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Impaired renal function is associated with worse self-reported outcomes after kidney transplantation

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Abstract

Purpose

We sought to determine the association between health-related quality of life (HRQOL) and graft function in renal transplant recipients.

Design and Methods

We enrolled 577 kidney transplant recipients aged 18–74 years (response rate 87%). Recipients with multiple or multi-organ transplantation, creatine kinase >200 U/L, acute renal failure or cellular rejection (n = 64), and without creatinine assessments in 3 months pre-enrollment (n = 127) were excluded. The questionnaire included Euro QOL 5 Dimensions (EQ-5D), Health Utility Index III (HUI-III), Kidney Disease Quality of Life-36 (KDQOL36) which include a generic section (RAND SF-12). Data on medical conditions, therapy regimens, and biochemistry results were extracted from clinical charts. We used general linear models adjusted for demographic, socioeconomic, and clinical characteristics to assess the association between HRQOL and severity of chronic kidney disease (CKD).

Results

Patients with more advanced CKD were more likely to be African-American, covered by public insurance, more likely to have shorter time after transplantation, higher phosphorus and lower hemoglobin, serum albumin, and calcium levels. All HRQOL scales were inversely associated with CKD severity. All associations were robust to adjustment for possible confounders.

Conclusions

Several health-related quality of life dimensions may be affected by poor renal function after transplantation.

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Abbreviations

AIC:

Akaike information criteria

ALT:

Alanine transaminase

AST:

Aspartate transaminase

BKD:

Burden of kidney disease

eGFR:

Estimated glomerular filtration rate

CKD:

Chronic kidney disease

EKD:

Effect of kidney disease

EQ-5D:

Euro quality of life 5 dimensions questionnaire

ESRD:

End stage renal disease

GLM:

General linear models

HRQOL:

Health-related quality of life

HUI III:

Health utility index mark III

KDQOL:

Kidney disease quality of life scale

KDQOL-36:

Kidney disease quality of life 36 items

LCD:

Liver cellular damage

MCS:

Mental composite score

MDRD:

Modification of diet in renal disease study

PCA:

Principal component analysis

PCS:

Physical composite score

QALY:

Quality adjusted life years

RRT:

Renal replacement therapy

SES:

Socioeconomic status

SF-12:

Short form 12 items

SYMP.LIST:

Symptoms and problems scale

References

  1. Mathew, T., McDonald, S., & Russ, G. (2001). ANZDATA Registry Report 2001. In: Renal transplant outcome beyond 5 years, Chap. 13.

  2. Burdmann, E. A., et al. (2003). Cyclosporine nephrotoxicity. Seminars in Nephrology, 23(5), 465–476.

    Article  PubMed  CAS  Google Scholar 

  3. Miller, L. W. (2002). Cardiovascular toxicities of immunosuppressive agents. American Journal of Transplantation, 2(9), 807–818.

    Article  PubMed  CAS  Google Scholar 

  4. Nankivell, B. J., et al. (2003). The natural history of chronic allograft nephropathy. New England Journal of Medicine, 349(24), 2326–2333.

    Article  PubMed  CAS  Google Scholar 

  5. Ojo, A. O., et al. (2000). Long-term survival in renal transplant recipients with graft function. Kidney International, 57(1), 307–313.

    Article  PubMed  CAS  Google Scholar 

  6. Chow, F. Y., et al. (2003). Health-related quality of life in Australian adults with renal insufficiency: A population-based study. American Journal of Kidney Diseases, 41(3), 596–604.

    Article  PubMed  Google Scholar 

  7. Gorodetskaya, I., et al. (2005). Health-related quality of life and estimates of utility in chronic kidney disease. Kidney International, 68(6), 2801–2808.

    Article  PubMed  Google Scholar 

  8. Kurella, M., et al. (2004). Physical and sexual function in women with chronic kidney disease. American Journal of Kidney Diseases, 43(5), 868–876.

    Article  PubMed  Google Scholar 

  9. Kusek, J. W., et al. (2002). Cross-sectional study of health-related quality of life in African Americans with chronic renal insufficiency: The African American study of kidney disease and hypertension trial. American Journal of Kidney Diseases, 39(3), 513–524.

    Article  PubMed  Google Scholar 

  10. Rocco, M. V., et al. (1997). Cross-sectional study of quality of life and symptoms in chronic renal disease patients: The modification of diet in renal disease study. American Journal of Kidney Diseases, 29(6), 888–896.

    Article  PubMed  CAS  Google Scholar 

  11. Rossert, J., et al. (2006). Effect of early correction of anemia on the progression of CKD. American Journal of Kidney Diseases, 47(5), 738–750.

    Article  PubMed  CAS  Google Scholar 

  12. Barotfi, S., et al. (2006). Validation of the kidney disease quality of life-short form questionnaire in kidney transplant patients. Journal of Psychosomatic Research, 60, 495–504.

    Article  PubMed  Google Scholar 

  13. Bohlke, M., et al. (2009). Factors associated with health-related quality of life after successful kidney transplantation: A population-based study. Quality of Life Research, 18, 1185–1193.

    Article  PubMed  Google Scholar 

  14. Hays, R. D., et al. (1997). Kidney Disease Quality of Life Short Form (KDQOL-SF), Version 1.3: A Manual for Use and Scoring. pp. 1–39.

  15. Brazier, J. E., & Roberts, J. (2004). The estimation of a preference -based measure of health from the SF-12. Medical Care, 42(9), 851–859.

    Article  PubMed  Google Scholar 

  16. Brazier, J. E., et al. (1992). Validating the SF-36: A new outcome measure for primary care. BMJ, 305(6846), 160–164.

    Article  PubMed  CAS  Google Scholar 

  17. Garrat, A., et al. (1993). The SF-36 health survey questionnaire: An outcome measure suitable for routine use within the NHS. BMJ, 306(6890), 1440–1444.

    Article  Google Scholar 

  18. Harper, R., et al. (1997). A comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting. Thorax, 52(10), 879–887.

    Article  PubMed  CAS  Google Scholar 

  19. Hollingsworth, W., et al. (1995). Measuring changes in quality of life following magnetic-resonance- imaging of the knee-SF-36, Euroqol, or Rosser Index. Quality of Life Research, 4(4), 325–334.

    Article  Google Scholar 

  20. McHorney, C., et al. (1994). The MOS 36-item short form health survey (SF-36): III. Tests of data quality, assumptions, and reliability across diverse patient groups. Medical Care, 32(1), 40–52.

    Article  PubMed  CAS  Google Scholar 

  21. Weinstein, M. C., et al. (1996). Recommendations of the panel on cost-effectiveness in health and medicine. JAMA, 276(15), 1253–1258.

    Article  PubMed  CAS  Google Scholar 

  22. Cleemput, I., et al. (2004). The construct and concurrent validity of the EQ-5D in a renal transplant population. Value in Health, 7(4), 499–509.

    Article  PubMed  Google Scholar 

  23. Shaw, J. W., Johnson, J. A., & Coons, S. J. (2005). US valuation of the EQ-5D health states: Development and testing of the D1 valuation model. Medical Care, 43(3), 203–220.

    Article  PubMed  Google Scholar 

  24. Furlong, W. J., Feeny, D. H., Torrance, G. W., & Barr, R. D. (2001). The health utilities index (HUI) system for assessing health-related quality of life in clinical studies. Annals of Medicine, 33(5), 375–384.

    Article  PubMed  CAS  Google Scholar 

  25. Hsu, C. Y. (2005). Clinical evaluation of kidney function. In A. Greenberg (Ed.), Primer on kidney disease (4th ed., pp. 20–24). Philadelphia: Elsevier-Saunders.

    Google Scholar 

  26. Duan, N. (1983). Smearing estimate: A nonparametric retransformation method. Journal of the American Statistical Association, 78(383), 605–610.

    Article  Google Scholar 

  27. Rosemberger, J., et al. (2006). Predictors of perceived health status in patients after kidney transplantation. Transplantation, 81, 1306–1310.

    Article  Google Scholar 

  28. Sherbourne, C. D., Meredith, L. S., Rogers, W., & Ware, J. E. (1992). Social support and stressful life events: Age differences in their effects on health-related quality of life among the chronically ill. Quality of Life Research, 1, 235–246.

    Article  PubMed  CAS  Google Scholar 

  29. Zenger, M., Hinz, A., Stolzenburg, J.-U., Rabenalt, R., Schwalenberg, T., & Schwarz, R. (2009). Health-related quality of life of prostate cancer patients compared to the general german population: Age-specific results. Urologia Internationalis, 83, 166–170.

    Article  PubMed  Google Scholar 

  30. Yeh, S. C. J., Huang, C. H., Chou, H. C., & Wan, T. T. H. (2009). Gender differences in stress and coping among elderly patients on hemodialysis. Sex Roles, 60, 44–56.

    Article  Google Scholar 

  31. Mariat, C., et al. (2008). Estimated glomerular filtration rate as an end point in kidney transplant trial: Where do we stand? Nephrology, Dialysis, Transplantation, 23(1), 33–38.

    Article  PubMed  Google Scholar 

  32. Van Steel, H. F., & Buskens, E. (2006). Comparison of the SF-6D and the EQ-5D in patients with coronary heart disease. Health and Quality of Life Outcomes, 4, 20.

    Article  Google Scholar 

  33. Bosch, J. L., & Hunink, M. G. (2000). Comparison of the Health Utilities Index Mark 3 (HUI3) and the EuroQol EQ-5D in patients treated for intermittent claudication. Quality of Life Research, 9(6), 591–601.

    Article  PubMed  CAS  Google Scholar 

  34. Luo, N., et al. (2005). Self-reported health status of the general adult U.S. population as assessed by the EQ-5D and Health Utilities Index. Medical Care, 43(11), 1078–1086.

    Article  PubMed  Google Scholar 

  35. Dolan, P. (1997). Modeling valuations for EuroQol health states. Medical Care, 35(11), 1095.

    Article  PubMed  CAS  Google Scholar 

  36. Walters, S. J., & Brazier, J. E. (2003). What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D. Health and Quality of Life Outcomes, 1(4).

  37. Grootendorst, P., Feeny, D., & Furlong, W. (2000). Health Utilities Index Mark 3: Evidence of construct validity for stroke and arthritis in a population health survey. Medical Care, 38(3), 290.

    Article  PubMed  CAS  Google Scholar 

  38. Horsman, J, Furlong, W, Feeny, D, & Torrance, G. W. (2003). The Health Utility Index (HUI): concepts, measurement, properties and applications. Health and Quality of Life Outcomes, 1.

  39. Drummond, M. (2001). Introducing economic and quality of life measurements into clinical studies. Annals of Medicine, 33(5), 344.

    Article  PubMed  CAS  Google Scholar 

  40. Jayasinghe, U. W., Proudfoot, J., Barton, C. A., et al. (2009). Quality of life of Australian chronically-ill adults: Patient and practice characteristics matter. Health Qual Life Outcomes, 7, 50.

    Article  PubMed  Google Scholar 

  41. Mrus, J. M., Sherman, K. E., & Leonard, A. C. (2006). Health values of patients coinfected with HIV/Hepatitis C. Are two viruses worse than one? Medical Care, 44, 158–166.

    Article  PubMed  Google Scholar 

  42. Blanchard, C. M., Cote, I., & Feeny, D. (2004). Comparing short form and RAND physical and mental health summary scores: Results from total hip arthroplasty and high-risk primary care patients. International Journal of Technology Assessment Health Care, 20, 230–235.

    Google Scholar 

  43. Sloan, J., Symonds, T., Vargas-Chanes, D., & Fridley, B. (2003). Practical guidelines for assessing the clinical significance of health-related quality of life changes within clinical trials. Drug Information Journal, 37(1), 23–31.

    Google Scholar 

  44. Kovacs, A. Z., et al. (2010). Sleep disorders, depressive symptoms and health-related quality of life—a cross-sectional comparison between kidney transplant recipients and waitlisted patients on maintenance dialysis. NDT Advance Access published online on August 4, 2010. Nephrology Dialysis Transplantation. doi: 10.1093/ndt/gfq476.

  45. Pourfarziani, V., Taheri, S., Sharifi-Bonab, M. M., & Mohammadzadeh, M. (2010). Assessment of sleep disturbance in renal transplant recipients and associated risk factors. Saudi Journal of Kidney Diseases Transplantation, 21, 433–437.

    Google Scholar 

  46. Jofre, R., et al. (1998). Changes in quality of life after renal transplantation. American Journal of Kidney Diseases, 32(1), 93–100.

    Article  PubMed  CAS  Google Scholar 

  47. Johnson, C. D., et al. (1998). Racial and gender differences in quality of life following kidney transplantation. Image Journal of Nursing Scholarship, 30(2), 125–130.

    Article  CAS  Google Scholar 

  48. Franke, G. H., Trampenau, C., & Reimer, J. (2006). Switching from cyclosporine to tacrolimus leads to improved disease-specific quality of life in patients after kidney transplantation. Transplantion Proceedings, 38(5), 1293–1294.

    Article  CAS  Google Scholar 

  49. Reimer, J., et al. (2002). Quality of life in kidney recipients: Comparison of tacrolimus and cyclosporine-microemulsion. Clinical Transplantation, 16(1), 48–54.

    Article  PubMed  Google Scholar 

  50. Gross, C. R., et al. (2000). Impact of transplantation on quality of life in patients with diabetes and renal dysfunction. Transplantation, 70(12), 1736–1746.

    Article  PubMed  CAS  Google Scholar 

  51. Rosenberger, J., et al. (2006). Predictors of perceived health status in patients after kidney transplantation. Transplantation, 81(9), 1306–1310.

    Article  PubMed  Google Scholar 

  52. Hathaway, D., et al. (2003). The first report from the patient outcomes registry for transplant effects on life (PORTEL): Differences in side-effects and quality of life by organ type, time since transplant and immunosuppressive regimens. Clinical Transplantation, 17(3), 183–194.

    Article  PubMed  Google Scholar 

  53. Singer, E., & Bossarte, R. M. (2006). Incentives for survey participation: When are they “coercive”? American Journal of Preventive Medicine, 31(5), 411–418.

    Article  PubMed  Google Scholar 

  54. Liem, Y. S., Bosch, J. L., & Hunink, M. G. (2008). Preference-based quality of life of patients on renal replacement therapy: A systematic review and meta-analysis. Value Health, 11(4), 733–741.

    Article  PubMed  Google Scholar 

  55. Rohlfing, C. L., et al. (2002). Defining the relationship between plasma glucose and HbA1c, analysis of glucose profiles and HbA1c in the diabetes control and complications trial. Diabetes Care, 25, 275–278.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The present paper has been partially funded by BMS pharmaceuticals. The abstract of this work has been presented at the American Transplant Congress held in Boston, (May–June 2009).

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Authors and Affiliations

  1. Dipartimento di Medicina del Lavoro, Clinica del Lavoro “L. Devoto”—Divisione di Ergonomia e Psicologia del Lavoro, Università degli Studi di Milano, Via San Barnaba 8, Milan, Italy

    Luca Neri

  2. Department of Health Management and Policy, Center for Outcomes Research, Saint Louis University, 3454 Lafayette Ave., St. Louis, MO, 63104, USA

    Luca Neri, Jonathan Dukes, Susmitha Seelam, Srividya Desiraju & Mark Schnitzler

  3. Unit of Transplant Nephrology, Washington University, St. Louis, MO, USA

    Daniel C. Brennan

  4. Unit of Transplant Surgery, University of Washington, Seattle, WA, USA

    Paulo R. Salvalaggio

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  1. Luca Neri
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  2. Jonathan Dukes
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Correspondence to Luca Neri.

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Neri, L., Dukes, J., Brennan, D.C. et al. Impaired renal function is associated with worse self-reported outcomes after kidney transplantation. Qual Life Res 20, 1689–1698 (2011). https://doi.org/10.1007/s11136-011-9905-8

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