Journal
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 11, Issue 7, Pages 1154-1162Publisher
AMER SOC NEPHROLOGY
DOI: 10.2215/CJN.09990915
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Funding
- National Institutes of Diabetes and Digestive and Kidney Diseases [U01DK60980, R01DK72231, K24DK092290, K23DK094829, K23DK097183-02]
- National Institute of Diabetes and Digestive and Kidney Diseases [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902]
- Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science award National Institutes of Health (NIH)/National Center for Advancing Translational Sciences (NCATS) [UL1TR000003]
- Johns Hopkins University [UL1 TR-000424]
- University of Maryland General Clinical Research Center [M01 RR-16500]
- Clinical and Translational Science Collaborative of Cleveland from the NCATS component of the NIH [UL1TR000439]
- NIH Roadmap for Medical Research
- Michigan Institute for Clinical and Health Research [UL1TR000433]
- University of Illinois at Chicago Clinical and Translational Science Award [UL1RR029879]
- Tulane University Translational Research in Hypertension and Renal Biology [P30GM103337]
- Kaiser Permanente NIH/National Center for Research Resources [UCSF-CTSI UL1 RR-024131]
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Background and objectives Low health related quality of life is associated with increased mortality in patients with ESRD. However, little is known about demographic and clinical factors associated with health related quality of life or its effect on outcomes in adults with CKD. Design, settings, participants, & measurements Data from 3837 adult participants with mild to severe CKD enrolled in the prospective observational Chronic Renal Insufficiency Cohort and Hispanic Chronic Renal Insufficiency Cohort Studies were analyzed. Health related quality of life was assessed at baseline with the Kidney Disease Quality of Life-36 and its five subscales: mental component summary, physical component summary, burden of kidney disease (burden), effects of kidney disease (effects), and symptoms and problems of kidney disease (symptoms). Low health related quality of life was defined as baseline score >1 SD below the mean. Using Cox proportional hazards analysis, the relationships between low health related quality of life and the following outcomes were examined: (1) CKD progression (50% eGFR loss or incident ESRD), (2) incident cardiovascular events, and (3) all-cause death. Results Younger age, women, low education, diabetes, vascular disease, congestive heart failure, obesity, and lower eGFR were associated with low baseline health related quality of life (P<0.05). During a median follow-up of 6.2 years, there were 1055 CKD progression events, 841 cardiovascular events, and 694 deaths. Significantly higher crude rates of CKD progression, incident cardiovascular events, and all-cause death were observed among participants with low health related quality of life in all subscales (P<0.05). In fully adjusted models, low physical component summary, effects, and symptoms subscales were independently associated with a higher risk of incident cardiovascular events and death, whereas low mental component summary was independently associated with a higher risk of death (P<0.05). Low health related quality of life was not associated with CKD progression. Conclusions Low health related quality of life across several subscales was independently associated with a higher risk of incident cardiovascular events and death but not associated with CKD progression.
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