Quality of life in chronic kidney disease

Abstract

Background - Quality of life (QOL) is suboptimal in end-stage renal disease. However, studies indicate that QOL is already impaired prior to the initiation of renal replacement therapy, implying that the initial decline originates in the chronic kidney disease (CKD) phase of the renal disease trajectory. Given the significance of QOL as a clinical outcome, there is a paucity of QOL research in CKD. Aims - To measure QOL at three distinct phases (based on creatinine clearance - Ccr) of the disease trajectory in CKD: normal renal function (NRF) with underlying renal disease, moderate CKD, and advanced CKD (Ccr >=75, 40-60, and <=30 ml/minute, respectively), and to establish if QOL is different between these groups. Methods - Data was collected from 25 patients from each of the Ccr bands (N=75). We measured self-reported QOL (Schedule for the Evaluation of Individual Quality of Life - SEIQOL), uraemic symptoms (Leicester Uraemic Symptom Scale - LUSS), and laboratory variables. Results - SEIQOL was significantly lower (p<0.001), and symptom number, frequency, and intrusiveness significantly higher (all p<0.001) in the advanced CKD group when compared to the NRF group. Although SEIQOL and symptom intrusiveness did not differ between the advanced and moderate CKD groups, SEIQOL was significantly lower (p<0.05) and symptom intrusiveness significantly higher (p<0.05) in the moderate CKD group when compared to the NRF group. Conclusion - QOL is already impaired in moderate CKD. The significant difference in QOL and symptom intrusiveness between the moderate CKD and NRF groups may denote a causal relationship between symptom intrusiveness and QOL early in CKD.