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The impact of progressive chronic kidney disease on health-related quality-of-life: a 12-year community cohort study

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Abstract

Purpose

Quality-of-life is poor in end-stage kidney disease; however, the relationships between earlier stages of chronic kidney disease (CKD) and are poorly understood. This study explored longitudinal quality-of-life changes in a community-based CKD cohort and assessed associations between CKD and quality-of-life over time, and between baseline quality-of-life and CKD outcomes.

Methods

We used the Australian diabetes, obesity and lifestyle study—a nationally representative, prospective cohort with data collected at baseline, year 5 and year 12—to examine the relationships between CKD stage, quality-of-life and outcomes. Linear mixed regression, cox proportional hazards, Kaplan–Meier and competing risks analyses were used.

Results

Of 1112 participants with CKD and baseline quality-of-life data, the physical component summary (PCS) score was significantly lower than for the general population (p = 0.01 age and sex adjusted), while the mental component summary (MCS) score was no different (p = 0.9 age and sex adjusted). In our unadjusted mixed effects model, more advanced kidney disease was associated with lower PCS and higher MCS at baseline (p < 0.001 and p < 0.01, respectively); however, this effect was no longer significant after adjustment for demographic and clinical variables. The rate of decline in PCS over the period of follow-up was greatest for those with more advanced kidney disease (p < 0.001 in unadjusted model, p = 0.007 in adjusted model). There was no association between change in MCS over the period of follow-up and severity of kidney disease in either the unadjusted or adjusted model (p = 0.7 and p = 0.1, respectively). Lower PCS, but not MCS, was associated with increased cardiovascular and increased all-cause mortality even after adjustment for key demographic and clinical variables (p < 0.001).

Conclusions

Physical, but not mental, quality-of-life is significantly impaired in CKD, and continues to decline with disease progression.

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References

  1. Go, A. S., Chertow, G. M., Fan, D., McCulloch, C. E., & Hsu, C. Y. (2004). Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. The New England Journal of Medicine, 351(13), 1296–1305. https://doi.org/10.1056/NEJMoa041031.

    Article  CAS  PubMed  Google Scholar 

  2. Wyld, M., Morton, R. L., Hayen, A., Howard, K., & Webster, A. C. (2012). A systematic review and meta-analysis of utility-based quality of life in chronic kidney disease treatments. PLoS Medicine, 9(9), e1001307. https://doi.org/10.1371/journal.pmed.1001307.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sanson-Fisher, R., & Perkins, J. (1998). Adaptation and validation of the SF-36 Health Survey for use in Australia. Journal of Clinical Epidemiology, 51, 961–967.

    Article  CAS  Google Scholar 

  4. Dunstan, D. W., Zimmet, P. Z., Welborn, T. A., Cameron, A. J., Shaw, J., de Courten, M., et al. (2002). The Australian diabetes, obesity and lifestyle study (AusDiab)--methods and response rates. Diabetes Research and Clinical Practice, 57(2), 119–129.

    Article  Google Scholar 

  5. Stevens, P. E., Levin, A., & Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group (2013). Evaluation and management of chronic kidney disease: synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline. Annals of Internal Medicine, 158(11), 825–830. https://doi.org/10.7326/0003-4819-158-11-201306040-00007.

    Article  PubMed  Google Scholar 

  6. White, S., Polkinghorne, K., Atkins, R., & Chadban, S. (2010). Comparison of the prevalence and mortality risk of CKD in Australia using the CKD Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) Study GFR estimating equations: the AusDiab (Australian Diabetes, Obesity and Lifestyle) Study. American Journal of Kidney Diseases, 55(4), 660–670.

    Article  Google Scholar 

  7. Coresh, J., Turin, T. C., Matsushita, K., Sang, Y., Ballew, S. H., Appel, L. J., et al. (2014). Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality. JAMA, 311(24), 2518–2531. https://doi.org/10.1001/jama.2014.6634.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Ryan, P. (1999). SF36: Stata module to calculate summary statistics for the SF-36 Health Survey Instrument. Statistical Software Components. Boston College Department of Economics.

  9. Samsa, G., Edelman, D., Rothman, M. L., Williams, G. R., Lipscomb, J., & Matchar, D. (1999). Determining clinically important differences in health status measures: A general approach with illustration to the Health Utilities Index Mark II. Pharmacoeconomics, 15(2), 141–155.

    Article  CAS  Google Scholar 

  10. Leaf, D. E., & Goldfarb, D. S. (2009). Interpretation and review of health-related quality of life data in CKD patients receiving treatment for anemia. Kidney International, 75(1), 15–24. https://doi.org/10.1038/ki.2008.414.

    Article  PubMed  Google Scholar 

  11. Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41(5), 582–592. https://doi.org/10.1097/01.MLR.0000062554.74615.4C.

    Article  PubMed  Google Scholar 

  12. Drummond, M., Sculpher, M., Torrance, G., O’Brien, M., & Stoddart, G. (2005). Methods for the economic evaluation of health care programmes (3rd ed.). Oxford: Oxford University Press.

    Google Scholar 

  13. Norman, R., Viney, R., Brazier, J., Burgess, L., Cronin, P., King, M., et al. (2014). Valuing SF-6D health states using a discrete choice experiment. Medical Decision Making, 34, 773–786.

    Article  Google Scholar 

  14. Drummond, M. (2001). Introducing economic and quality of life measurements into clinical studies. Annals of Medicine, 33(5), 344–349. https://doi.org/10.3109/07853890109002088.

    Article  CAS  PubMed  Google Scholar 

  15. Magliano, D., Barr, E., Zimmet, P., Cameron, A., Dunstan, D., Colagiuri, S., et al. (2008). Glucose indices, health behaviours and the incidence of diabetes in Australia: The Australian diabetes, obesity and lifestyle study (AusDiab). Diabetes Care, 31, 267–272.

    Article  Google Scholar 

  16. World Health Organisation (2000). Obesity: preventing and managing the global epidemic, Report of a WHO Consultation (WHO Technical Report Series 894).

  17. Commonwealth Department of Health and Aged Care. (1999). National physical activity guidelines for adults. Canberra: Active Australia.

    Google Scholar 

  18. White, S. L., Polkinghorne, K. R., Cass, A., Shaw, J. E., Atkins, R. C., & Chadban, S. J. (2009). Alcohol consumption and 5-year onset of chronic kidney disease: The AusDiab study. Nephrology Dialysis Transplantation, 24(8), 2464–2472. https://doi.org/10.1093/ndt/gfp114.

    Article  Google Scholar 

  19. Magliano, D., Liew, D., Pater, H., Kirby, A., Hunt, D., Simes, J., et al. (2003). Accuracy of the Australian national death index: comparison with adjudicated fatal outcomes among Australian participants in the long-term intervention with pravastatin in ischaemic disease (LIPID) study. Australian and New Zealand Journal of Public Health, 27(6), 649–653. https://doi.org/10.1111/j.1467-842X.2003.tb00615.x.

    Article  PubMed  Google Scholar 

  20. von Elm, E., Altman, D., Egger, M., Pocock, S., Gøtzsche, P., Vandenbroucke, J., et al. (2007). The Strengthening the reporting of observational studies in epidemiology (STROBE)statement: Guidelines for reporting observational studies. PLoS Medicine. 4(10), e296.

    Article  Google Scholar 

  21. Mckenzie, S. F. G., Richardson, K., & Carter, K. (2014). Do changes in socioeconomic factors lead to changes in mental health? Findings from three waves of a population based panel study. Journal of Epidemiology and Community Health, 68, 253–260.

    Article  Google Scholar 

  22. Williams, J., Cunich, M., & Byles, J. (2013). The impact of socioeconomic status on changes in the general and mental health of women over time: Evidence from a longitudinal study of Australian women. International Journal for Equity in Health, 12, 25.

    Article  Google Scholar 

  23. Chadban, S., Briganti, E., Kerr, P., Dunstan, D., Welborn, T., Zimmet, P., et al. (2003). Prevalence of kidney damage in Australian adults: The AusDiab kidney study. Journal of the American Society of Nephrology, 14(Suppl 2), S131–S138.

    Article  Google Scholar 

  24. Wong, M., Ninomiya, T., Liyanage, T., Sukkar, L., Hirakawa, Y., Wang, Y., et al. (2018). Physical component quality of life (QOL) reflects the impact of time and moderate chronic kidney disease, unlike SF-6D utility and mental component SF-36 QOL: An AUSDiab analysis. Nephrology, https://doi.org/10.1111/nep.13445.

    Article  PubMed  Google Scholar 

  25. Osthus, T., Preljevic, V., Sandvik, L., Leivestad, T., Nordhus, I., Dammen, T., et al. (2012). Mortality and health-related quality of life in prevalent dialysis patients: Comparison between 12-items and 36-items short-form health survey. Health and Quality of Life Outcomes, 10(1), 1.

    Article  Google Scholar 

  26. Mapes, D., Lopes, A., Satayathum, S., Mccullough, K., Goodkin, D., Locatelli, F., et al. (2003). Health-related quality of life as a predictor of mortality and hospitalization: The dialysis outcomes and practice patterns study (DOPPS). Kidney International, 64, 339–349.

    Article  Google Scholar 

  27. Cavrini, G., Broccoli, S., Puccini, A., & Zoli, M. (2012). EQ-5D as a predictor of mortality and hospitalization in elderly people. Quality of Life Research, 21(2), 269–280.

    Article  Google Scholar 

  28. Mathews, W., & May, S. (2007). EuroQol (EQ-5D) measure of quality of life predicts mortality, emergency department utilization, and hospital discharge rates in HIV-infected adults under care. Health and Quality of Life Outcomes, 5, 5. https://doi.org/10.1186/1477-7525-1185-1185.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Brown, D., Thompson, W., Zack, M., Arnold, S., & Barile, J. (2015). Associations between health-related quality of life and mortality in older adults. Prevention Science, 16, 21–30. https://doi.org/10.1007/s11121-11013-10437-z.

    Article  Google Scholar 

  30. Porter, A., Fischer, M. J., Wang, X., Brooks, D., Bruce, M., Charleston, J., et al. (2014). Quality of life and outcomes in African Americans with CKD. Journal of the American Society of Nephrology, 25(8), 1849–1855. https://doi.org/10.1681/ASN.2013080835.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Norman, R., Church, J., van den Berg, B., & Goodall, S. (2013). Australian health-related quality of life population norms derived from the SF-6D. Australian and New Zealand Journal of Public Health, 37(1), 17–23.

    Article  Google Scholar 

Download references

Acknowledgements

The AusDiab study co-ordinated by the Baker IDI Heart and Diabetes Institute gratefully acknowledges the generous support given by the National Health and Medical Research Council (NHMRC Grant 233200), Australian Government Department of Health and Ageing, Amgen, Abbott Australasia Pty Ltd, Alphapharm Pty Ltd, AstraZeneca, Bristol-Myers Squibb, City Health Centre-Diabetes Service-Canberra, Department of Health and Community Services—Northern Territory, Department of Health and Human Services—Tasmania, Department of Health—New South Wales, Department of Health—Western Australia, Department of Health—South Australia, Department of Human Services—Victoria, Diabetes Australia, Diabetes Australia Northern Territory, Eli Lilly Australia, Estate of the Late Edward Wilson, GlaxoSmithKline, Jack Brockhoff Foundation, Janssen-Cilag, Kidney Health Australia, Marian & FH Flack Trust, Menzies Research Institute, Merck Sharp & Dohme, Novartis Pharmaceuticals, Novo Nordisk Pharmaceuticals, Pfizer Pty Ltd, Pratt Foundation, Queensland Health, Roche Diagnostics Australia, Royal Prince Alfred Hospital, Sydney, Sanofi Aventis, Sanofi Synthelabo. The AusDiab study co-ordinators are also grateful to (A) Allman, (B) Atkins, S. Bennett, A. Bonney, S. Chadban, M. de Courten, M. Dalton, D. Dunstan, T. Dwyer, H. Jahangir, D. Jolley, D. McCarty, A. Meehan, N. Meinig, S. Murray, K. O’Dea, K. Polkinghorne, P. Phillips, (C) Reid, A. Stewart, R. Tapp, H. Taylor, T. Whalen, F. Wilson and P. Zimmet for their invaluable contribution to the set-up and field activities of AusDiab. MW was supported by a NHMRC post-graduate scholarship # 1094327. RM was supported by an Australian NHMRC early career researcher fellowship #1054216.

Author information

Authors and Affiliations

  1. Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    Melanie L. R. Wyld & Steve Chadban

  2. Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Melanie L. R. Wyld & Steve Chadban

  3. NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia

    Rachael L. Morton

  4. Royal Adelaide Hospital, Adelaide, Australia

    Phil Clayton

  5. Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Royal Adelaide Hospital, Adelaide, Australia

    Phil Clayton & Steve Chadban

  6. The George Institute for Global Health, Sydney, NSW, Australia

    Muh Geot Wong & Meg Jardine

  7. Concord Repatriation Hospital, Sydney, NSW, Australia

    Meg Jardine

  8. Monash Medical Centre and Monash University, Clayton, VIC, Australia

    Kevan Polkinghorne

Authors
  1. Melanie L. R. Wyld
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  3. Phil Clayton
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  7. Steve Chadban
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Contributions

MW, RM, SC: research idea and study design; MW, RM, SC: data analysis/interpretation; MW: statistical analysis; MW: drafting the paper; MW, RM, SC: critical revisions of the paper. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

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Correspondence to Melanie L. R. Wyld.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Wyld, M.L.R., Morton, R.L., Clayton, P. et al. The impact of progressive chronic kidney disease on health-related quality-of-life: a 12-year community cohort study. Qual Life Res 28, 2081–2090 (2019). https://doi.org/10.1007/s11136-019-02173-1

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