The impact of comorbid chronic kidney disease and diabetes on health-related quality-of-life: a 12-year community cohort study

Abstract

Background Quality-of-life is an essential outcome for clinical care. Both chronic kidney disease (CKD) and diabetes have been associated with poorer quality-of-life. The combined impact of having both diseases is less well understood. As diabetes is the most common cause of CKD, it is imperative that we deepen our understanding of their joint impact. Methods This was a prospective, longitudinal cohort study of community-based Australians aged ≥25 years who participated in the Australian Diabetes, Obesity and Lifestyle study. Quality-of-life was measured by physical component summary (PCS) and mental component summary sub-scores of the Short Form (36) Health Survey. Univariate and multivariate linear mixed effect regressions were performed. Results Of the 11 081 participants with quality-of-life measurements at baseline, 1112 had CKD, 1001 had diabetes and of these 271 had both. Of the 1112 with CKD 421 had Stage 1, 314 had Stage 2, 346 had Stage 3 and 31 had Stages 4/5. Adjusted linear mixed effect models showed baseline PCS was lower for those with both CKD and diabetes compared with either disease alone (P < 0.001). Longitudinal analysis demonstrated a more rapid decline in PCS in those with both diseases. Conclusions The combination of CKD and diabetes has a powerful adverse impact on quality-of-life, and participants with both diseases had significantly poorer quality-of-life than those with one condition.

Chronic Kidney Disease on Health-Related Quality of Life in Patients with Diabetes Mellitus: A National Representative Study

“…In this study, DM patients with more severe CKD were more likely to have problems in the mobility and usual activities dimensions, which is consistent with previous studies [26][27][28]. In a cross-sectional study of patients with DM and CKD, the mean physical composite summary of the Kidney Disease Quality of Life (KDQOL-36) subscales was lower with more advanced stages of CKD [28].…”

“…Similarly, the presence of DM was significantly associated with lower HRQoL, particularly with lower physical function, in CKD patients [29]. Furthermore, in previous studies, poor physical quality of life was associated with a higher risk of mortality in patients with CKD or comorbid DM and CKD [26,30,31]. This suggests that interventions in diabetic patients with early stage CKD to maintain or improve physical function and quality of life may help mitigate declining physical quality of life and mortality.…”

“…There was also no clear trend in the association between progressive stages of CKD and having any problem in anxiety/depression dimension. Other studies have also found that CKD, even comorbid DM and CKD, was not associated with poorer mental quality of life [26][27][28]. It is possible that the three-level EQ-5D descriptive system may not be sensitive enough to be used as an indicator to determine the anxiety/depression aspect of HRQoL in patients with chronic conditions or with multiple complications.…”

“…In a cross-sectional study of patients with DM and CKD, the mean physical composite summary of the Kidney Disease Quality of Life (KDQOL-36) subscales was lower with more advanced stages of CKD [28]. In addition, in a longitudinal study, those with both DM and CKD had much faster decline in the physical component summary scores measured using SF-36 than those with either disease alone [26]. Although this study used a different metric to measure quality of life, their findings also supported poor HRQoL in mobility and usual activities dimensions among those with both DM and CKD.…”

Admission kidney function is a strong predictor for the response to nutritional support in patients at nutritional risk

“…Whether higher targets would have produced similar results, however, remains unclear from our trial. Third, functional ability including quality of life or activities of daily living have been found to be significantly impaired in CKD patients [32,33]. Previous research found functional disability to aggravate along with worsening of the kidney function [34].…”