Quality of Life and Symptom Burden among Chronic Kidney Disease of Uncertain Etiology (CKDu) Patients in Girandurukotte, Sri Lanka

Abstract

Symptom burden and health-related quality of life (HRQOL) are important predictors of how a disease affects patients’ lives, especially for endemic health problems such as chronic kidney disease of uncertain etiology (CKDu). Our study describes symptom burden, HRQOL, and associated demographic and clinical variables in CKDu patients in the Girandurukotte area, Sri Lanka. A cross-sectional study included 120 CKDu patients attending the renal clinic in the endemic area. The instruments applied were the Kidney Disease Quality of Life—Short Form (KDQOL-SFTM) version 1.3 and CKD Symptom Index—Sri Lanka. Socio-demographic, disease-related, and anthropometric variables were also investigated. The mean age of patients was 61.87 (SD 11.31), while 69.2% were male. The mean glomerular filtration rate was 28.17 (SD 14.03) mL/min/1.73 min2, and 70.8% were anemic. Bone/joint pain was the most experienced symptom while the median number of symptoms reported by patients was 5 (IQR 3–7). The mean symptom burden, physical component summary, mental component summary, and kidney-disease-specific component scores were 12.71 (SD 10.45), 68.63 (SD 19.58), 78.53 (SD 18.78), and 81.57 (SD 5.86), respectively. Age was found to be a significant predictor of HRQOL, while hemoglobin level and being a farmer were significant predictors of symptom burden. Our data indicate that CKDu patients in all stages experience at least one symptom affecting all aspects of HRQOL.

Health-related Quality of Life Among Patients With Chronic Kidney Disease of Unknown Etiology (CKDu) of an Agricultural Community in Kebithigollawa, Sri Lanka  

“…Patients undergo a barrage of symptoms including fatigue and pain which are contributing factors for reduced QOL even at the early disease stages (Table 2). Our ndings are in accordance with previous studies on symptom burden of CKD/CKDu patients, where they demonstrated that excessive tiredness, sleep disturbance and pain in the bones or joints were reported more commonly among patients not requiring renal replacement therapy [21,22,33]. Moreover, in the study done to assess the symptom burden of patients with renal disease in the Anuradhapura district, the authors suggested that the high symptom burden of CKDu patients could be attributed to the low socio-economic conditions in the Anuradhapura district [34].…”

“…A clear decrement in the KDQOL TM -36 sub scales is evident in the present study, implying reduced QOL across all stages of CKDu (Table 2), and the ndings are consistent with previous studies conducted with CKD/CKDu patients [9,13,[18][19][20][21][22]. Interestingly, "MCS" scores were found to be much lower compared to "PCS" scores in the early stage of the disease (group A).…”

“…Overall, the "SPKD", "EKD", "BKD", mental and physical components of KDQOL™-36 were signi cantly impaired and in general it follows the pattern of impairment observed in previous studies on CKD patients [9,13,[18][19][20][21][22]. The poor HRQOL in the earlier stages might be a contributing factor for the rate of progression to the ESRD.…”

“…However, majority of studies indicate that males have better CKD related health outcomes than the females [9,13,40]. A possible reason for this could be due to the current study cohort residing in an agricultural setting in the North Central Province, mainly composed of male farmers with low socioeconomic status [8,21,22]. Since majority of the males are the breadwinner of the family they tend to work even with the disease and the physical and mental stress could accelerate the disease progression.…”

“…A limited number of studies have evaluated the association between HRQOL in different stages of CKD [9,13,16,[18][19][20], including fewer studies done in Sri Lanka on CKD/CKDu patients [21,22]. CKDu has been perceived a disease of high prevalence with trends of increasing prevalence.…”