The impact of symptoms on health-related quality of life in elderly pre-dialysis patients: effect and importance in the EQUAL study

Voskamp, Pauline; Diepen, Merel van; Evans, Marie; Caskey, Fergus; Torino, Claudia; Postorino, Maurizio; Szymczak, Maciej; Klinger, Marian; Wallquist, Carin; Luijtgaarden, Moniek W.M. van de; Chesnaye, Nicholas C.; Wanner, Christoph; Jager, Kitty J.; Dekker, Friedo W.

doi:10.1093/ndt/gfy167

Cited by 34 publications

(35 citation statements)

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“…45 Moreover, a higher symptom burden has also been associated to a lower quality of life. 2 In our present study, we found that both constipation and decreased appetite were risk factors for decline in nutritional status. Constipation is prevalent in older adults and has previously been reported to be associated with poor appetite and nausea, factors that affect the energy and nutrient intake.…”

Section: Discussionsupporting

confidence: 50%

“…O LDER ADULTS WITH advanced chronic kidney disease (CKD) form a high-risk group for poor nutritional status and high overall disease burden. 1,2 The prevalence of protein-energy wasting (PEW) in this vulnerable population is high, and increases with age. 3 Patients who undergo maintenance dialysis have a significant decline in nutritional parameters, and those diagnosed with PEW have a higher risk of mortality and hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

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Patient-Reported Measures and Lifestyle Are Associated With Deterioration in Nutritional Status in CKD Stage 4-5: The EQUAL Cohort Study

Windahl

Irving

Almquist

et al. 2022

Journal of Renal Nutrition

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The aim of this study was to explore the changes in nutritional status before dialysis initiation and to identify modifiable risk factors of nutritional status decline in older adults with advanced renal disease.Design and Methods: The European Quality Study on treatment in advanced chronic kidney disease (EQUAL) is a prospective, observational cohort study involving six European countries. We included 1,103 adults .65 years with incident estimated glomerular filtration rate ,20 mL/min/1.73 m 2 not on dialysis, attending nephrology care. Nutritional status was assessed with the 7-point Subjective Global Assessment tool (7-p SGA), patient-reported outcomes with RAND-36 and the Dialysis Symptom Index. Logistic regression was used to estimate the associations between potential risk factors and SGA decline.Results: The majority of the patients had a normal nutritional status at baseline, 28% were moderately malnourished (SGA #5). Overall, mean SGA decreased by 20.18 points/year, (95% confidence interval 20.21; 20.14). More than one-third of the study participants (34.9%) deteriorated in nutritional status (1 point decline in SGA) and 10.9% had a severe decline in SGA ($2 points). The proportion of patients with low SGA (#5) increased every 6 months. Those who dropped in SGA also declined in estimated glomerular filtration rate and mental health score. Every 10 points decrease in physical function score increased the odds of decline in SGA by 23%. Lower physical function score at baseline, gastrointestinal symptoms, and smoking were risk factors for impaired nutritional status. There was an interaction between diabetes and physical function on SGA decline.

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Patient-Reported Measures and Lifestyle Are Associated With Deterioration in Nutritional Status in CKD Stage 4-5: The EQUAL Cohort Study

Windahl

Irving

Almquist

et al. 2022

Journal of Renal Nutrition

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“…Patients with advanced chronic kidney disease (CKD) have shown to be more vulnerable to mental health problems, such as anxiety and depression [10]. In this population, emotional symptoms, like symptoms of anxiety and depression, worrying, sleep disorders, perceived lack of social support, and reduced social interactions, affect not only health-related quality of life (HRQoL) [11][12][13][14], but have also been associated with adverse clinical outcomes and increased mortality risk [15,16]. Above and beyond, the presence of CKD is an important risk factor for a more severe course of COVID-19, as patients with advanced CKD (stage G4/G5; severely decreased glomerular filtration rate or kidney failure) have a 2.5 times increased mortality risk, compared to those with normal kidney function [1].…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on symptoms of anxiety and depression and health-related quality of life in older patients with chronic kidney disease

et al. 2021

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Background Older patients with advanced chronic kidney disease are at increased risk for a severe course of the coronavirus disease-2019 (COVID-19) and vulnerable to mental health problems. We aimed to investigate prevalence and associated patient (demographic and clinical) characteristics of mental wellbeing (health-related quality of life [HRQoL] and symptoms of depression and anxiety) before and during the COVID-19 pandemic in older patients with advanced chronic kidney disease. Methods An ongoing Dutch multicentre prospective cohort study enrols patients of ≥70 years with an eGFR < 20 mL/min/1.73m2 from October 2018 onward. With additional questionnaires during the pandemic (May–June 2020), disease-related concerns about COVID-19 and general anxiety symptoms were assessed cross-sectionally, and depressive symptoms, HRQoL, and emotional symptoms longitudinally. Results The 82 included patients had a median age of 77.5 years (interquartile range 73.9–82.1), 77% were male and none had tested positive for COVID-19. Cross-sectionally, 67% of the patients reported to be more anxious about COVID-19 because of their kidney disease, and 43% of the patients stated that their quality of life was reduced due to the COVID-19 pandemic. Compared to pre-COVID-19, the presence of depressive symptoms had increased (11 to 22%; p = .022) and physical HRQoL declined (M = 40.4, SD = 10.1 to M = 36.1, SD = 10.4; p < .001), particularly in males. Mental HRQoL (M = 50.3, SD = 9.6 to M = 50.4, SD = 9.9; p = .913) and emotional symptoms remained similar. Conclusions Older patients with advanced chronic kidney disease suffered from disease-related anxiety about COVID-19, increased depressive symptoms and reduced physical HRQoL during the COVID-19 pandemic. The impact of the pandemic on this vulnerable patient group extends beyond increased mortality risk, and awareness of mental wellbeing is important. Trial registration The study is registered at the Netherlands Trial Register (NTR), trial number NL7104. Date of registration: 06-06-2018.

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“…Impaired HRQoL is well described among patients with chronic kidney disease (CKD) and found to correlate with factors such as symptom burden [ 9 ], hypertension, anemia, nutritional status, dialysis modality, depression, cognitive dysfunction and frailty [ 10–14 ], and also education, depression, exercise habits [ 15 ], proteinuria [ 16 ] and inflammatory status [ 17 ]. Low HRQoL scores in dialysis patients have proved to be strong and independent predictors of hospitalization and mortality [ 18–20 ].…”

Section: Introductionmentioning

confidence: 99%

Patient-reported outcome measures as a new application in the Swedish Renal Registry: health-related quality of life through RAND-36

Pagels

Stendahl

Evans

2019

Clinical Kidney Journal

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Background Although patient-reported outcome measures (PROMs) are gaining increased interest in developing health care quality and are a useful tool in person-centered care, their use in routine care is still limited. The aim of this study is to describe the implementation and initial results of PROMs via the Swedish Renal Registry (SRR) on a national level. Methods After testing and piloting the electronic PROM application, nationwide measures were carried out in 2017 for completing the RAND-36 questionnaire online or by paper in a wide range of chronic kidney disease (CKD) patients (Stages 3–5, dialysis and transplantation) through the SRR. Cross-sectional results during the first year were analyzed by descriptive statistics and stratified by treatment modality. Results A total of 1378 patients from 26 of 68 renal units (39%) completed the questionnaire. The response rate for all participating hemodialysis units was 38.9%. The CKD patients had an impaired health profile compared with a Swedish general population, especially regarding physical functions and assessed general health (GH). Transplanted patients had the highest scores, whereas patients on dialysis treatment had the lowest scores. The youngest age group assessed their physical function higher and experienced fewer physical limitations and less bodily pain than the other age groups but assessed their GH and vitality (VT) relatively low. The oldest age group demonstrated the lowest health profile but rated their mental health higher than the other age groups. The older the patient, the smaller the difference compared with persons of the same age in the general population. Conclusions Nationwide, routine collection of PROMs is feasible in Sweden. However, greater emphasis is needed on motivating clinical staff to embrace the tool and its possibilities in executing person-centered care. CKD patients demonstrate impaired health-related quality of life, especially regarding limitations related to physical problems, GH and VT/energy/fatigue.

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The impact of symptoms on health-related quality of life in elderly pre-dialysis patients: effect and importance in the EQUAL study

Abstract: In elderly CKD Stage 4/5 patients, symptoms have a substantial impact on QoL. This indicates symptoms should have a more prominent role in clinical decision-making.

Cited by 34 publications

References 31 publications

Patient-Reported Measures and Lifestyle Are Associated With Deterioration in Nutritional Status in CKD Stage 4-5: The EQUAL Cohort Study

Patient-Reported Measures and Lifestyle Are Associated With Deterioration in Nutritional Status in CKD Stage 4-5: The EQUAL Cohort Study

Impact of the COVID-19 pandemic on symptoms of anxiety and depression and health-related quality of life in older patients with chronic kidney disease

Patient-reported outcome measures as a new application in the Swedish Renal Registry: health-related quality of life through RAND-36

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