Symptom Burden Affects Quality of Life in Patients With Nondialysis CKD

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In patients with nondialysis chronic kidney disease (CKD), high symptom burden is strongly associated with decreased health-related quality of life, reports a paper in the American Journal of Kidney Diseases.

The cross-sectional study included 4430 patients with stage 3 to 5 nondialysis CKD enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). Participants were drawn from Brazil, France, and the United States. Among the patients, 60% were men, the mean age was 68 years, and the mean baseline estimated glomerular filtration rate was 30 mL/min/1.73 m2.

The Kidney Disease Quality of Life Short Form was used to assess the presence and severity of 13 individual symptoms and to classify overall symptom burden as low, intermediate, or high. Associations of symptom burden with the Kidney Disease Quality of Life Short Form physical and mental component scores were assessed.

Patients reported being “very much to extremely bothered” by a median of six symptoms. Muscle soreness and feeling “washed out or drained” were the most common bothersome symptoms, followed by cramps, shortness of breath, dry skin, diminished sex life, and numbness in hands or feet. With adjustment for other factors, symptoms showing the greatest increase in prevalence with CKD stage were lack of appetite, nausea or upset stomach, and feeling washed out or drained. Women were more likely to report high bothersome symptoms from all symptoms except impact on sex life, which was three times more frequent in men.

High symptom burden was more common among women, in France, and in patients with severe albuminuria and various comorbid conditions, although not in patients with a lower estimated glomerular filtration rate. High symptom burden compared with low symptom burden was associated with lower quality of life: a 13.4-point difference in the physical component scores and a 7.7-point difference in the mental component scores.

The CKDopps data show a high symptom burden among patients with nondialysis CKD, with associated reductions in disease-specific quality of life. The findings “indicate the importance and need to assess symptoms more systematically and to enhance provider [clinician]/patient communication as part of ND-CKD [nondialysis-CKD] care aiming to improve patients’ quality of life and prioritized clinical outcomes,” the investigators conclude [Speyer E, et al.; CKDopps Investigators. Symptom burden and its impact on quality of life in patients with moderate to severe CKD: The international Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). Am J Kidney Dis, published online August 6, 2024. doi: 10.1053/j.ajkd.2024.06.011].

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