Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 19;17(2):sfae010.
doi: 10.1093/ckj/sfae010. eCollection 2024 Feb.

Potentially modifiable factors associated with health-related quality of life among people with chronic kidney disease: baseline findings from the National Unified Renal Translational Research Enterprise CKD (NURTuRE-CKD) cohort

Thomas Phillips  1 , Scott Harris  1 , Olalekan Lee Aiyegbusi  2 , Bethany Lucas  3   4 , Melissa Benavente  3   4 , Paul J Roderick  1 , Paul Cockwell  2   5 , Philip A Kalra  6 , David C Wheeler  7 , Maarten W Taal  3   4 , Simon D S Fraser  1
Affiliations

Potentially modifiable factors associated with health-related quality of life among people with chronic kidney disease: baseline findings from the National Unified Renal Translational Research Enterprise CKD (NURTuRE-CKD) cohort

Thomas Phillips et al. Clin Kidney J. .

Abstract

Background: Many non-modifiable factors are associated with poorer health-related quality of life (HRQoL) experienced by people with chronic kidney disease (CKD). We hypothesize that potentially modifiable factors for poor HRQoL can be identified among CKD patients, providing potential targets for intervention.

Method: The National Unified Renal Translational Research Enterprise Chronic Kidney Disease (NURTuRE-CKD) cohort study recruited 2996 participants from nephrology centres with all stages of non-dialysis-dependent CKD. Baseline data collection for sociodemographic, anthropometric, biochemical and clinical information, including Integrated Palliative care Outcome Scale renal, Hospital Anxiety and Depression score (HADS) and the 5-level EuroQol-5D (EQ-5D-5L) as HRQoL measure, took place between 2017 and 2019. EQ-5D-5L dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) were mapped to an EQ-5D-3L value set to derive index value. Multivariable mixed effects regression models, adjusted for known factors affecting HRQoL with recruitment region as a random effect, were fit to assess potentially modifiable factors associated with index value (linear) and within each dimension (logistic).

Results: Among the 2958/2996 (98.7%) participants with complete EQ-5D data, 2201 (74.4%) reported problems in at least one EQ-5D-5L dimension. Multivariable linear regression identified independent associations between poorer HRQoL (EQ-5D-3L index value) and obesity (body mass index ≥30.0 kg/m2, β -0.037, 95% CI -0.058 to -0.016, P = .001), HADS depression score ≥8 (β -0.159, -0.182 to -0.137, P < .001), anxiety score ≥8 (β -0.090, -0.110 to -0.069, P < .001), taking ≥10 medications (β -0.065, -0.085 to -0.046, P < .001), sarcopenia (β -0.062, -0.080 to -0.043, P < .001) haemoglobin <100 g/L (β -0.047, -0.085 to -0.010, P = .012) and pain (β -0.134, -0.152 to -0.117, P < .001). Smoking and prescription of prednisolone independently associated with problems in self-care and usual activities respectively. Renin-angiotensin system inhibitor (RASi) prescription associated with fewer problems with mobility and usual activities.

Conclusion: Potentially modifiable factors including obesity, pain, depression, anxiety, anaemia, polypharmacy, smoking, steroid use and sarcopenia associated with poorer HRQoL in this cohort, whilst RASi use was associated with better HRQoL in two dimensions.

Keywords: chronic kidney disease; health-related quality of life; population health; quality of life.

PubMed Disclaimer

Conflict of interest statement

T.P. receives funding from Kidney Research UK (Charity number: 252 892) who are also funders of the NURTuRE-CKD study. S.H. has no conflicts of interest to declare. O.L.A. receives funding from the National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre (BRC), NIHR Applied Research Collaboration (ARC), West Midlands, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics at the University of Birmingham and University Hospitals Birmingham NHS Foundation, The Health Foundation, Innovate UK (part of UK Research and Innovation), Gilead Sciences Ltd, Merck, Anthony Nolan, and Sarcoma UK. O.L.A. declares personal fees from Gilead Sciences Ltd, GlaxoSmithKline (GSK) and Merck outside the submitted work. B.L. is funded by the NIHR. M.B. has no conflicts of interest to declare. P.J.R. has no conflicts of interest to declare. P.C. reports a leadership role in the UK Kidney Association and a non-remunerated research consultancy with Boehringer Ingelheim. P.A.K. has received honoraria for lecturing and advisory board attendance from AstraZeneca and UCB, which are both funders of the NURTuRE study. D.C.W. has an ongoing consultancy contract with AstraZeneca. In the last 3 years, he has received payments from the following companies in relation to consultancy work, speaker engagements or service on trials committees: Astellas, Bayer, Boehringer Ingelheim, Eledon, GSK, Galderma, Janssen, Menarini, Merck, Pharmacosmos, Mineralys, ProKidney, Tricida and Vifor. M.W.T. reports consulting fees from Boehringer Ingelheim, honoraria from Bayer and support to attend conferences from Bayer and a leadership role in the International Society of Nephrology. S.D.S.F. has no conflicts of interest to declare.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Distribution of the percentage of participants reporting problems within the five dimensions of EQ-5D-5L.
Figure 2:
Figure 2:
Forest plot of associations with mapped EQ-5D-3L index values in mixed effects multivariable linear regression.
See this image and copyright information in PMC

References

    1. Perlman RL, Finkelstein FO, Liu L et al. Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study. Am J Kidney Dis 2005;45:658–66. 10.1053/j.ajkd.2004.12.021 - DOI - PubMed
    1. Legrand K, Speyer E, Stengel B et al. Perceived health and quality of life in patients with CKD, including those with kidney failure: findings from national surveys in France. Am J Kidney Dis 2020;75:868–78. 10.1053/j.ajkd.2019.08.026 - DOI - PubMed
    1. Krishnan A, Teixeira-Pinto A, Lim WH et al. Health-related quality of life in people across the spectrum of CKD. Kidney Int Rep 2020;5:2264–74. 10.1016/j.ekir.2020.09.028 - DOI - PMC - PubMed
    1. Fraser SD, Barker J, Roderick PJ et al. Health-related quality of life, functional impairment and comorbidity in people with mild-to-moderate chronic kidney disease: a cross-sectional study. BMJ Open 2020;10:e040286. 10.1136/bmjopen-2020-040286 - DOI - PMC - PubMed
    1. Mujais SK, Story K, Brouillette J et al. Health-related quality of life in CKD patients: correlates and evolution over time. Clin J Am Soc Nephrol 2009;4:1293–301. 10.2215/CJN.05541008 - DOI - PMC - PubMed