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. 2022 Nov;17(11):1588-1597.
doi: 10.2215/CJN.06140522.

Five-Year Symptom Trajectories in Nondialysis-Dependent CKD Patients

Moustapha Faye  1 , Karine Legrand  2   3 , Lisa Le Gall  4   5 , Karen Leffondre  4   5 , Abdou Y Omorou  2   3 , Natalia Alencar de Pinho  6   7 , Christian Combe  8   9 , Denis Fouque  10 , Christian Jacquelinet  11 , Maurice Laville  12 , Sophie Liabeuf  13 , Ziad A Massy  6   7 , Elodie Speyer  6   7 , Roberto Pecoits Filho  14 , Bénédicte Stengel  6 , Luc Frimat  3   15 , Carole Ayav; CKD-REIN Study Group
Affiliations

Five-Year Symptom Trajectories in Nondialysis-Dependent CKD Patients

Moustapha Faye et al. Clin J Am Soc Nephrol. 2022 Nov.

Abstract

Background and objectives: Late stages of CKD are characterized by significant symptom burden. This study aimed to identify subgroups within the 5-year trajectories of symptom evolution in patients with CKD and to describe associated patient characteristics and outcomes.

Design, setting, participants, & measurements: Among 2787 participants (66% men) with eGFR <60 ml/min per 1.73 m2 enrolled in the CKD-Renal Epidemiology and Information Network (CKD-REIN) cohort study from July 2013 to May 2016, we assessed symptoms annually using the Kidney Disease Quality of Life-36 (KDQOL-36) questionnaire until December 2020. A total of 9121 measures were reported over follow-up; all participants had symptoms scored for at least one time point. We used a joint latent class-mixed model to distinguish profiles of symptom trajectories.

Results: Patient mean age (±SD) at baseline was 67±13 years, and mean eGFR was 33±13 ml/min per 1.73 m2. The prevalence of each symptom ranged from 24% (chest pain) to 83% (fatigue), and 98% of participants reported at least one symptom. After a median (interquartile range) follow-up of 5.3 (3.4-6.0) years, 690 participants initiated KRT, and 490 died before KRT. We identified two profiles of symptom trajectories: a "worse symptom score and worsening trajectory" in 31% of participants, characterized by a low initial symptom score that worsened more than ten points over time, and a "better symptom score and stable trajectory" in 69% of participants, characterized by a high initial score that remained stable. Participants in the worse symptom score and worsening trajectory group had more risk factors for CKD progression at baseline, worse quality of life, and a higher risk of KRT and death before KRT than other participants.

Conclusions: This study highlights a significant worsening of symptoms in about one third of the participants, whereas the majority reported low symptom severity throughout the study.

Keywords: CKD; clinical epidemiology; cohort studies; quality of life; symptoms.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Flow chart of study participants. CKD–Renal Epidemiology and Information Network (CKD-REIN) cohort.
Figure 2.
Figure 2.
Prevalence and severity of 11 symptoms at baseline in study participants, CKD-REIN cohort (n=2787). Kidney Disease Quality of Life-36 (KDQOL-36) symptoms: muscle pain and soreness, chest pain, cramps, itchy skin, dry skin, shortness of breath, faintness and dizziness, lack of appetite, fatigue, numbness in hands or feet, nausea, or upset stomach.
Figure 3.
Figure 3.
Predicted mean trajectories (dark lines) of symptom score in the two identified latent classes and their confidence intervals (shaded bands). The worse symptom score and worsening trajectory group is represented in red and the better symptom score and stable trajectory in green. CKD-REIN cohort.
Figure 4.
Figure 4.
Unadjusted probability of KRT (left panel) and death before KRT (right panel) by class of symptom score trajectory. CKD-REIN cohort.
See this image and copyright information in PMC

Comment in

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