Symptom-burden in people living with frailty and chronic kidney disease

A C Nixon,H.M.L Young,M W Taal,T J Wilkinson,A C Smith,S Mitra,A P Dhaygude,M E Brady,N Pendleton

doi:10.1186/s12882-020-02063-6

Abstract

BackgroundFrailty is independently associated with worse health-related quality of life (HRQOL) in chronic kidney disease (CKD). However, the relationship between frailty and symptom experience is not well described in people living with CKD. This study’s aim was to evaluate the relationship between frailty and symptom-burden in CKD.MethodsThis study is a secondary analysis of a cross-sectional observational study, the QCKD study (ISRCTN87066351), in which participants completed physical activity, cardiopulmonary fitness, symptom-burden and HRQOL questionnaires. A modified version of the Frailty Phenotype, comprising 3 self-report components, was created to assess frailty status. Multiple linear regression was performed to assess the association between symptom-burden/HRQOL and frailty. Logistic regression was performed to assess the association between experiencing symptoms frequently and frailty. Principal Component Analysis was used to assess the experienced symptom clusters.ResultsA total of 353 patients with CKD were recruited with 225 (64%) participants categorised as frail. Frail participants reported more symptoms, had higher symptom scores and worse HRQOL scores. Frailty was independently associated with higher total symptom score and lower HRQOL scores. Frailty was also independently associated with higher odds of frequently experiencing 9 out of 12 reported symptoms. Finally, frail participants experienced an additional symptom cluster that included loss of appetite, tiredness, feeling cold and poor concentration.ConclusionsFrailty is independently associated with high symptom-burden and poor HRQOL in CKD. Moreover, people living with frailty and CKD have a distinctive symptom experience. Proactive interventions are needed that can effectively identify and address problematic symptoms to mitigate their impact on HRQOL.

Highlights

Frailty is independently associated with worse health-related quality of life (HRQOL) in chronic kidney disease (CKD)
Multiple linear regression was used to assess the association between symptomburden (KSQ total frequency score) and HRQOL (SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores) and frailty status, demographics and clinical parameters
This study involved an older population with early stage CKD and did not describe ethnicity, results may not be generalizable to other populations, including those with more advanced CKD. In conclusion, this secondary analysis has highlighted that frailty is independently associated with high symptom-burden and poor HRQOL in people with CKD

Summary

Introduction

Frailty is independently associated with worse health-related quality of life (HRQOL) in chronic kidney disease (CKD). With increased longevity comes an increased prevalence of older individuals living with multimorbidity. This trend is predicted to continue with 20.4 million people estimated to be ≥65 years old by 2066 in the UK, compared with 11.8 million in 2016 [1]. The fastest increase is predicted to be in the ≥85-year-old age group [1] Both ageing and multimorbidity are associated with frailty, the state of vulnerability to disproportionate changes in health status when exposed to stressor events [2,3,4]. For nephrology services, the prevalence of frailty appears to be far greater in those with chronic kidney disease (CKD) than in the general older population, with one study reporting a prevalence as high as 73% in dialysis dependent CKD [6]

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