Evolution of quality of life in renal transplant recipients and patients with multiple sclerosis: a follow-up study

[The influence of multiple sclerosis-related symptoms on health-related quality of life]

BACKGROUND

Multiple sclerosis (MS) is a chronic disease that is associated with a variety of MS-specific symptoms. Many of these symptoms have a negative impact on health-related quality of life (HRQoL). Until now it is unclear which MS-specific symptoms have the highest impact on the HRQoL.

METHODOLOGY

The study is based on the data of a member survey of the German MS Society (DMSG) in 2015 (n = 424). Considering socio-demographic variables and general medical variables, the influence of MS-specific symptoms on HRQoL was examined. The HRQoL was collected using the Multiple Sclerosis Quality of Life-54 (MSQOL-54) instrument. In a pretest, all influencing variables were tested for a significant mean difference (p = 0.05), or a mean correlation (Pearson's r ≥ 0.3). Subsequently, the influence of the variables identified in the pretest on the HRQoL was investigated by multiple linear regression analysis.

RESULTS

We calculated a mean physical health composite score (PHCS) of 48.3 (sd = 17.7) and a mean mental health composite score (MHCS) of 56.0 (sd = 20.1). The most fundamental factors influencing HRQoL were the MS-specific symptoms of depression, pain and cognitive impairment. MS-related symptoms with a mobility context showed declining PHCS. Speech disorder and dizziness were associated with a decreasing MHCS. Employment status was the only socio-economic factor that significantly affected HRQoL in multiple regression. The general medical factors showed no significant influence on HRQoL.

CONCLUSION

MS-specific symptoms have a major impact on the HRQoL of people with MS. Our study show that especially the so-called 'hidden symptoms' such as the symptoms of depression, pain and cognitive impairment have a significant influence on the HRQoL. Greater attention should be paid to these in the care of people with MS.

Global Performance Status Score: A New Tool to Assess Physical Performance in Kidney Transplant Patients

BACKGROUND

Information on physical performance in renal transplantation is limited because of the shortage of specifically designed evaluation instruments. Therefore, we elaborated and validated the Global Performance Status (GloPerSta) score to provide a new and comprehensive tool, exploring the different components of physical performance in kidney transplant patients.

METHODS

We elaborated the GloPerSta score on the basis of the data obtained from a cross-sectional study, in which we evaluated the physical performance of a cohort of kidney transplant patients. The results of these analyses were weighted to describe the different contribution of any single test, via the generation of a structural equation model, resulting in the definition of the GloPerSta. Then, to internally validate this score, we studied its correlation with clinical parameters and quality of life (evaluated as KDQOL-SF, Kidney Disease Quality of Life-Short Form) in the same patient population.

RESULTS

We enrolled 132 patients in whom the functional tests revealed a great heterogeneity. GloPerSta allowed the stratification of the patients in 3 different physical performance categories (low: score 0-11; medium: 12-22; high: 23-33). Internal validation showed that GloPerSta was directly and significantly correlated with the quality of life and allograft function, independent of the time from transplantation.

CONCLUSIONS

The GloPerSta is a reliable tool to assess physical performance in a kidney transplant population. Its application might be of help in identifying patients needing intensive and personalized rehabilitation programs.

Assessment of physical performance and quality of life in kidney-transplanted patients: a cross-sectional study

BACKGROUND

Information on physical and mental wellness in renal transplantation is limited. Therefore, we performed a cross-sectional study to evaluate and describe the different components of physical performance and quality of life (QoL) in a cohort of kidney-transplanted patients.

METHODS

Physical performance and QoL were determined through the administration of validated tests and questionnaires [muscle strength, dynamometer handgrip, tactile sensitivity, visual analogue scale (VAS) for pain, Timed Up and Go (TUG) test, Fatigue Severity Scale (FSS) and the 36-item Short Form Health Survey]. The patients were divided into three groups based on time elapsed since transplantation: early (in the first 6 months), middle (from 7 to 60 months) and late (>60 months).

RESULTS

Of 132 enrolled patients, 11 patients (8.3%) presented a severe reduction of muscle strength, 63 patients (47%) had significant bilateral impaired handgrip and tactile sensitivity was altered in 23 patients (17.4%). TUG assessment showed significant mobility limitation in 29 patients (21.9%). The FSS presented a pathological value in 50 patients (37.3%), while the mean VAS was 1.8 ± 2.7. There were no significant differences in physical performance parameters among the three patient groups. There were inverse correlations among different components of physical performance and age, comorbidity and dialysis vintage, and there was a direct correlation with renal function. During the first months after transplantation there were limitations in physical, social and emotional activities. Overall, the self-perceived physical performance was significantly lower in transplanted patients with respect to the normal reference level.

CONCLUSION

Kidney-transplanted patients may present different degrees of impairment in physical performance and quality of life. Systematic functional assessment is essential to identify patients needing intensive and personalized rehabilitation programmes.

Depression, Anxiety, Resilience and Coping Pre and Post Kidney Transplantation - Initial Findings from the Psychiatric Impairments in Kidney Transplantation (PI-KT)-Study

PURPOSE

Depression/anxiety, impaired Health-Related Quality of Life (HRQoL) and coping and resilience structures, are associated with increased mortality/poor outcome in chronic kidney disease (CKD) patients before (CKD/pre-KT) and after kidney (CKD-T) transplantation. Less is known about prevalence rates of psychiatric symptoms and impaired HRQoL of non-transplanted compared with transplanted patients.

METHODS

In a cross-sectional study comparing 101 CKD/pre-KT patients with 151 cadaveric-transplanted (CKD-T) patients, we examined prevalence of depression/anxiety (HADS questionnaire) and coping, resilience and HRQoL (SF-12, Resilience-Scale and FKV-questionnaire).

RESULTS

The prevalence of both depressive and anxiety symptoms was not significantly different between different pre-/and CKD-T patient groups. In CKD-T no significant relations of coping strategies with kidney function were identified. Furthermore, the Resilience Scales for acceptance and competence did not suggest any differences between the CKD/pre-KT and CKD-T subgroup. In the CKD/pre-KT patients, significant correlations were identified between the acceptance subscale and partnership, as well as between the competence subscale and older age/partnership.

CONCLUSIONS

Both the CKD/pre-KT and CKD-T patients exhibited notable impairments in the HRQoL which which showed a comparable pattern of results. KT itself does not appear to be the main risk factor for the development of mental impairments.

Impact of different immunosuppressive regimens on the health-related quality of life following orthotopic liver transplantation

BACKGROUND

The influence of immunosuppression on the recipients' quality of life (QoL) is of major importance after OLT and has not yet been evaluated.

METHODS

The impact of different immunosuppression regimens after OLT was evaluated in 275 patients using the Short Form 36 (SF-36) survey. The following immunosuppressive strategies were compared: (a) CNI, (b) mTOR inhibitors, and (c) mTOR combined with CNI. All regimens were prescribed alone (mono) or in combination (+) with prednisolone and/or mycophenolate mofetil (MMF).

RESULTS

Highest scores were evident in patients in the mTOR+ group. There were significantly higher values for general health perceptions (GH, p = 0.049), vitality (VIT, p = 0.020), and physical component summary (PCS, p = 0.041) when compared to CNImono and for GH (p = 0.042) and VIT (p = 0.043), when compared to mTORmono. Early conversion to mTOR inhibitors (<two months after OLT) was associated with higher values for 7 of 10 scales, when compared to a late conversion (>two months after OLT), with a statistically significant improvement for the dimension role-emotional (RE, p = 0.027).

DISCUSSION

mTOR inhibitor-based regimens appear to have beneficial effects on QoL after OLT, especially after an early conversion.

Comparison of the affective symptomatology between liver transplant recipients and patients with multiple sclerosis considering their functional impairment

OBJECTIVES

We aimed to compare the affective symptomatology in two medical conditions under immunotherapy (cadaveric liver transplantation [G1] and multiple sclerosis [G2]), considering their functional impairment, and to assess the clinical significance of the results regarding a representative age-adjusted sample of the general Spanish population (G3).

METHODS

Using a cross-sectional design, 164 patients (82 per clinical group) were selected, matched for gender, and homogenized regarding age and functional impairment according to the Physical functioning subscale from the SF-36 Health Survey. The criterion variables were the Mental health and Role-emotional SF-36 subscales and the Hospital Anxiety and Depression Scale. An analysis of covariance was conducted, controlling for age and the Physical functioning score as covariates. Cohen's d was reported as an effect size index and to analyze the clinical significance regarding a representative age-adjusted sample of the general Spanish population (n = 7881).

RESULTS

No statistically significant differences were found between conditions in any affective dimension (P > .05; ds₁₋₂ from 0.08 to 0.30) or in the percentage of clinical cases regarding the anxious (P = .628) or depressive spectrum (P = .716). The neurological patients showed clinically significant impairment in both SF-36 subscales (ds₂₋₃ = 0.55 and 0.52, respectively), but transplant recipients only differed from the general population in Role-emotional (d₁₋₃ = 0.81).

CONCLUSIONS

Despite having controlled for functional impairment, important deterioration in daily functioning was still found in liver recipients due to emotional problems, and no relevant differences were observed even when compared with a neurodegenerative condition such as multiple sclerosis.