Health-Related Quality-of-Life Trajectories over Time in Older Men and Women with Advanced Chronic Kidney Disease

Nicholas C Chesnaye; Yvette Meuleman; Esther N M de Rooij; Ellen K Hoogeveen; Friedo W Dekker; Marie Evans; Agneta A Pagels; Fergus J Caskey; Claudia Torino; Gaetana Porto; Maciej Szymczak; Christiane Drechsler; Christoph Wanner; Kitty J Jager; EQUAL Study Investigators

doi:10.2215/CJN.08730621

Health-Related Quality-of-Life Trajectories over Time in Older Men and Women with Advanced Chronic Kidney Disease

Clin J Am Soc Nephrol. 2022 Feb;17(2):205-214. doi: 10.2215/CJN.08730621. Epub 2022 Jan 24.

Authors

Nicholas C Chesnaye¹, Yvette Meuleman², Esther N M de Rooij², Ellen K Hoogeveen^{2

3}, Friedo W Dekker², Marie Evans⁴, Agneta A Pagels^{5

6}, Fergus J Caskey⁷, Claudia Torino⁸, Gaetana Porto⁹, Maciej Szymczak¹⁰, Christiane Drechsler¹¹, Christoph Wanner¹¹, Kitty J Jager¹²; EQUAL Study Investigators

Affiliations

¹ European Renal Association-European Dialysis and Transplant Association Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands n.c.chesnaye@amsterdamumc.nl.
² Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
³ Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
⁴ Renal Unit, Department of Clinical Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
⁵ Department of Medicine, Karolinska Institute, Stockholm, Sweden.
⁶ Department of Nephrology, Karolinska University Hospital, Stockholm, Sweden.
⁷ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
⁸ Institute of Clinical Physiology-National Research Council, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
⁹ Grande Ospedale Metropolitano, Bianchi Melacrino Morelli, Reggio Calabria, Italy.
¹⁰ Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
¹¹ Division of Nephrology, University Hospital of Wurzburg, Wurzburg, Germany.
¹² European Renal Association-European Dialysis and Transplant Association Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

Abstract

Background and objectives: The effect of sex on longitudinal health-related quality of life remains unknown in CKD. Here we assess differences in the sex-specific evolution of health-related quality of life in older men and women with advanced CKD.

Design, setting, participants, & measurements: The European Quality Study on Treatment in Advanced Chronic Kidney Disease is a European observational prospective cohort study in referred patients with CKD and an incident eGFR<20 ml/min per 1.73 m² who are ≥65 years of age not on dialysis. Health-related quality of life was measured using the 36-Item Short Form Survey at 3- to 6-month intervals between April 2012 and September 2020, providing Physical Component Summary and Mental Component Summary scores. Trajectories were modeled by sex using linear mixed models, and sex differences in health-related quality-of-life slope were explored.

Results: We included 5345 health-related quality-of-life measurements in 1421 participants. At baseline, women had considerably lower mean Physical Component Summary (42) and Mental Component Summary (60) compared with men (Physical Component Summary: 55; Mental Component Summary: 69; P<0.001). However, during follow-up, Physical Component Summary and Mental Component Summary scores declined approximately twice as fast in men (Physical Component Summary: 2.5 per year; 95% confidence interval, 1.8 to 3.1; Mental Component Summary: 2.7 per year; 95% confidence interval, 2.0 to 3.4) compared with in women (Physical Component Summary: 1.1 per year; 95% confidence interval, 0.1 to 2.0; Mental Component Summary: 1.6 per year; 95% confidence interval, 0.7 to 2.6). This difference was partly attenuated after adjusting for important covariates, notably eGFR decline. Higher serum phosphate, lower hemoglobin, and the presence of preexisting diabetes were associated with lower Physical Component Summary and Mental Component Summary scores in men but to a lesser extent in women.

Conclusions: Among older men and women with advanced CKD, women had lower health-related quality of life at baseline, but men experienced a more rapid decline in health-related quality of life over time.

Keywords: aged; chronic kidney disease; quality of life; sex differences.

Publication types

Comparative Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Male
Prospective Studies
Quality of Life*
Renal Insufficiency, Chronic* / diagnosis
Severity of Illness Index
Time Factors