The impacts of different stages of chronic kidney disease, as well as the co-morbidities of diabetes and heart disease, on patients' quality of life

Siromani, Jerome D. (2014) The impacts of different stages of chronic kidney disease, as well as the co-morbidities of diabetes and heart disease, on patients' quality of life. Masters thesis, Memorial University of Newfoundland.

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Abstract

Background: Health-related Quality of Life (QoL) pertains to how medical conditions affect the lives of people suffering from those respective conditions, and QoL measurements therefore help to define the everyday impacts of the conditions; understanding these impacts can lead to improvements in the healthcare provisions for patients with each condition. There is yet to be a large-sample Study that compares QoL across different stages of Chronic Kidney Disease (CKD) while (i) utilizing a predominantly North American adult population, and (ii) factoring in commonly-associated co-morbidities (i.e. Diabetes and Heart Disease). Methods: A Retrolective Cross-sectional Observational Study utilizing historical baseline data from 1135 anonymous adult CKD patients was performed; CKD Stages 3 and 5 were predominant, and every selected patient had answered to a comparable version of the Short Form 36 (SF-36) Health Survey, having had CKD with/without a co-morbidity at baseline. SF-36 Domain and Summary scores were compared, across the stages of CKD (in terms of medians, as distributions were skewed); similar comparisons were also performed with co-morbidities and demographic factors as respective grouping variables. Regression models were subsequently built to analyse the associations between relevant SF-36 scores and each of these independent variables – Stage of CKD, Diabetes, Heart Disease, Age, and Gender. Results: The Physical Component Summary (PCS) score was significantly (p < 0.05) lowest among patients with Stage 5 CKD, while patients with Stage 4 CKD, in turn, exhibited significantly lower PCS scores than patients with Stage 3 CKD; Stage 5 CKD patients - who were all on Hemodialysis therapy - also scored lowest (significantly) on five of the eight SF-36 Domains. Coexisting Diabetes and Heart Disease were each associated with further significant decreases in the PCS score and three physical health-related Domain scores. Compared to females, males scored significantly higher on the PCS measure and on four Domains. Patients’ Age did not impact QoL, definitively - while the Mental Component Summary (MCS) score and mental health-related Domain scores were seen to gradually but inconsistently increase with Age, physical health-related QoL was generally unaffected by Age. Regression models, by and large, confirmed the findings from the comparisons of medians. Conclusions: Greater negative impacts on physical health appear to occur, as CKD progresses from stage to stage, but the effects of CKD progression on mental health seem to be negligible. Among CKD patients, Diabetes and Heart Disease appear to further reduce patient perceptions of physical health. Male patients with CKD appear to have more favourable perceptions of their overall health status, as compared to female patients with CKD. Recommendations: Regarding future research - a prospective longitudinal study that periodically assesses QoL across a cohort with CKD would be advisable (in order to further assess the impact of CKD progression on QoL, and to overcome the issues of “missing” data that were encountered during this Study). Regarding the clinical perspective - considerable efforts should be made to prevent (or slow) the progression of CKD towards the final stage of the disease, while enabling patient education, too.

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