4.6 Article

Kidney function and symptom development over time in elderly patients with advanced chronic kidney disease: results of the EQUAL cohort study

Journal

NEPHROLOGY DIALYSIS TRANSPLANTATION
Volume 36, Issue 5, Pages 862-870

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/ndt/gfz277

Keywords

chronic kidney disease; clinical epidemiology; kidney function; kidney function decline; symptoms

Funding

  1. European Renal Association European Dialysis and Transplant Association (ERA-EDTA)
  2. Swedish Medical Association (SLS)
  3. Stockholm County Council ALF
  4. Njurfonden (Sweden)
  5. Italian Society of Nephrology (SIN-Reni)
  6. Dutch Kidney Foundation [SB 142]
  7. National Institute for Health Research (NIHR) in the UK
  8. Young Investigators grant in Germany

Ask authors/readers for more resources

The study found that faster kidney function decline in advanced CKD patients was associated with a steeper increase in both the number and severity of symptoms. It is important to pay attention to symptom development in addition to monitoring kidney function decline during clinical decision-making.
Background. Initiation of renal replacement therapy often results from a combination of kidney function deterioration and symptoms related to chronic kidney disease (CKD) progression. We investigated the association between kidney function decline and symptom development in patients with advanced CKD. Methods. In the European Quality study on treatment in advanced CKD (EQUAL study), a European prospective cohort study, patients with advanced CKD aged >= 65 years and a kidney function that dropped <20 mL/min/1.73 m(2) were followed for 1 year. Linear mixed-effects models were used to assess the association between kidney function decline and symptom development. The sum score for symptom number ranged from 0 to 33 and for overall symptom severity from 0 to 165, using the Dialysis Symptom Index. Results. At least one kidney function estimate with symptom number or overall symptom severity was available for 1109 and 1019 patients, respectively. The mean (95% confidence interval) annual kidney function decline was 1.70 (1.32; 2.08) mL/min/1.73 m(2). The mean overall increase in symptom number and severity was 0.73 (0.28; 1.19) and 2.93 (1.34; 4.52) per year, respectively. A cross-sectional association between the level of kidney function and symptoms was lacking. Furthermore, kidney function at cohort entry was not associated with symptom development. However, each mL/min/1.73 m(2) of annual kidney function decline was associated with an extra annual increase of 0.23 (0.07; 0.39) in the number of symptoms and 0.87 (0.35; 1.40) in overall symptom severity. Conclusions. A faster kidney function decline was associated with a steeper increase in both symptom number and severity. Considering the modest association, our results seem to suggest that repeated thorough assessment of symptom development during outpatient clinic visits, in addition to the monitoring of kidney function decline, is important for clinical decision-making.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.6
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available