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      Impaired kidney function is associated with lower quality of life among community-dwelling older adults : The screening for CKD among older people across Europe (SCOPE) study

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          Abstract

          Background

          Quality of life (QoL) refers to the physical, psychological, social and medical aspects of life that are influenced by health status and function. The purpose of this study was to measure the self-perceived health status among the elderly population across Europe in different stages of Chronic Kidney Disease (CKD).

          Methods

          Our series consisted of 2255 community-dwelling older adults enrolled in the Screening for Chronic Kidney Disease (CKD) among Older People across Europe (SCOPE) study. All patients underwent a comprehensive geriatric assessment (CGA), including included demographics, clinical and physical assessment, number of medications taken, family arrangement, Geriatric Depression Scale (GDS), Cumulative Illness Rating Scale, History of falls, Lower urinary tract symptoms, and Short Physical Performance Battery (SPPB). Estimated glomerular filtration rate (eGFR) was calculated by Berlin Initiative Study (BIS) equation. Quality of life was assessed by Euro Qol questionnaire (Euro-Qol 5D) and EQ-Visual Analogue Scale (EQ-VAS). The association between CKD (eGFR < 60, < 45 ml or < 30 ml/min/1.73m 2) and low EQoL-VAS was investigated by multivariable logistic regression models.

          Results

          CKD was found to be significantly associated with low EQoL-VAS in crude analysis (OR = 1.47, 95%CI = 1.16–1.85 for eGFR< 60; OR = 1.38, 95%CI = 1.08–1.77 for eGFR< 45; OR = 1.57, 95%CI = 1.01–2.44). Such association was no longer significant only when adjusting for SPPB (OR = 1.20, 95%CI = 0.93–1.56 for eGFR< 60; OR = 0.87, 95%CI = 0.64–1.18 for eGFR< 45; OR = 0.84, 95%CI = 0.50–1.42), CIRS and polypharmacy (OR = 1.16, 95%CI = 0.90–1.50 for eGFR< 60; OR = 0.86, 95%CI = 0.64–1.16 for eGFR< 45; OR = 1.11, 95%CI = 0.69–1.80) or diabetes, hypertension and chronic obstructive pulmonary disease (OR = 1.28, 95%CI = 0.99–1.64 for eGFR< 60; OR = 1.16, 95%CI = 0.88–1.52 for eGFR< 45; OR = 1.47, 95%CI = 0.92–2.34). The association between CKD and low EQoL-VAS was confirmed in all remaining multivariable models.

          Conclusions

          CKD may significantly affect QoL in community-dwelling older adults. Physical performance, polypharmacy, diabetes, hypertension and COPD may affect such association, which suggests that the impact of CKD on QoL is likely multifactorial and partly mediated by co-occurrent conditions/risk factors.

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          Most cited references 34

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          The prevalence of symptoms in end-stage renal disease: a systematic review.

          Symptoms in end-stage renal disease (ESRD) are underrecognized. Prevalence studies have focused on single symptoms rather than on the whole range of symptoms experienced. This systematic review aimed to describe prevalence of all symptoms, to better understand total symptom burden. Extensive database, "gray literature," and hand searches were undertaken, by predefined protocol, for studies reporting symptom prevalence in ESRD populations on dialysis, discontinuing dialysis, or without dialysis. Prevalence data were extracted, study quality assessed by use of established criteria, and studies contrasted/combined to show weighted mean prevalence and range. Fifty-nine studies in dialysis patients, one in patients discontinuing dialysis, and none in patients without dialysis met the inclusion criteria. For the following symptoms, weighted mean prevalence (and range) were fatigue/tiredness 71% (12% to 97%), pruritus 55% (10% to 77%), constipation 53% (8% to 57%), anorexia 49% (25% to 61%), pain 47% (8% to 82%), sleep disturbance 44% (20% to 83%), anxiety 38% (12% to 52%), dyspnea 35% (11% to 55%), nausea 33% (15% to 48%), restless legs 30% (8%to 52%), and depression 27% (5%to 58%). Prevalence variations related to differences in symptom definition, period of prevalence, and level of severity reported. ESRD patients on dialysis experience multiple symptoms, with pain, fatigue, pruritus, and constipation in more than 1 in 2 patients. In patients discontinuing dialysis, evidence is more limited, but it suggests they too have significant symptom burden. No evidence is available on symptom prevalence in ESRD patients managed conservatively (without dialysis). The need for greater recognition of and research into symptom prevalence and causes, and interventions to alleviate them, is urgent.
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            Chronic kidney disease management in the United Kingdom: NEOERICA project results.

            Early identification of patients with chronic kidney disease (CKD) may allow health-care systems to implement interventions aimed at decreasing disease progression and eventual morbidity and mortality. Primary care in the United Kingdom is computerized suggesting a separate screening program for CKD may not be necessary because identifying data already populates primary care databases. Our study utilized a data set of 163 demographic, laboratory, diagnosis, and prescription variables from 130 226 adults in the regions of Kent, Manchester, and Surrey. The patients were 18 years of age and older in a 5-year study period culminating in November 2003. Estimated glomerular filtration rate was calculated from the four-variable Modification of Diet in Renal Disease equation using calibrated creatinine levels. A valid creatinine value was recorded in almost 30% of this cohort. The age-standardized prevalence of stage 3-5 CKD was 10.6% for females and 5.8% for males. In these patients, the odds ratio for hypertension was 2.1, for diabetes 1.33, and for cardiovascular disease 1.69. Only 20% of the diabetic people with stage 3-5 CKD had a blood pressure less than or equal to 130/80 mm Hg. The proportion of patients with anemia significantly rose as renal function declined. We suggest that stage 3-5 CKD is easily detected in existing computerized records. The associated comorbidity and management is readily available enabling intervention and targeting of specialist resources.
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              Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study.

              Health-related quality of life (QOL) is an important measure of how disease affects patients' lives. Dialysis patients have decreased QOL relative to healthy controls. Little is known about QOL in patients with chronic kidney disease (CKD) before renal replacement therapy. The Medical Outcomes Study Short Form-36 (SF-36), a standard QOL instrument, was used to evaluate 634 patients (mean glomerular filtration rate [GFR], 23.6 +/- 9.6 mL/min/1.73 m2 [0.39 +/- 0.16 mL/s/1.73 m2]) enrolled in a 4-center, prospective, observational study of CKD. SF-36 scores in these patients were compared with those in a prevalent cohort of hemodialysis (HD) patients and healthy controls (both from historical data). QOL data also were analyzed for correlations with GFR and albumin and hemoglobin levels in multivariable analyses. Patients with CKD had higher SF-36 scores than a large cohort of HD patients (P < 0.0001 for 8 scales and 2 summary scales), but lower scores than those reported for the US adult population (P < 0.0001 for 7 of 8 scales and 1 of 2 summary scales). Patients with CKD stage 4 had lower QOL scores than patients with CKD stage 5, although differences were not significant. Hemoglobin level was associated positively with higher mental and physical QOL scores (P < 0.05) in all individual and component scales except Pain. SF-36 scores were higher in this CKD cohort compared with HD patients, but lower than in healthy controls. GFR was not significantly associated with QOL. Hemoglobin level predicted both physical and mental domains of the SF-36. Longitudinal studies are needed to define at-risk periods for decreases in QOL during progression of CKD.
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                Author and article information

                Contributors
                artzir@bgu.ac.il
                robert.kob@fau.de
                p.fabbietti@inrca.it
                f.lattanzio@inrca.it
                a.corsonello@inrca.it
                MELZER_Y@mac.org.il
                Regina.Roller-Wirnsberger@medunigraz.at
                Gerhard.Wirnsberger@medunigraz.at
                f.mattaceraso@erasmusmc.nl
                l.tap@erasmusmc.nl
                pgil@salud.madrid.org
                slainezm@outlook.es
                fformiga@bellvitgehospital.cat
                rmoregog@bellvitgehospital.cat
                tomasz.kostka@umed.lodz.pl
                agnieszka.guligowska@umed.lodz.pl
                johan.arnlov@ki.se
                axel.carlsson@ki.se
                Ellen.Freiberger@fau.de
                itzikm@bgu.ac.il
                Journal
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                2 October 2020
                2 October 2020
                2020
                : 20
                Issue : Suppl 1 Issue sponsor : SCOPE study and publication costs are funded by the European Union Horizon 2020 program. The articles have undergone the journal's standard peer review process for supplements. The Supplement Editors declare that they have no competing interests.
                Affiliations
                [1 ]GRID grid.7489.2, ISNI 0000 0004 1937 0511, Department of Nursing, Recanati School for Community Health Professions at the faculty of Health Sciences, , Ben-Gurion University of the Negev, ; Beer-sheva, Israel
                [2 ]GRID grid.7489.2, ISNI 0000 0004 1937 0511, Department of Physical Therapy, Recanati School for Community Health Professions at the faculty of Health Sciences, , Ben-Gurion University of the Negev, ; Beer-sheva, Israel
                [3 ]GRID grid.5330.5, ISNI 0000 0001 2107 3311, Department of Internal Medicine-Geriatrics, , Institute for Biomedicine of Aging, Krankenhaus Barmherzige Brüder, Friedrich-Alexander Universität Erlangen-Nürnberg, ; Koberger Strasse 60, 90408 Nuremberg, Germany
                [4 ]GRID grid.418083.6, ISNI 0000 0001 2152 7926, Italian National Research Center on Aging (IRCCS INRCA), ; Ancona, Fermo and Cosenza Italy
                [5 ]Laboratory of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
                [6 ]Maccabi Health Organization, Negev district, Tel Aviv-Yafo, Israel
                [7 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Department of Internal Medicine, , Medical University of Graz, ; Graz, Austria
                [8 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Division of Nephrology, Department of Internal Medicine, , Medical University of Graz, ; Graz, Austria
                [9 ]GRID grid.5645.2, ISNI 000000040459992X, Department of Internal Medicine, Section of Geriatric Medicine, , Erasmus MC, University Medical Center Rotterdam, ; Rotterdam, The Netherlands
                [10 ]GRID grid.411068.a, ISNI 0000 0001 0671 5785, Department of Geriatric Medicine, , Hospital Clinico San Carlos, ; Madrid, Spain
                [11 ]GRID grid.411129.e, ISNI 0000 0000 8836 0780, Geriatric Unit, Internal Medicine Department, , Bellvitge University Hospital – IDIBELL – L’Hospitalet de Llobregat, ; Barcelona, Spain
                [12 ]GRID grid.8267.b, ISNI 0000 0001 2165 3025, Department of Geriatrics, Healthy Ageing Research Centre, , Medical University of Lodz, ; Lodz, Poland
                [13 ]GRID grid.8993.b, ISNI 0000 0004 1936 9457, Department of Medical Sciences, , Uppsala University, ; Uppsala, Sweden
                [14 ]GRID grid.411953.b, ISNI 0000 0001 0304 6002, School of Health and Social Studies, , Dalarna University, ; Falun, Sweden
                [15 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, , Karolinska Institutet, ; Huddinge, Sweden
                Article
                1697
                10.1186/s12877-020-01697-3
                7530949
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100010661, Horizon 2020 Framework Programme;
                Award ID: 634869
                Award ID: 634869
                Award ID: 634869
                Award ID: 634869
                Award ID: 634869
                Award ID: 634869
                Award ID: 634869
                Award ID: 634869
                Award Recipient :
                Categories
                Research
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                © The Author(s) 2020

                Geriatric medicine

                old adults, quality of life, chronic kidney disease

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