The CARI guidelines. Quality of life

Association between vitamin D deficiency and health-related quality of life in patients with chronic kidney disease from the KNOW-CKD study

Vitamin D deficiency is a growing health problem in both the general population and in patients with chronic kidney disease (CKD). However, the relationship between serum 25-hydroxyvitamin D levels and health-related quality of life in CKD is not well established. This study examined the association between vitamin D deficiency and quality of life in pre-dialysis CKD patients. Serum 25-hydroxyvitamin D levels and the Korean version of the Kidney Disease Quality of Life short form were obtained for 1844 pre-dialysis CKD patients in the prospective KoreaN cohort Study for Outcomes in patients With Chronic Kidney Disease (KNOW-CKD). The baseline estimated glomerular filtration rate was 50.26 ± 0.71 mL/min/1.73 m2. We identified 1294 (70.2%) patients with vitamin D deficiency, defined as a 25-hydroxyvitamin D level < 20 ng/ml. The scores of the kidney disease component summary, physical component summary, and mental component summary in the vitamin D deficiency group were significantly lower compared to the scores of those without vitamin D deficiency. The serum 25-hydroxyvitamin D level was independently associated with the kidney disease component summary and mental component summary scores (β = 0.147, p = 0.003 and β = 0.151, p = 0.047). In conclusion, there was a significant association between serum 25-hydroxyvitamin D levels and kidney disease component summary and mental component summary scores in pre-dialysis CKD patients.

Predictors of Health-Related Quality of Life in Patients with Co-Morbid Diabetes and Chronic Kidney Disease

BACKGROUND

People living with diabetes and chronic kidney disease (CKD) experience compromised quality of life. Consequently, it is critical to identify and understand factors influencing their health-related quality of life (HRQoL). This study examined factors associated with HRQoL among patients with diabetes and CKD.

METHODS

A cross sectional study among adults with comorbid diabetes and CKD (eGFR <60 mL/min/1.73m2) recruited from renal and diabetes clinics of four large tertiary referral hospitals in Australia was performed. Each participant completed the Kidney Disease Quality of Life (KDQoL ™ -36) questionnaire, which is comprised of two composite measures of physical and mental health and 3 kidney disease specific subscales with possible scores ranging from 0 to 100 with higher values indicating better HRQoL. Demographic and clinical data were also collected. Regression analyses were performed to determine the relationship between HRQoL and potential predictor factors.

RESULTS

A total of 308 patients were studied with a mean age of 66.9 (SD = 11.0) years and 70% were males. Mean scores for the physical composite summary, mental composite summary, symptom/problem list, effects of kidney disease and burden of kidney disease scales were 35.2, 47.0, 73.8, 72.5 and 59.8 respectively. Younger age was associated with lower scores in all subscales except for the physical composite summary. Female gender, obese or normal weight rather than overweight, and smoking were all associated with lower scores in one or more subscales. Scores were progressively lower with more advanced stage of CKD (p<0.05) in all subscales except for the mental composite summary.

CONCLUSION

In patients with diabetes and CKD, younger age was associated with lower scores in all HRQoL subscales except the physical composite summary and female gender, obese or normal weight and more advanced stages of CKD were associated with lower scores in one or more subscales. Identifying these factors will inform the timely implementation of interventions to improve the quality of life of these patients.

How much is enough? An investigation of the relationship between haemodialysis adequacy and quality of life of elderly patients

AIM

The average age of patients requiring haemodialysis is on the rise and has resulted in an increase in the number of elderly people receiving dialysis. While haemodialysis is one of the treatment options for this patient group, questions about its effectiveness have been raised. A second question centres on how much haemodialysis is actually needed to maintain quality of life (QoL). This study examined the relationship between dialysis adequacy and the QoL of elderly patients on haemodialysis.

METHOD

A prospective cohort of 40 haemodialysis patients aged 75 years and above was recruited and studied over 3 months. Quality of life was assessed with the European Quality of Life-5 Dimensions questionnaire and dialysis adequacy with the urea reduction ratio (URR), and the relationship between the two examined using a simple linear regression model.

RESULTS

The average age of the participants was 79.8 ± (3.9 years; 45% were women, and diabetes was the main cause of kidney disease (42.5%). The mean URR, visual analogue scale, European Quality of Life-5 Dimensions indices score and Charlson comorbidity index scores were 78.1 ± (5.5)%, 65.4 ± (13.7)%, 0.7 ± (0.27) and 6.3 ± (2.15), respectively. There was no clear relationship between dialysis adequacy and QoL, r = 0.093. Dialysis adequacy did not significantly predict QoL (P = 0.09).

CONCLUSION

There was no evidence for an association between haemodialysis adequacy and QoL in elderly patients receiving haemodialysis across a URR range of 64.0% to 88.9%. Attempts to improve dialysis adequacy beyond these levels may not be necessary for maintaining the QoL of elderly patients on dialysis.

KEY MESSAGE

Modern therapy should embrace the concept of quality of life and focus more on symptom relief and optimization of self-management skills to improve the well-being of the elderly patients with ESKD.