Longitudinal Assessment of Health-Related Quality of Life in Adults with CKD

Abstract

Dialysis linked with poorer quality of life compared with transplant patients and patients with CKD. Quality of life trends were similar in both domain-specific and overall quality-of-life measures. There are sparse data about the change in health-related quality of life (HRQoL) with the temporal progression of CKD. In this study, we assessed the association between change in CKD stages, overall and domain-specific quality of life and determined the factors that were associated with this change. Data were sourced from a multicenter study that included 1290 adult patients aged 18 years and older across six centers in Australia. Three-level EuroQol five-dimensional questionnaire was collected at baseline and 2 and 4 years. Changes in CKD stages were treated as a time-varying exposure; generalized estimating equations were used to model the changes in HRQoL. With reference to patients with CKD (G3-5), patients treated with dialysis had a reduction of 0.06 (-0.09 to -0.04) in overall HRQoL scores over the 4 years and experienced higher odds of reporting lower HRQoL across all domains: mobility (1.91 [1.53-2.38]), self-care (2.30 [1.67-3.16]), usual activity (2.70 [2.18-3.38]), pain (1.19 [0.97-1.46]), and anxiety (1.40 [1.12-1.75]). Transplant recipients showed no significant decline in overall HRQoL ( P = 0.13), but had increased odds of reduced mobility (1.74 [1.40-2.18]) and usual activity (1.35 [1.07-1.71]). Female sex, smoking, prevalent diabetes mellitus, lower educational attainment, and Middle Eastern ethnicity were associated with lower HRQoL. Patients on maintenance dialysis, but not transplant recipients, experienced a significant decline in overall HRQoL (0.06) over the 4 years compared with patients with CKD (G3-5). These utility-based HRQoL estimates are essential for future economic evaluations in kidney trials.