Quality of Life Is Associated with Cardiac Biomarkers, Echocardiographic Indices, and Mortality in CKD Stage 4–5 Patients Not on Dialysis

Abstract

<b><i>Introduction:</i></b> Patients with CKD have an impaired health-related quality of life (QoL). Most studies have been conducted on dialysis patients, and less is known about QoL and its determinants in predialysis patients. We studied the association between QoL and comorbidities, cardiac biomarkers, echocardiography, and mortality in patients with CKD stage 4–5 not on dialysis. <b><i>Methods:</i></b> A total of 140 patients enrolled in the Chronic Arterial Disease, Quality of Life and Mortality in Chronic Kidney Injury (CADKID) study filled the Kidney Disease Quality of Life Short Form (KDQOL-SF) at the beginning of the study. Echocardiography and biochemical parameters were obtained at baseline. Patients were followed up for at least 2 years or until death. <b><i>Results:</i></b> The median age was 66 years, and 51 (36%) patients were female. The median estimated glomerular filtration rate was 13 mL/min per 1.73 m<sup>2</sup>. Obesity, diabetes, atrial fibrillation, and congestive heart failure were associated with lower QoL scores in multiple KDQOL-SF domains. Cardiac biomarkers, troponin T (<i>p</i> = 0.02), N-terminal pro-B-type natriuretic peptide (<i>p</i> = 0.006), and the echocardiographic parameter of cardiac systolic function left ventricular global longitudinal strain (<i>p</i> = 0.02) were significant predictors of lower physical component summary (PCS) score in multivariable regression models after controlling for age, BMI, and diabetes. A low PCS score predicted mortality in a multivariable Cox proportional hazards model [HR 0.96 (95% CI 0.92–0.99), <i>p</i> = 0.03]. QoL was not associated with kidney disease progression. <b><i>Conclusion:</i></b> Impaired QoL in CKD stage 4–5 patients not on dialysis is associated with cardiac biomarker levels, echocardiographic indices, and mortality.

Association of maximal stress ergometry performance with troponin T and abdominal aortic calcification score in advanced chronic kidney disease

“…Our current results suggest that increased TnT in CKD is a determinant of cardiovascular burden that affects the day to day life of patients with advanced CKD by limiting their maximal physical performance in addition to increasing their risk for incident cardiovascular death. In accordance with this finding we have previously shown that the physical composite score of the Short Form 36 Items Health Survey (SF-36 QOL) is inversely associated with TnT in the CADKID study population [21].…”

Evolution of Quality of Life in Chronic Kidney Disease Stage 4–5 Patients Transitioning to Dialysis and Transplantation

“…Few QoL studies have utilized echocardiographic data. We previously demonstrated an association between PCS and left ventricular systolic and diastolic function in echocardiography [7]. In the present follow-up study, mean EF was the only variable independently associated with dPCS in multivariable analysis.…”

“…No power calculations were performed as there are no previous data on the development of QoL in nondialysis CKD stage 4-5 patients transitioning to different RRT modalities. The baseline data for QoL measures in the CADKID study population have been reported earlier [7]. According to the original study plan reported at clinicaltrials.gov, re-assessment of QoL was scheduled to be performed 2 years after the first assessment.…”

“…Cardiovascular disease is the most common cause of mortality in the CKD population. Furthermore, cardiac biomarkers and echocardiographic indices are associated with both QoL and mortality in CKD patients [6, 7]. Thus, QoL is an important indicator of both well-being and prognosis in CKD patients.…”