TY - JOUR
T1 - Health-related quality of life in patients with autosomal dominant polycystic kidney disease and CKD stages 1-4
T2 - A cross-sectional study
AU - Miskulin, Dana C.
AU - Abebe, Kaleab Z.
AU - Chapman, Arlene B.
AU - Perrone, Ronald D.
AU - Steinman, Theodore I.
AU - Torres, Vicente E.
AU - Bae, K. Ty
AU - Braun, William
AU - Winklhofer, Franz T.
AU - Hogan, Marie C.
AU - Rahbari-Oskoui, Fred
AU - Moore, Charity G.
AU - Flessner, Michael F.
AU - Schrier, Robert W.
N1 - Funding Information:
Support: This study was supported by cooperative agreements (grants DK62408 , DK62401 , DK62410 , DK62402 , and DK62411 ) with the National Institute of Diabetes and Digestive and Kidney Diseases , NIH , the National Center for Research Resources General Clinical Research Centers ( RR000039 Emory University , RR00585 Mayo Clinic , RR000054 Tufts University , RR000051 University of Colorado , RR23940 Kansas University , and RR024296 Beth Israel Deaconess Medical Center ), and the Centers for Translational Science Activities at the participating institutions ( RR025008 Emory University , RR024150 Mayo Clinic , RR025752 Tufts University , RR025780 University of Colorado , and RR024989 Cleveland Clinic ). Support for the study enrollment phase was also provided by grants to the Publications and Communications Committees from the PKD Research Foundation. Study drugs were donated by Boehringer Ingelheim Pharmaceuticals Inc (telmisartan and placebo) and Merck & Co Inc (lisinopril).
PY - 2014/2
Y1 - 2014/2
N2 - Background In people with early autosomal dominant polycystic kidney disease (ADPKD), average total kidney volume (TKV) is 3 times normal and increases by an average of 5% per year despite a seemingly normal glomerular filtration rate (GFR). We hypothesized that increased TKV would be a source of morbidity and diminished quality of life that would be worse in patients with more advanced disease. Study Design Cross-sectional. Setting & Participants 1,043 patients with ADPKD, hypertension, and a baseline estimated GFR (eGFR) > 20 mL/min/1.73 m2. Predictors (1) eGFR, (2) height-adjusted TKV (htTKV) in patients with eGFR > 60 mL/min/1.73 m2. Outcomes 36-Item Short Form Health Survey (SF-36) and the Wisconsin Brief Pain Survey. Measurements Questionnaires were self-administered. GFR was estimated from serum creatinine using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. htTKV was measured by magnetic resonance imaging. Results Back pain was reported by 50% of patients, and 20% experienced it "often, usually, or always." In patients with early disease (eGFR > 60 mL/min/1.73 m2), there was no association between pain and htTKV, except in patients with large kidneys (htTKV > 1,000 mL/m). Comparing across eGFR levels and including patients with eGFRs < 60 mL/min/1.73 m 2, patients with eGFRs of 20-44 mL/min/1.73 m2 were significantly more likely to report that pain impacted on their daily lives and had lower SF-36 scores than patients with eGFRs of 45-60 and ≥60 mL/min/1.73 m2. Symptoms relating to abdominal fullness were reported by 20% of patients and were related significantly to lower eGFRs in women, but not men. Limitations TKV and liver volume were not measured in patients with eGFR < 60 mL/min/1.73 m2. The number of patients with eGFRs < 30 mL/min/1.73 m2 is small. Causal inferences are limited by cross-sectional design. Conclusions Pain is a common early symptom in the course of ADPKD, although it is not related to kidney size in early disease (eGFR > 60 mL/min/1.73 m2), except in individuals with large kidneys (htTKV > 1,000 mL/m). Symptoms relating to abdominal fullness and pain are greater in patients with more advanced (eGFR, 20-45 mL/min/1.73 m2) disease and may be due to organ enlargement, especially in women. More research about the role of TKV in quality of life and outcomes of patients with ADPKD is warranted.
AB - Background In people with early autosomal dominant polycystic kidney disease (ADPKD), average total kidney volume (TKV) is 3 times normal and increases by an average of 5% per year despite a seemingly normal glomerular filtration rate (GFR). We hypothesized that increased TKV would be a source of morbidity and diminished quality of life that would be worse in patients with more advanced disease. Study Design Cross-sectional. Setting & Participants 1,043 patients with ADPKD, hypertension, and a baseline estimated GFR (eGFR) > 20 mL/min/1.73 m2. Predictors (1) eGFR, (2) height-adjusted TKV (htTKV) in patients with eGFR > 60 mL/min/1.73 m2. Outcomes 36-Item Short Form Health Survey (SF-36) and the Wisconsin Brief Pain Survey. Measurements Questionnaires were self-administered. GFR was estimated from serum creatinine using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. htTKV was measured by magnetic resonance imaging. Results Back pain was reported by 50% of patients, and 20% experienced it "often, usually, or always." In patients with early disease (eGFR > 60 mL/min/1.73 m2), there was no association between pain and htTKV, except in patients with large kidneys (htTKV > 1,000 mL/m). Comparing across eGFR levels and including patients with eGFRs < 60 mL/min/1.73 m 2, patients with eGFRs of 20-44 mL/min/1.73 m2 were significantly more likely to report that pain impacted on their daily lives and had lower SF-36 scores than patients with eGFRs of 45-60 and ≥60 mL/min/1.73 m2. Symptoms relating to abdominal fullness were reported by 20% of patients and were related significantly to lower eGFRs in women, but not men. Limitations TKV and liver volume were not measured in patients with eGFR < 60 mL/min/1.73 m2. The number of patients with eGFRs < 30 mL/min/1.73 m2 is small. Causal inferences are limited by cross-sectional design. Conclusions Pain is a common early symptom in the course of ADPKD, although it is not related to kidney size in early disease (eGFR > 60 mL/min/1.73 m2), except in individuals with large kidneys (htTKV > 1,000 mL/m). Symptoms relating to abdominal fullness and pain are greater in patients with more advanced (eGFR, 20-45 mL/min/1.73 m2) disease and may be due to organ enlargement, especially in women. More research about the role of TKV in quality of life and outcomes of patients with ADPKD is warranted.
KW - Autosomal dominant polycystic kidney disease (ADPKD)
KW - activities of daily life
KW - chronic kidney disease (CKD)
KW - extrarenal symptoms
KW - patient-reported outcomes
KW - quality of life (QoL)
KW - renal disease
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U2 - 10.1053/j.ajkd.2013.08.017
DO - 10.1053/j.ajkd.2013.08.017
M3 - Article
C2 - 24183837
AN - SCOPUS:84892934879
SN - 0272-6386
VL - 63
SP - 214
EP - 226
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -