Abstract
Importance: With an increasing prevalence of diabetes mellitus (DM) and comorbid chronic kidney disease (CKD), health-related quality of life (HRQoL) in patients with DM and CKD needs to be better understood. Objective: To investigate the association between the severity of CKD on HRQoL in DM patients. Design: A cross-sectional study of a nationally representative population-based survey, the Korea National Health and Nutrition Examination Survey (KNHANES). Setting: Data collected between 2007 and 2018 from the KNHANES. Participants: Adult participants with DM who completed the self-administered European Quality of Life Questionnaire Five Dimension (EQ-5D) questionnaire (n = 7243). Exposures: CKD stages defined by the Kidney Disease Improving Global System (KDIGO) staging system. Main Outcomes and Measures: We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) of the presence of having problems in the 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) of EQ-5D by CKD stage after adjusting for socio-demographic parameters and comorbid conditions. In addition, the EQ-5D index, reflecting the overall health status, was compared across CKD stages. Results: Among 7243 participants (mean (standard error) age 58.2 (0.2) 56.9% male), 24.0% (n = 1768) had CKD and 8.6% (n = 775) had stage 3–5 CKD. Pain/discomfort was the most common problem (30.5%) among patients with DM. Participants with more advanced CKD were more likely to experience problems in all dimensions of EQ-5D except the anxiety/depression dimension. In particular, compared to those without CKD, the adjusted ORs (95% CI) for any problem in the usual activities dimension was 1.65 (1.30, 2.10) in CKD stage 3 and 4.23 (2.07, 8.67) in CKD stage 4–5. Moreover, participants with stage 3 (−0.016 (−0.029, −0.003)) and stage 4–5 CKD (−0.088 (−0.129, −0.048)) had significantly lower EQ-5D index than those without CKD. However, compared with no CKD, CKD stage 1–2 was not significantly associated with having any problem in any dimensions. Conclusions and Relevance: In this nationally representative study, patients with DM had a high prevalence of self-reported poor HRQoL and the prevalence increased with more advanced stages of CKD. Therefore, assessment of HRQoL and interventions are necessary at early stages of CKD in DM patients.
Highlights
Diabetes Mellitus (DM) is a global epidemic and an increasing public health concern.DM is the eighth leading cause of death and is estimated to affect about 460 million people globally [1]
Among 7243 participants included in the study, 24.0% (n = 1768) had chronic kidney disease (CKD) and
Participants without CKD and those with CKD stage 1–2 had the highest prevalence of problems in the pain/discomfort dimension (30.5% and 24.7%, respectively)
Summary
DM is the eighth leading cause of death and is estimated to affect about 460 million people globally [1]. Patients with DM, have an increased burden due to its negative effects on the aspects of physical, psychological, and social well-being [5]. CKD is a common complication of DM, affecting about 25–40% of patients [6,7,8]. The presence of CKD in patients with DM further increases the risk of CVD, progression to endstage renal disease (ESRD), and mortality [9,10]. Patients with DM-CKD experience a wide range of physical and psychological symptoms that may have serious adverse effects on their quality of life [11]. The majority of CKD patients experience bone and joint pain, muscle cramps, sadness, irritability, and difficulty sleeping
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