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The impact of symptoms on health-related quality of life in elderly pre-dialysis patients : effect and importance in the EQUAL study

Voskamp, Pauline W.M. ; van Diepen, Merel ; Evans, Marie ; Caskey, Fergus J. ; Torino, Claudia ; Postorino, Maurizio ; Szymczak, Maciej ; Klinger, Marian ; Wallquist, Carin LU and van de Luijtgaarden, Moniek W.M. , et al. (2019) In Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 34(10). p.1707-1715
Abstract

BACKGROUND: Quality of life (QoL) is an important outcome in chronic kidney disease (CKD). Patients feel that symptoms are an important determinant of QoL. However, this relation is unknown. The aims of this study were to investigate the impact of the number and severity of symptoms on QoL in elderly pre-dialysis patients, assessed by both the effect of symptoms and their importance relative to kidney function, and other clinical variables on QoL. METHODS: The European Quality study (EQUAL study) is an ongoing European prospective follow-up study in late Stage 4/5 CKD patients aged ≥65 years. We used patients included between March 2012 and December 2015. Patients scored their symptoms with the Dialysis Symptom Index, and QoL with the... (More)

BACKGROUND: Quality of life (QoL) is an important outcome in chronic kidney disease (CKD). Patients feel that symptoms are an important determinant of QoL. However, this relation is unknown. The aims of this study were to investigate the impact of the number and severity of symptoms on QoL in elderly pre-dialysis patients, assessed by both the effect of symptoms and their importance relative to kidney function, and other clinical variables on QoL. METHODS: The European Quality study (EQUAL study) is an ongoing European prospective follow-up study in late Stage 4/5 CKD patients aged ≥65 years. We used patients included between March 2012 and December 2015. Patients scored their symptoms with the Dialysis Symptom Index, and QoL with the research and development-36 (RAND-36) item Health Survey (RAND-36). The RAND-36 results in a physical component summary (PCS) and a mental component summary (MCS). We used linear regression to estimate the relation between symptoms and QoL at baseline and after 6 months, and to calculate the variance in QoL explained by symptoms. RESULTS: The baseline questionnaire was filled in by 1079 (73%) patients (median age 75 years, 66% male, 98% Caucasian), and the follow up questionnaire by 627 (42%) patients. At baseline, every additional symptom changed MCS with -0.81 [95% confidence interval (CI): -0.91 to -0.71] and PCS with -0.50 (95% CI: -0.62 to -0.39). In univariable analyses, number of symptoms explained 22% of MCS variance and 11% of PCS variance, whereas estimated glomerular filtration rate only explained 1%. CONCLUSIONS: In elderly CKD Stage 4/5 patients, symptoms have a substantial impact on QoL. This indicates symptoms should have a more prominent role in clinical decision-making.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
CKD, clinical epidemiology, pre-dialysis, quality of life, symptoms
in
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
volume
34
issue
10
pages
9 pages
publisher
Oxford University Press
external identifiers
  • pmid:29939304
  • scopus:85072888157
ISSN
1460-2385
DOI
10.1093/ndt/gfy167
language
English
LU publication?
no
id
a9bda947-4b01-45b3-8b10-16571fdc1670
date added to LUP
2019-10-16 14:34:29
date last changed
2020-11-24 04:10:34
@article{a9bda947-4b01-45b3-8b10-16571fdc1670,
  abstract     = {<p>BACKGROUND: Quality of life (QoL) is an important outcome in chronic kidney disease (CKD). Patients feel that symptoms are an important determinant of QoL. However, this relation is unknown. The aims of this study were to investigate the impact of the number and severity of symptoms on QoL in elderly pre-dialysis patients, assessed by both the effect of symptoms and their importance relative to kidney function, and other clinical variables on QoL. METHODS: The European Quality study (EQUAL study) is an ongoing European prospective follow-up study in late Stage 4/5 CKD patients aged ≥65 years. We used patients included between March 2012 and December 2015. Patients scored their symptoms with the Dialysis Symptom Index, and QoL with the research and development-36 (RAND-36) item Health Survey (RAND-36). The RAND-36 results in a physical component summary (PCS) and a mental component summary (MCS). We used linear regression to estimate the relation between symptoms and QoL at baseline and after 6 months, and to calculate the variance in QoL explained by symptoms. RESULTS: The baseline questionnaire was filled in by 1079 (73%) patients (median age 75 years, 66% male, 98% Caucasian), and the follow up questionnaire by 627 (42%) patients. At baseline, every additional symptom changed MCS with -0.81 [95% confidence interval (CI): -0.91 to -0.71] and PCS with -0.50 (95% CI: -0.62 to -0.39). In univariable analyses, number of symptoms explained 22% of MCS variance and 11% of PCS variance, whereas estimated glomerular filtration rate only explained 1%. CONCLUSIONS: In elderly CKD Stage 4/5 patients, symptoms have a substantial impact on QoL. This indicates symptoms should have a more prominent role in clinical decision-making.</p>},
  author       = {Voskamp, Pauline W.M. and van Diepen, Merel and Evans, Marie and Caskey, Fergus J. and Torino, Claudia and Postorino, Maurizio and Szymczak, Maciej and Klinger, Marian and Wallquist, Carin and van de Luijtgaarden, Moniek W.M. and Chesnaye, Nicolas C. and Wanner, Christoph and Jager, Kitty J. and Dekker, Friedo W.},
  issn         = {1460-2385},
  language     = {eng},
  number       = {10},
  pages        = {1707--1715},
  publisher    = {Oxford University Press},
  series       = {Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association},
  title        = {The impact of symptoms on health-related quality of life in elderly pre-dialysis patients : effect and importance in the EQUAL study},
  url          = {http://dx.doi.org/10.1093/ndt/gfy167},
  doi          = {10.1093/ndt/gfy167},
  volume       = {34},
  year         = {2019},
}