TY - JOUR
T1 - Health-Related Quality of Life, Depressive Symptoms, and Kidney Transplant Access in Advanced CKD
T2 - Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
AU - CRIC Study Investigators
AU - Harhay, Meera Nair
AU - Yang, Wei
AU - Sha, Daohang
AU - Roy, Jason
AU - Chai, Boyang
AU - Fischer, Michael J.
AU - Hamm, L. Lee
AU - Hart, Peter D.
AU - Hsu, Chi yuan
AU - Huan, Yonghong
AU - Huml, Anne M.
AU - Kallem, Radhakrishna Reddy
AU - Tamura, Manjula Kurella
AU - Porter, Anna C.
AU - Ricardo, Ana C.
AU - Slaven, Anne
AU - Rosas, Sylvia E.
AU - Townsend, Raymond R.
AU - Reese, Peter P.
AU - Lash, James P.
AU - Akkina, Sanjeev
AU - Appel, Lawrence J.
AU - Feldman, Harold I.
AU - Go, Alan S.
AU - He, Jiang
AU - Kusek, John W.
AU - Rao, Panduranga
AU - Rahman, Mahboob
N1 - Funding Information:
Funding for the CRIC Study was obtained under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; U01DK060990 , U01DK060984 , U01DK061022 , U01DK061021 , U01DK061028 , U01DK060980 , U01DK060963 , and U01DK060902 ). In addition, this work was supported in part by the Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award National Institutes of Health ( NIH )/ National Center for Advancing Translational Sciences ( NCATS ) UL1TR000003 , Johns Hopkins University UL1 TR-000424 , University of Maryland General Clinical Research Center M01 RR-16500 , Clinical and Translational Science Collaborative of Cleveland , UL1TR000439 from the NCATS component of the NIH and NIH Roadmap for Medical Research, Michigan Institute for Clinical and Health Research UL1TR000433 , University of Illinois at Chicago Clinical and Translational Science Award UL1RR029879 , Tulane University Translational Research in Hypertension and Renal Biology P30GM103337 , Kaiser Permanente NIH/ National Center for Research Resources UCSF-CTSI UL1 RR-024131. Dr Harhay is funded by the NIDDK K23DK105207 and R01DK124388 Awards. Dr Ricardo is funded by the NIDDK K23DK094829 Award. Dr Lash is funded by the NIDDK K24DK092290 and R01-DK072231-91 Awards. Dr Reese’s efforts were supported by National Institute of Allergy and Infectious Diseases K24AI146137 . Funders of this study did not have any role in study design, analysis and interpretation of data, writing the manuscript, or the decision to submit the manuscript for publication.
Funding Information:
Lawrence J. Appel, MD, MPH, Harold I. Feldman, MD, MSCE, Alan S. Go, MD, Jiang He, MD, PhD, John W. Kusek, PhD, Panduranga Rao, MD, and Mahboob Rahman, MD. Meera Nair Harhay, MD, MSCE, Wei Yang, PhD, Daohang Sha, PhD, Jason Roy, PhD, Boyang Chai, MS, Michael J. Fischer, MD, L. Lee Hamm, MD, Peter D. Hart, MD, Chi-yuan Hsu, MD, Yonghong Huan, MD, Anne M. Huml, MD, Radhakrishna Reddy Kallem, MD, Manjula Kurella Tamura, MD, Anna C. Porter, MD, Ana C. Ricardo, MD, Anne Slaven, MSSA, Sylvia E. Rosas, MD, Raymond R. Townsend, MD, Peter P. Reese, MD, James P. Lash, MD, and Sanjeev Akkina, MD. Research idea and study design: MNH, WY, JR, MF, LH, PH, C-yH, YH, AH, RRK, MKT, AP, AR, AS, SR, RT, PPR, JL, SA; data acquisition: MNH, PPR, JL, SA; data analysis/interpretation: MNH, WY, DS, JR, BC, PPR, JL, SA; supervision or mentorship: WY, PPR, JL, SA. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. Funding for the CRIC Study was obtained under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902). In addition, this work was supported in part by the Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award National Institutes of Health (NIH)/National Center for Advancing Translational Sciences (NCATS) UL1TR000003, Johns Hopkins University UL1 TR-000424, University of Maryland General Clinical Research Center M01 RR-16500, Clinical and Translational Science Collaborative of Cleveland, UL1TR000439 from the NCATS component of the NIH and NIH Roadmap for Medical Research, Michigan Institute for Clinical and Health Research UL1TR000433, University of Illinois at Chicago Clinical and Translational Science Award UL1RR029879, Tulane University Translational Research in Hypertension and Renal Biology P30GM103337, Kaiser Permanente NIH/National Center for Research Resources UCSF-CTSI UL1 RR-024131. Dr Harhay is funded by the NIDDK K23DK105207 and R01DK124388 Awards. Dr Ricardo is funded by the NIDDK K23DK094829 Award. Dr Lash is funded by the NIDDK K24DK092290 and R01-DK072231-91 Awards. Dr Reese's efforts were supported by National Institute of Allergy and Infectious Diseases K24AI146137. Funders of this study did not have any role in study design, analysis and interpretation of data, writing the manuscript, or the decision to submit the manuscript for publication. The authors declare that they have no relevant financial interests. Received January 13, 2020. Evaluated by 2 external peer reviewers, with direct editorial input from the Statistical Editor, an Associate Editor and the Editor-in-Chief. Accepted in revised form June 28, 2020.
Publisher Copyright:
© 2020 The Authors
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Rationale & Objective: Among individuals with chronic kidney disease (CKD), poor self-reported health is associated with adverse outcomes including hospitalization and death. We sought to examine the association between health-related quality-of-life (HRQoL) and depressive symptoms in advanced CKD and subsequent access to the kidney transplant waiting list. Study Design: Prospective cohort study. Setting & Population: 1,676 Chronic Renal Insufficiency Cohort (CRIC) study participants with estimated glomerular filtration rates ≤ 30 mL/min/1.73 m2 at study entry or during follow-up. Exposures: HRQoL ascertained by 5 scales of the Kidney Disease Quality of Life-36 Survey (Physical Component Summary [PCS], Mental Component Summary, Symptoms, Burdens, and Effects), with higher scores indicating better HRQoL, and depressive symptoms ascertained using the Beck Depression Inventory. Outcomes: Time to kidney transplant wait-listing and time to pre-emptive wait-listing. Analytic Approach: Time-to-event analysis using Cox proportional hazards regression. Results: During a median follow-up of 5.1 years, 652 (39%) participants were wait-listed, of whom 304 were preemptively wait-listed. Adjusted for demographics, comorbid conditions, estimated glomerular filtration rate slope, and cognitive function, participants with the highest scores on the Burden and Effects scales, respectively, had lower rates of wait-listing than those with the lowest scores on the Burden (wait-listing adjusted hazard ratio [aHR], 0.70; 95% CI, 0.57-0.85; P < 0.001) and Effects scales (wait-listing aHR, 0.74; 95% CI, 0.59-0.92; P = 0.007). Participants with fewer depressive symptoms (ie, Beck Depression Inventory score < 14) had lower wait-listing rates than those with more depressive symptoms (aHR, 0.81; 95% CI, 0.66-0.99; P = 0.04). Participants with lower Burden and Effects scale scores and those with higher Symptoms and PCS scores had higher pre-emptive wait-listing rates (aHR in highest tertile of PCS relative to lowest tertile, 1.58; 95% CI, 1.12-2.23; P = 0.01). Limitations: Unmeasured confounders. Conclusions: Self-reported health in late-stage CKD may influence the timing of kidney transplantation.
AB - Rationale & Objective: Among individuals with chronic kidney disease (CKD), poor self-reported health is associated with adverse outcomes including hospitalization and death. We sought to examine the association between health-related quality-of-life (HRQoL) and depressive symptoms in advanced CKD and subsequent access to the kidney transplant waiting list. Study Design: Prospective cohort study. Setting & Population: 1,676 Chronic Renal Insufficiency Cohort (CRIC) study participants with estimated glomerular filtration rates ≤ 30 mL/min/1.73 m2 at study entry or during follow-up. Exposures: HRQoL ascertained by 5 scales of the Kidney Disease Quality of Life-36 Survey (Physical Component Summary [PCS], Mental Component Summary, Symptoms, Burdens, and Effects), with higher scores indicating better HRQoL, and depressive symptoms ascertained using the Beck Depression Inventory. Outcomes: Time to kidney transplant wait-listing and time to pre-emptive wait-listing. Analytic Approach: Time-to-event analysis using Cox proportional hazards regression. Results: During a median follow-up of 5.1 years, 652 (39%) participants were wait-listed, of whom 304 were preemptively wait-listed. Adjusted for demographics, comorbid conditions, estimated glomerular filtration rate slope, and cognitive function, participants with the highest scores on the Burden and Effects scales, respectively, had lower rates of wait-listing than those with the lowest scores on the Burden (wait-listing adjusted hazard ratio [aHR], 0.70; 95% CI, 0.57-0.85; P < 0.001) and Effects scales (wait-listing aHR, 0.74; 95% CI, 0.59-0.92; P = 0.007). Participants with fewer depressive symptoms (ie, Beck Depression Inventory score < 14) had lower wait-listing rates than those with more depressive symptoms (aHR, 0.81; 95% CI, 0.66-0.99; P = 0.04). Participants with lower Burden and Effects scale scores and those with higher Symptoms and PCS scores had higher pre-emptive wait-listing rates (aHR in highest tertile of PCS relative to lowest tertile, 1.58; 95% CI, 1.12-2.23; P = 0.01). Limitations: Unmeasured confounders. Conclusions: Self-reported health in late-stage CKD may influence the timing of kidney transplantation.
KW - Kidney Transplant
KW - depression
KW - quality-of-life
KW - wait-listing
UR - http://www.scopus.com/inward/record.url?scp=85089860857&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089860857&partnerID=8YFLogxK
U2 - 10.1016/j.xkme.2020.06.010
DO - 10.1016/j.xkme.2020.06.010
M3 - Article
C2 - 33089138
AN - SCOPUS:85089860857
SN - 2590-0595
VL - 2
SP - 600-609.e1
JO - Kidney Medicine
JF - Kidney Medicine
IS - 5
ER -