#2929 FACTORS ASSOCIATED WITH QUALITY OF LIFE IN KIDNEY FAILURE MANAGED CONSERVATIVE AND WITH DIALYSIS: A RETROSPECTIVE CROSS-SECTIONAL STUDY
Authors: So Sarah , Li Kelly 
Published: June 2023

Abstract

Background and Aims
Internationally, chronic kidney disease (CKD) affects over 10% of the general population. As patients approach CKD Stage 5, they are faced with the decision of whether to proceed with dialysis or conservative, non-dialysis, kidney management (CKM). Regardless of pathway, worsening CKD is associated with poorer self-perceived health-related quality of life (HRQOL). Psychological factors such as depression and anxiety have been linked with poorer HRQOL. Quality of life is a major consideration for many patients. Patients’ experiences of disease and significant contributors to HRQOL should be recognised as an important area for healthcare providers to identify, understand and target. The primary aim is to determine if anxiety or depressive symptoms are significantly associated with HRQOL, in patients with CKD Stage 5. The secondary aim is to determine which patient-associated factors (such as comorbidities, symptoms or biochemical parameters) are associated with HRQOL in patients with CKD Stage 5.

Method
Patients that attend the St George Hospital Kidney Supportive Care (KSC) clinic complete surveys of their functional ‘domains’ and quality of life (EQ-5D-5L, EuroQOL Research Foundation, 2019) and symptom surveys (IPOS-Renal, Cicely Saunders Institute, 2016) at the beginning of each clinic visit. Demographic data, comorbidities and biochemical data are also obtained from the St George Hospital electronic medical records system and entered into the KSC database, with corresponding survey data. We included all patients from St George and Sutherland Hospitals that attended the KSC Clinic between 1 July 2015 and 30 June 2022 with CKD Stage 5, who were managed with either CKM or dialysis, and completed EQ5D5L and IPOS-Renal surveys at their first KSC visit. The primary outcome is self-perceived health-related quality of life score, measured using EQ-VAS, a continuous 100-point scale on the EQ-5D-5L survey. We performed multivariable linear regression analysis with pre-specified variables including age, sex, eGFR (for those on CKM), “Feeling depressed,” (IPOS-Renal) “Feeling anxious” (IPOS-Renal) and “Anxiety/depression” (EQ5D5L), for the CKM and dialysis pathways. Statistical analyses were performed with IBM SPSS Statistics V26.0. p-values of &lt;0.05 were regarded as significant.

Results
We included 339 patients (216 patients on CKM and 123 patients on dialysis). Patients receiving CKM were significantly older than those on dialysis, with a median age of 83 years, compared to 73 years. Most patients on dialysis received haemodialysis (85.4%). For patients receiving CKM, variables independently associated with poorer EQ-VAS were difficulty performing usual activities (EQ5D5L), drowsiness (IPOS-Renal) and shortness of breath (IPOS-Renal) (Figure 1). For patients receiving dialysis, variables independently associated with poorer EQ-VAS were reduced ability to perform self-care (EQ5D5L) and lack of energy (IPOS-Renal) (Figure 2). Anxiety and depressive symptoms were not significantly associated with poorer EQ-VAS for either CKM or dialysis patients.

Conclusion
We did not find an association between anxiety and depressive symptoms and poorer EQ-VAS for patients with CKD Stage 5. For patients receiving CKM, symptoms that significantly reduce EQ-VAS include shortness of breath and drowsiness. Impaired functional ability significantly reduced EQ-VAS in patients with CKD Stage 5 managed with and without dialysis. Optimization of multidisciplinary teams within KSC units are likely to be of benefit.