Butcher E, Walker R, Wyeth E, Samaranayaka A, Schollum J, Derrett S. Health-Related Quality of Life and Disability Among Older New Zealanders With Kidney Failure: A Prospective Study.
Can J Kidney Health Dis 2022;
9:20543581221094712. [PMID:
35493402 PMCID:
PMC9052826 DOI:
10.1177/20543581221094712]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background:
Disability is prevalent in individuals with kidney failure and can contribute
to significantly reduced quality of life and survival. In older individuals
with kidney failure, disability can be caused by a combination of factors,
including issues directly related to their kidney disease and/or treatment,
including weakness, low energy, and low activity. Few studies have
investigated health-related quality of life (HRQoL) as a possible predictor
of disability among older individuals experiencing kidney failure.
Objective:
This study aimed to determine if patient-reported HRQoL, and/or other factors
at baseline, predicts disability in people with kidney failure, aged ≥65
years, after 12 months of follow-up.
Design:
The DOS65+ study was an accelerated longitudinal cohort design comprising of
both cross-sectional and longitudinal components. Participants were eligible
if they were aged ≥65 years, had chronic kidney disease stage 5G (CKD 5G)
(estimated glomerular filtration rate (eGFR) <15 ml/min/1.73
m2), and had: commenced kidney replacement education, or were
on an active conservative pathway, or were newly incident dialysis patients
commencing dialysis therapy or prevalent on dialysis.
Setting:
Three New Zealand District Health Board (DHB) nephrology units (Counties
Manukau, Hawke’s Bay, and Southern DHB) were involved in the study.
Participants:
Participants were eligible if they were aged ≥65 years, had CKD 5G (eGFR
<15 ml/min/1.73 m2), and had: commenced kidney replacement
education, or were on an active conservative pathway, or were newly incident
dialysis patients commencing dialysis therapy or prevalent on dialysis.
Measurements:
Disability and HRQoL were measured by EQ-5D-3L, a WHO Disability Assessment
Schedule (WHODAS) 2.0.
Methods:
Baseline and 12-month data from our longitudinal dialysis outcomes in older
New Zealanders’ study were analyzed to determine if HRQoL at baseline
predicted disability outcomes 12 months later.
Results:
Of the 223 participants at baseline, 157 participants completed a follow-up
interview 12 months later. Individuals with “considerable disability” at
baseline had a significantly (86%) higher risk of experiencing “considerable
disability” at 12 months compared with those with “lesser/no disability” at
baseline. Two thirds of those with ≥3 comorbidities were experiencing
“considerable disability.” In addition, those with problems with EQ-5D-3L
self-care, EQ-5D-3L usual activities, and EQ-5D-3L anxiety/depression
reported higher rates of disability.
Limitations:
Selection bias is likely to have been an issue in this study as participants
were excluded from the follow-up interview if they had an intercurrent
illness requiring hospitalization within 2 weeks of the survey interview or
if the treating nephrologist judged that the individual’s ability to take
part was significantly impaired. Sample size meant there were a limited
number of explanatory/confounding variables that could be investigated in
the multivariable model.
Conclusions:
EQ-5D-3L mobility and self-care may be useful in predicting subsequent
disability for individuals with CKD 5G. Although individuals with kidney
failure often experience disability, previous studies have not clearly
identified HRQoL or disability as predictors of later disability for
individuals with kidney failure. Therefore, we would recommend the
assessment of mobility and self-care, in conjunction with existing
disabilities in the clinical review and pre-dialysis education of
individuals with kidney failure as they approach the need for kidney
replacement therapy.
Trial registration: the Australian and New Zealand clinical trials registry:
ACTRN12611000024943.
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