Determining which symptoms have the greatest impact on quality of life in patients with non-dialysis dependent CKD

Dharmaratnam, Abina; Wilkinson, Thomas; Nixon, Daniel; O'sullivan, Tom; Niyi-Odumosu, Faatihah A; Palmer, Jared; Smith, Alice

Abstract

INTRODUCTION: CKD patients suffer with a high symptom burden which is inadequately measured in clinical practice. This high symptom burden is known to impact quality of life, however there is limited understanding of which symptoms most affect patients particularly in the early stages of CKD. The aim of this study was to determine which individual symptoms have the greatest impact on quality of life in patients with non-dialysis CKD.

METHODS: Self-reported symptoms of 155 CKD patients [43% females, mean age, 55.0 (SD: 17.1) years, eGFR, 40.6 (SD: 26.6) ml/min/1.73m²] were assessed using the recently validated Kidney Symptom Questionnaire. The 13 symptoms were classified into binary variables (i.e. apparent: at least once per week or non-apparent). Linear regression was used to determine the association between individual symptoms and quality of life, measured using the EQ5D index values (where 1 equates to highest quality of life and -0.594 to lowest quality of life).

RESULTS: In order of prevalence, the top six most common symptoms were: ‘Feeling tired’ (90%); ‘Cramp/muscle stiffness’ (78%), ‘Polynocturia’ (76%); ‘Sleep disturbance/insomnia’ (71%), ‘Feeling cold’ (66%) and ‘Bone/joint pain’ (65%). The mean total symptom score was 22.7 (SD: 12.9) out of a possible 52. The mean EQ5D index was 0.70 (SD: 0.27).

Increasing symptom burden was significantly correlated with a lower quality of life (r=-0.617, p<0.001). Pain in the bones or joints was the greatest predictor of poor quality of life even after adjusting for age, gender, and eGFR, followed by cramp/muscle stiffness. (Table 1)

Table 1: Linear regression between the top 6 most common symptoms and EQ5D index values.

Symptom Standardised coefficient βUnadjusted Model 1 Standardised coefficient βModel 2: age and gender Standardised coefficient βModel 3: age gender and eGFR
Feeling tired -0.069 (p=0.403) -0.061 (p=0.546) -0.061 (p=0.553)
Cramp/muscle stiffness -0.191 (p=0.056) -0.198 (p=0.050) -0.197 (p=0.052)
Polynocturia 0.080 (p=0.389) 0.075 (p=0.428) 0.076 (p=0.425)
Sleep disturbance/ insomnia 0.029 (p=0.775) 0.027 (p=0.787) 0.024 (p=0.817)
Feeling cold -0.115 (p=0.210) -0.113 (p=0.228) -0.112 (p=0.235)
Bone/joint pain -0.295 (p=0.003*) -0.299 (p=0.003*) -0.296 (p=0.004*)
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CONCLUSIONS: Patients with non-dialysis CKD suffer from numerous symptoms which have a negative impact on quality of life. This study shows that the symptoms most impacting quality of life are bone/joint pain, cramp/muscle stiffness and poor concentration. Results from this study highlight an incongruity between symptoms known to be most common and those that have been shown to impact quality of life. Feeling tired, the most common symptom does not correlate to having the most impact on quality of life. Clinicians should consider addressing these key symptoms in their management strategies to more effectively improve quality of life in non-dialysis CKD patients.

• Presentation Conference Type: Conference Paper (published)
• Acceptance Date: Apr 16, 2019
• Publication Date: Jun 13, 2019
• Deposit Date: Aug 16, 2022
• Journal: Nephrology Dialysis Transplantation
• Print ISSN: 0931-0509
• Electronic ISSN: 1460-2385
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 34
• Issue: Issue Supplement_1, June 2019, gfz106.FP425
• DOI: https://doi.org/10.1093/ndt/gfz106.FP425
• Keywords: hemodialysis kidney failure, chronic dialysis procedure quality of life impact
• Public URL: https://uwe-repository.worktribe.com/output/9879967
• Publisher URL: https://academic.oup.com/ndt/article/34/Supplement_1/gfz106.FP425/5516024?login=true