Abstract
BackgroundPatients with chronic kidney disease (CKD) have poor health-related quality of life (HRQoL). The association of CKD-related complications such as anemia and mineral and bone disorders (MBD) with HRQoL in pre-dialysis patients is not well-studied. As such, this study aimed to determine the association of anemia and MBD with HRQoL in pre-dialysis patients.MethodsThis was a cross-sectional study involving 311 adult pre-dialysis patients with stage 3–5 CKD from an acute-care hospital in Singapore. Patients’ HRQoL were assessed using Kidney Disease Quality of Life Short Form (KDQOL-SF™) and EuroQol 5 Dimensions–3 levels (EQ5D-3L). HRQoL between patients with and without anemia or MBD were compared by separate hierarchical multiple linear regression analyses using various HRQoL scales as dependent variables, adjusted for sociodemographic, clinical and psychosocial variables.ResultsAfter adjusting for MBD, anemia was associated with lower HRQoL scores on work status (WS), physical functioning (PF) and role physical [β (SE): −10.9 (4.18), p = 0.010; −3.0 (1.28), p = 0.018; and −4.2 (1.40), p = 0.003, respectively]. However, significance was lost after adjustments for sociodemographic variables. Patients with MBD had poorer HRQoL with respect to burden of kidney disease, WS, PF and general health [(β (SE): −7.9 (3.88), p = 0.042; −9.5 (3.99), p = 0.018; −3.0 (1.22) p = 0.014; −3.6 (1.48), p = 0.015, respectively]. Although these remained significant after adjusting for sociodemographic variables, significance was lost after adjusting for clinical variables, particularly pill burden. This is of clinical importance due to the high pill burden of CKD patients, especially from medications for the management of multiple comorbidities such as cardiovascular and mineral and bone diseases.ConclusionsNeither anemia nor MBD was associated with HRQoL in our pre-dialysis patients. Instead, higher total daily pill burden was associated with worse HRQoL. Medication reconciliation should therefore be routinely performed by clinicians and pharmacists to reduce total daily pill burden where possible.
Highlights
Patients with chronic kidney disease (CKD) have poor health-related quality of life (HRQoL)
Results are presented as beta coefficient aReference group: No anemia; bReference group: No mineral and bone disorders (MBD) cAdjusted for MBD or anemia, where appropriate dAdjusted for sociodemographic variables: centered age, gender, race (Chinese/Malay/Indians/Others), marital status, education level and monthly income level eAdjusted for sociodemographic variables plus clincal variables: CKD stage (3/4/5), the presence of co-morbidities and daily pill burden
Due to the large percentage of missing data for intact parathyroid hormone (iPTH) (50.0 %) and 25(OH)D levels (68.8 %), these two parameters were not included as part of our study’s definition for MBD. While this could have led to potential misclassification of patients, the problem was minimised as patients with suboptimal iPTH and 25(OH)D levels were likely to have been on treatment for MBD, which was encompassed in our definition of MBD
Summary
Patients with chronic kidney disease (CKD) have poor health-related quality of life (HRQoL). The association of CKD-related complications such as anemia and mineral and bone disorders (MBD) with HRQoL in pre-dialysis patients is not well-studied. This study aimed to determine the association of anemia and MBD with HRQoL in pre-dialysis patients. Chronic kidney disease (CKD) is a serious public health problem affecting 12.8 % of Singapore’s population [1]. Anemia and mineral and bone disorders (MBD) are two common complications of CKD that have been shown to increase morbidity and mortality in CKD patients [3, 4]. Mineral and bone disorder results from abnormalities in calcium (Ca), phosphorous (P), vitamin D and intact parathyroid hormone (iPTH) homeostasis and high turnover bone disease is predominant in CKD patients with secondary. Clinical presentation of MBD includes bone pain, fractures and extraskeletal calcification
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