD.

Keywords: EuroQoL-5D3L; chronic kidney disease; domain-specific QoL; quality of life.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Participant flowchart. ∗Sites, 11 centers across Australia, New Zealand, Canada, and Spain. CKD, chronic kidney disease; FIT, fecal immunohistochemistry test.
Figure 2
Figure 2
Quality of life in participants with chronic kidney disease (CKD), stratified by stage. EQ-5D, EuroQoL, 5 dimension.
Figure 3
Figure 3
Forest plot of overall quality of life (QoL) and QoL by chronic kidney disease (CKD) stage. ∗Multivariate-adjusted model; 1, compared with college/university; 2, compared with married/partnered; 3, compared with waitlisted; CI, confidence interval; ESA, erythropoiesis-stimulating agent.
Figure 4
Figure 4
Forest plot of domain-level quality of life. ∗Multivariate-adjusted model; 1, compared with college/university; 2, compared with married/partnered; CI, confidence interval; CKD, chronic kidney disease.
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