TY - JOUR
T1 - Health-Related Quality of Life, Depressive Symptoms, and Kidney Transplant Access in Advanced CKD
T2 - Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
AU - CRIC Study Investigators
AU - Harhay, Meera Nair
AU - Yang, Wei
AU - Sha, Daohang
AU - Roy, Jason
AU - Chai, Boyang
AU - Fischer, Michael J.
AU - Hamm, L. Lee
AU - Hart, Peter D.
AU - Hsu, Chi yuan
AU - Huan, Yonghong
AU - Huml, Anne M.
AU - Kallem, Radhakrishna Reddy
AU - Tamura, Manjula Kurella
AU - Porter, Anna C.
AU - Ricardo, Ana C.
AU - Slaven, Anne
AU - Rosas, Sylvia E.
AU - Townsend, Raymond R.
AU - Reese, Peter P.
AU - Lash, James P.
AU - Akkina, Sanjeev
AU - Appel, Lawrence J.
AU - Feldman, Harold I.
AU - Go, Alan S.
AU - He, Jiang
AU - Kusek, John W.
AU - Rao, Panduranga
AU - Rahman, Mahboob
N1 - Publisher Copyright:
© 2020 The Authors
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Rationale & Objective: Among individuals with chronic kidney disease (CKD), poor self-reported health is associated with adverse outcomes including hospitalization and death. We sought to examine the association between health-related quality-of-life (HRQoL) and depressive symptoms in advanced CKD and subsequent access to the kidney transplant waiting list. Study Design: Prospective cohort study. Setting & Population: 1,676 Chronic Renal Insufficiency Cohort (CRIC) study participants with estimated glomerular filtration rates ≤ 30 mL/min/1.73 m2 at study entry or during follow-up. Exposures: HRQoL ascertained by 5 scales of the Kidney Disease Quality of Life-36 Survey (Physical Component Summary [PCS], Mental Component Summary, Symptoms, Burdens, and Effects), with higher scores indicating better HRQoL, and depressive symptoms ascertained using the Beck Depression Inventory. Outcomes: Time to kidney transplant wait-listing and time to pre-emptive wait-listing. Analytic Approach: Time-to-event analysis using Cox proportional hazards regression. Results: During a median follow-up of 5.1 years, 652 (39%) participants were wait-listed, of whom 304 were preemptively wait-listed. Adjusted for demographics, comorbid conditions, estimated glomerular filtration rate slope, and cognitive function, participants with the highest scores on the Burden and Effects scales, respectively, had lower rates of wait-listing than those with the lowest scores on the Burden (wait-listing adjusted hazard ratio [aHR], 0.70; 95% CI, 0.57-0.85; P < 0.001) and Effects scales (wait-listing aHR, 0.74; 95% CI, 0.59-0.92; P = 0.007). Participants with fewer depressive symptoms (ie, Beck Depression Inventory score < 14) had lower wait-listing rates than those with more depressive symptoms (aHR, 0.81; 95% CI, 0.66-0.99; P = 0.04). Participants with lower Burden and Effects scale scores and those with higher Symptoms and PCS scores had higher pre-emptive wait-listing rates (aHR in highest tertile of PCS relative to lowest tertile, 1.58; 95% CI, 1.12-2.23; P = 0.01). Limitations: Unmeasured confounders. Conclusions: Self-reported health in late-stage CKD may influence the timing of kidney transplantation.
AB - Rationale & Objective: Among individuals with chronic kidney disease (CKD), poor self-reported health is associated with adverse outcomes including hospitalization and death. We sought to examine the association between health-related quality-of-life (HRQoL) and depressive symptoms in advanced CKD and subsequent access to the kidney transplant waiting list. Study Design: Prospective cohort study. Setting & Population: 1,676 Chronic Renal Insufficiency Cohort (CRIC) study participants with estimated glomerular filtration rates ≤ 30 mL/min/1.73 m2 at study entry or during follow-up. Exposures: HRQoL ascertained by 5 scales of the Kidney Disease Quality of Life-36 Survey (Physical Component Summary [PCS], Mental Component Summary, Symptoms, Burdens, and Effects), with higher scores indicating better HRQoL, and depressive symptoms ascertained using the Beck Depression Inventory. Outcomes: Time to kidney transplant wait-listing and time to pre-emptive wait-listing. Analytic Approach: Time-to-event analysis using Cox proportional hazards regression. Results: During a median follow-up of 5.1 years, 652 (39%) participants were wait-listed, of whom 304 were preemptively wait-listed. Adjusted for demographics, comorbid conditions, estimated glomerular filtration rate slope, and cognitive function, participants with the highest scores on the Burden and Effects scales, respectively, had lower rates of wait-listing than those with the lowest scores on the Burden (wait-listing adjusted hazard ratio [aHR], 0.70; 95% CI, 0.57-0.85; P < 0.001) and Effects scales (wait-listing aHR, 0.74; 95% CI, 0.59-0.92; P = 0.007). Participants with fewer depressive symptoms (ie, Beck Depression Inventory score < 14) had lower wait-listing rates than those with more depressive symptoms (aHR, 0.81; 95% CI, 0.66-0.99; P = 0.04). Participants with lower Burden and Effects scale scores and those with higher Symptoms and PCS scores had higher pre-emptive wait-listing rates (aHR in highest tertile of PCS relative to lowest tertile, 1.58; 95% CI, 1.12-2.23; P = 0.01). Limitations: Unmeasured confounders. Conclusions: Self-reported health in late-stage CKD may influence the timing of kidney transplantation.
KW - Kidney Transplant
KW - depression
KW - quality-of-life
KW - wait-listing
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U2 - 10.1016/j.xkme.2020.06.010
DO - 10.1016/j.xkme.2020.06.010
M3 - Article
C2 - 33089138
AN - SCOPUS:85089860857
SN - 2590-0595
VL - 2
SP - 600-609.e1
JO - Kidney Medicine
JF - Kidney Medicine
IS - 5
ER -