Longitudinal Assessment of Health-Related Quality of Life in Adult with CKD

Background: There is sparse data about the change in HRQoL with the temporal progression of CKD. In this study, we assessed the association between change in CKD stages, overall and domain-specific QoL and determined the factors that were associated with this change. Methods: Data was sourced from a multi-centre study that included 1,290 adult patients aged 18 years and over across 6 centres in Australia. EQ-5D-3L was collected at baseline, 2 and 4 years. Changes in CKD stages were treated as a time-varying exposure; generalized estimating equations were used to model the changes in HRQoL. Results: With reference to patients with CKD (G3-5), patients treated with dialysis had a reduction of 0.06 (-0.09 to -0.04) in overall HRQoL scores over the 4-years and experienced higher odds of reporting lower HRQoL across all domains: mobility (1.91 [1.53 – 2.38]), self-care (2.30 [1.67 – 3.16]), usual activity (2.70 [ 2.18 – 3.38]), pain (1.19 [ 0.97 – 1.46]) and anxiety (1.40 [1.12 – 1.75]). Transplant recipients showed no significant decline in overall HRQoL (p = 0.13) but had increased odds of reduced mobility (1.74 [ 1.40 – 2.18]) and usual activity (1.35 [1.07 – 1.71]). Female sex, smoking, prevalent diabetes mellitus, lower educational attainment and Middle Eastern ethnicity were associated with lower HRQoL. Conclusions: Patients on maintenance dialysis, but not transplant recipients, experienced a significant decline in overall HRQoL (0.06) over the 4 years compared to patients with CKD (G3-5). These utility-based HRQOL estimates are essential for future economic evaluations in kidney trials.