#3393 PATIENT-REPORTED OUTCOMES IN EARLY VERSUS ADVANCED CHRONIC KIDNEY DISEASE: EVIDENCE FROM BASELINE DATA IN THE DISCOVER CKD PROSPECTIVE STUDY
Authors: Carrero Juan Jesus , Pollock Carol , Kanda Eiichiro , Lam Carolyn , Ofori-Asenso Richard , Chen Tony , Kashihara Naoki , Fishbane Steven , Sanchez Juan Jose Garcia , Pentakota Surendra , Pecoits-Filho Roberto , Wheeler David C 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease (CKD) negatively impacts patients' psychological and social wellbeing. Prior studies have suggested that CKD progression is associated with worsening of health-related quality of life (HRQoL), but these studies were limited in terms of racial and geographic composition. We compared patient-reported outcomes, including symptom burden, work productivity and HRQoL of patients with early versus advanced CKD, based on contemporary data from DISCOVER CKD, a multinational non-interventional cohort study of patients with CKD.

Methods
DISCOVER CKD (clinicaltrials.gov identifier: NCT04034992) is an ongoing study that aims to generate real-world evidence on the clinical management and experiences of patients with CKD. The study adopted a hybrid design comprising both retrospective and prospective cohorts. For the prospective phase, patients were recruited from the USA, Japan, Sweden, Italy, Spain, and the UK. Clinical data were extracted manually from existing patients’ health records into a standardised case report form. HRQoL was measured via the Short Form (SF)-36 questionnaire, work productivity was assessed with the Work Productivity and Activity Impairment (WPAI)-CKD questionnaire. Symptoms were recorded using a mobile phone application. In this analysis, early CKD was defined as stages 2-3 CKD and advanced CKD as stages 4-5 CKD (inclusive of dialysis patients). For each outcome, baseline scores were compared between patients with early and advanced CKD using an ANCOVA model with adjustment for age, sex, diabetes, hypertension and renin-angiotensin-aldosterone system inhibitor use. P&lt;0.05 was considered statistically significant. DISCOVER CKD received research ethics board approval and informed consent was obtained from all patients.

Results
A total of 1051 patients with CKD (early CKD, 69.2% [N = 727]: advanced CKD, 30.8% [N = 324]) were enrolled in the prospective phase of DISCOVER CKD. The population was racially diverse with approximately one-third being non-White. The mean age was 62.5 years (early CKD, 63.4 years: advanced CKD, 60.6 years) and 37% (early CKD, 37.7%: advanced CKD, 35.2%) were female. The mean WPAI-CKD scores for percentage work time missed, activity impairment, impairment at work and overall work productivity loss were significantly higher in patients with advanced CKD compared to those with early CKD, suggesting greater work and activity impairment (Figure 1). The mean symptom scores for fatigue, pruritis, problems with sleep, nausea, muscle cramping and overall feel about health were all significantly higher in the advanced CKD population (Table 1). The results of the SF-36 questionnaire reported significantly lower mean scores across more domains for patients with advanced CKD, and in particular for general health perception, vitality, physical functioning, social functioning, physical role functioning and emotional role functioning, suggestive of a less favourable overall HRQoL (Table 1). Of note, anxious and depressed feelings were similar for early and advanced CKD.

Conclusion
In this multinational cohort of patients with CKD, those with advanced disease appeared to experience greater symptom burden, lower HRQoL, and higher work and activity impairment. These findings highlight the need for early detection and treatment of CKD and its reported symptoms to reduce the likelihood of disease progression, which could adversely impact patients’ QoL.