Uraemic symptom burden and clinical condition in women and men of ≥65 years of age with advanced chronic kidney disease: results from the EQUAL study
Authors: van de Luijtgaarden Moniek W M , Caskey Fergus J , Wanner Christoph , Chesnaye Nicholas C , Postorino Maurizio , Janmaat Cynthia J , Rao Anirudh , Torino Claudia , Klinger Marian , Drechsler Christiane , Heimburger Olof , Szymczak Maciej , Evans Marie , Dekker Friedo W , Jager Kitty J ,   the EQUAL study investigators, Adamasco Cupisti I T , Adelia Sagliocca I T , Alberto Ferraro I T , Aleksandra Musiała P L , Alessandra Mele I T , Alessandro Naticchia I T , Alex Còsaro I T , Alistair Woodman U K , Andrea Ranghino I T , Andrea Stucchi I T , Andreas Jonsson S E , Andreas Schneider D E , Angelo Pignataro I T , Anita Schrander N L , Anke Torp D E , Anna McKeever U K , Anna Szymczak P L , Anna-Lena Blom S E , Antonella De Blasio I T , Antonello Pani I T , Aris Tsalouichos I T , Asad Ullah U K , Barbara McLaren U K , Bastiaan van Dam N L , Beate Iwig D E , Bellasi Antonio I T , Biagio Raffaele Di Iorio I T , Björn Rogland S E , Boris Perras D E , Butti Alessandra I T , Camille Harron U K , Carin Wallquist S E , Carl Siegert N L , Carla Barrett U K , Carlo Gaillard N L , Cataldo Abaterusso I T , Charles Beerenhout N L , Charlotte O’Toole U K , Chiara Somma I T , Christian Marx D E , Christina Summersgill U K , Christof Blaser D E , Claudia D’alessandro I T , Claudia Emde D E , Claudia Zullo I T , Claudio Pozzi I T , Colin Geddes U K , Cornelis Verburgh N L , Daniela Bergamo I T , Daniele Ciurlino I T , Daria Motta I T , Deborah Glowski U K , Deborah McGlynn U K , Denes Vargas S E , Detlef Krieter D E , Domenico Russo I T , Dunja Fuchs D E , Dympna Sands U K , Ellen Hoogeveen N L , Ellen Irmler D E , Emöke Dimény S E , Enrico Favaro I T , Eva Platen D E , Ewelina Olczyk P L , Ewout Hoorn N L , Federica Vigotti I T , Ferruccio Ansali I T , Ferruccio Conte I T , Francesca Cianciotta I T , Francesca Giacchino I T , Francesco Cappellaio I T , Francesco Pizzarelli I T , Fredrik Sundelin S E , Fredrik Uhlin S E , Gaetano Greco I T , Geena Roy U K , Gaetana Porto I T , Giada Bigatti I T , Giancarlo Marinangeli I T , Gianfranca Cabiddu I T , Gillian Hirst U K , Giordano Fumagalli I T , Giorgia Caloro I T , Giorgina Piccoli I T , Giovanbattista Capasso I T , Giovanni Gambaro I T , Giuliana Tognarelli I T , Giuseppe Bonforte I T , Giuseppe Conte I T , Giuseppe Toscano I T , Goffredo Del Rosso I T , Gunilla Welander S E , Hanna Augustyniak-Bartosik P L , Hans Boots N L , Hans Schmidt-Gürtler D E , Hayley King U K , Helen McNally U K , Hendrik Schlee D E , Henk Boom N L , Holger Naujoks D E , Houda Masri-Senghor U K , Hugh Murtagh U K , Hugh Rayner U K , Ilona Miśkowiec-Wiśniewska P L , Ines Schlee D E , Irene Capizzi I T , Isabel Bascaran Hernandez S E , Ivano Baragetti I T , Jacek Manitius P L , Jane Turner U K , Jan-Willem Eijgenraam N L , Jeroen Kooman N L , Joachim Beige D E , Joanna Pondel P L , Joanne Wilcox U K , Jocelyn Berdeprado U K , Jochen Röthele D E , Jonathan Wong U K , Joris Rotmans N L , Joyce Banda U K , Justyna Mazur D E , Kai Hahn D E , Kamila Jędrzejak P L , Katarzyna Nowańska P L , Katja Blouin D E , Katrin Neumeier D E , Kirsteen Jones U K , Kirsten Anding-Rost D E , Knut-Christian Gröntoft S E , Lamberto Oldrizzi I T , Lesley Haydock U K , Liffert Vogt N L , Lily Wilkinson U K , Loreto Gesualdo I T , Lothar Schramm D E , Luigi Biancone I T , Łukasz Nowak P L , Maarten Raasveld N L , Magdalena Durlik P L , Manuela Magnano I T , Marc Vervloet N L , Marco Ricardi I T , Margaret Carmody U K , Maria Di Bari I T , Maria Laudato I T , Maria Luisa Sirico I T , Maria Stendahl S E , Maria Svensson S E , Maria Weetman U K , Marjolijn van Buren N L , Martin Joinson U K , Martina Ferraresi I T , Mary Dutton U K , Merel van Diepen N L , Michael Matthews U K , Michele Provenzano I T , Monika Hopf D E , Moreno Malaguti I T , Nadja Wuttke D E , Neal Morgan U K , Nicola Palmieri I T , Nikolaus Frischmuth D E , Nina Bleakley U K , Paola Murrone I T , Paul Cockwell U K , Paul Leurs N L , Paul Roderick U K , Pauline Voskamp N L , Pavlos Kashioulis S E , Pawlos Ichtiaris D E , Peter Blankestijn N L , Petra Kirste D E , Petra Schulz D E , Phil Mason U K , Philip Kalra U K , Pietro Cirillo I T , Pietro Dattolo I T , Pina Acampora I T , Rincy Sajith U K , Rita Nigro I T , Roberto Boero I T , Roberto Scarpioni I T , Rosa Sicoli I T , Rosella Malandra I T , Sabine Aign D E , Sabine Cäsar D E , Sadie van Esch N L , Sally Chapman U K , Sandra Biribauer D E , Santee Navjee U K , Sarah Crosbie U K , Sharon Brown U K , Sheila Tickle U K , Sherin Manan D E , Silke Röser D E , Silvana Savoldi I T , Silvio Bertoli I T , Silvio Borrelli I T , Siska Boorsma N L , Stefan Heidenreich D E , Stefan Melander S E , Stefania Maxia I T , Stefano Maffei I T , Stefano Mangano I T , Stephanie Palm D E , Stijn Konings N L , Suresh Mathavakkannan U K , Susanne Schwedler D E , Sylke Delrieux D E , Sylvia Renker D E , Sylvia Schättel D E , Szyszkowska Dorota P L , Teresa Cicchetti I T , Teresa Nieszporek P L , Theresa Stephan D E , Thomas Schmiedeke D E , Thomas Weinreich D E , Til Leimbach D E , Tiziana Rappa I T , Tora Almquist S E , Torsten Stövesand D E , Udo Bahner D E , Ulrika Jensen S E , Valentina Palazzo I T , Walter De Simone I T , Wolfgang Seeger D E , Ying Kuan U K , Zbigniew Heleniak P L , Zeynep Aydin N L 
Published: May 2018

Background

The epidemiology and prognosis of chronic kidney disease (CKD) differ by sex. We aimed to compare symptom prevalence and the clinical state in women and men of ≥65 years of age with advanced CKD receiving routine nephrology care.

Methods

The European QUALity study on treatment in advanced chronic kidney disease (EQUAL) study follows patients from six European countries of ≥65 years of age  years whose estimated glomerular filtration rate (eGFR) dropped to ≤20 mL/min/1.73 m2 for the first time during the last 6 months. The Dialysis Symptom Index was used to assess the prevalence and severity of 33 uraemic symptoms. Data on the clinical state at baseline were collected from medical records. Prevalence was standardized using the age distribution of women as the reference.

Results

The results in women (n = 512) and men (n = 967) did not differ with age (77.0 versus 75.7 years) or eGFR (19.0 versus 18.5). The median number of symptoms was 14 [interquartile range (IQR) 9–19] in women, and 11 (IQR 7–16) in men. Women most frequently reported fatigue {39% [95% confidence interval (CI) 34–45]} and bone/joint pain [37% (95% CI 32–42)] as severe symptoms, whereas more men reported difficulty in becoming sexually aroused [32% (95% CI 28–35)] and a decreased interest in sex [31% (95% CI 28–35)]. Anaemia [73% (95% CI 69–77) versus 85% (95% CI 82–87)] was less common in women than in men, as were smoking history and cardiovascular comorbidity. However, a diagnosis of liver disease other than cirrhosis, psychiatric disease and mild malnutrition were more common among women.

Conclusions

Women in secondary care with an incident eGFR ≤20 mL/min/1.73 m2 reported a higher symptom burden, while their clinical state was considered similar or even more favourable as compared with men.