Kidney Disease-Specific Scores and Health Utility of Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis Patients and Their Caregivers

Clinical and Humanistic Burden of IgA Nephropathy in Adult Patients: A Global Real-World Survey

Key Points

IgA nephropathy (IgAN) exerts a significant humanistic burden on patients. Quality of life is impaired in patients with IgAN. Progression of disease in IgAN, especially proteinuria and GFR loss, are associated with the burden of disease.

Background

IgA nephropathy (IgAN) is a chronic, progressive kidney disease in which proteinuria, reduced eGFR, pain, and fatigue are common. How symptoms interact and affect patient quality of life (QoL) in real-world practice is poorly studied. This study investigated how patient and physician symptom perceptions differ and how proteinuria and eGFR correlate with pain, fatigue, and QoL in adult patients with IgAN.

Methods

Data were drawn from the Adelphi IgAN Disease Specific Program, a cross-sectional survey of physicians and their biopsy confirmed patients with IgAN in China, France, Germany, Italy, Spain, the United Kingdom, the United States, and Japan from June to October 2021. Physicians provided demographics and clinical characteristics, including pain and fatigue severity. The same patients completed a self-completion form containing questions on symptom severity, the EQ-5D-5L, Kidney Disease QoL, and Work Productivity and Activity Impairment questionnaires. Symptom scores were grouped by severity, and patients were grouped by proteinuria and eGFR. Analysis of variance, chi-squared, or Fisher exact tests were performed as appropriate and Dunn multiple comparisons with Bonferroni adjustment for pair-wise comparisons.

Results

Overall, 1515 patients were included (mean [SD] age: 43 [15] years, 60% [n =903] male, 70% [n =1020/1459] diagnosed >1 year ago). Pain was reported by 46% (n =374) of physicians and 47% (n =384) of patients and fatigue by 65% (n =530) of physicians and 76% (n =620) of patients. Both pain and fatigue increased with increased proteinuria and reduced eGFR (all P < 0.001). Finally, patients with increased proteinuria and reduced eGFR experienced worse (P < 0.05) QoL and work productivity across all measures (except work absenteeism).

Conclusions

Patients with higher proteinuria and lower eGFR face higher symptom burden and reduced QoL compared to their counterparts. Physicians underestimated fatigue levels faced by patients. To improve QoL, more effective treatments are needed to prevent high proteinuria and preserve eGFR.

Impact of dialysis modality conversion on the health-related quality of life of peritoneal dialysis patients: a retrospective cohort study in China

BACKGROUND

To analyze the health-related quality of life associated with the conversion of dialysis modality among end-stage renal disease patients in China.

METHODS

Patients were recruited from hospitals and a dialysis center in Kunshan, China. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis were recruited as the observation group (n = 64), and patients continuing with continuous ambulatory peritoneal dialysis treatment were included in the control group (n = 64) after matching in this retrospective cohort study. Their health-related quality of life was measured using the kidney disease quality of life instrument in 2019 and 2020, respectively. Baseline socio-demographic characteristics and clinical data were collected in 2019. The before-and-after cross-group comparisons of subscale scores of two groups were conducted using a Student's t-test. Multiple linear regression models were fitted to identify the factors associated with the change of each scale.

RESULTS

The health-related quality of life scores of the two groups was comparable in baseline, while the observation group had higher scores in Physical Component Summary (51.92 ± 7.50), Kidney Disease Component Summary (81.21 ± 8.41), Symptoms (90.76 ± 6.30), Effects (82.86 ± 11.42), and Burden (69.04 ± 15.69) subscales after one year. In multivariate regression analysis, the change of Physical Component Summary was significantly associated with conversion to APD (β = 11.54, 95% CI [7.26-15.82]); the change of Mental Component Summary with higher education (β =  - 5.96, 95% CI [-10.18--1.74]) and CCI (>2) (β = 5.39, 95% CI [1.05-9.73]); the change of Kidney Disease Component Summary with conversion to APD (β = 15.95, 95% CI [10.19-21.7]) and age (>60 years) (β =  - 7.36, 95% CI [-14.11--0.61]); the change of Symptoms with CCI (>2) (β = 7.96, 95% CI [1.49-14.44]); the change of Effects with conversion to APD (β = 19.23, 95% CI [11.57-26.88]); and the change of Burden with conversion to APD (β = 22.40, 95% CI [13.46-31.34]), age (>60 years) (β =  - 12.12, 95% CI [-22.59--1.65]), and higher education (β =  - 10.38, 95% CI [-19.79--0.98]).

CONCLUSIONS

The conversion of dialysis modality had a significant impact on the scores of most subscales. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis generally had improved health-related quality of life scores.

Relationship between hemodialysis and health-related quality of life: a cross-sectional study of diagnosis and duration of hemodialysis

Background

Hemodialysis is a medical technology implemented for various renal diseases and has a significant budget impact in Japan. Hemodialysis also affects health-related quality of life, as it interferes with daily life, but the effect of diagnosis and duration of hemodialysis is not clear. The purpose of this study was to examine the impact of hemodialysis on health-related quality of life, with a focus on diagnosis and duration of hemodialysis.

Methods

We conducted EQ-5D-5L surveys among hemodialysis patients at a single hemodialysis hospital between November 2015 and September 2017 and used a scoring algorithm that was developed in Japan to calculate the scores.

Results

A total of 274 subjects without missing data were included in the data analysis. The mean score of the entire group was 0.772 ± 0.215. Compared with other domains, pain/discomfort had the highest percentage of problems (59.1%). There were no differences in the distributions with respect to diagnostic names in any domain. Multiple regression analysis showed that hemodialysis duration was the only explanatory variable that had a mild significant effect on EQ-5D-5L scores, but it was not large.

Conclusions

QOL measured using the EQ-5D-5L survey score was not affected by age, gender, or diagnosis but was affected by hemodialysis duration. Future studies are needed to investigate the impact of prolonged hemodialysis on health-related quality of life.