The impact of progressive chronic kidney disease on health-related quality-of-life: a 12-year community cohort study
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.
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.
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).
Physical, but not mental, quality-of-life is significantly impaired in CKD, and continues to decline with disease progression.
KeywordsCKD Quality-of-life SF36 AUSDIAB
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.
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.
Compliance with ethical standards
Conflict of interest
All authors declare they have no conflict of interest.
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.
Informed consent was obtained from all individual participants included in the study.
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