Quality of life measures predict cardiovascular health and physical performance in chronic renal failure patients

A Rogan, K McCarthy, G McGregor, T Hamborg, G Evans, S Hewins, N Aldridge, S Fletcher, N Krishnan, R Higgins, D Zehnder, S M Ting, A Rogan, K McCarthy, G McGregor, T Hamborg, G Evans, S Hewins, N Aldridge, S Fletcher, N Krishnan, R Higgins, D Zehnder, S M Ting

Abstract

Background: Patients with advanced chronic kidney disease (CKD) experience complex functional and structural changes of the cardiopulmonary and musculoskeletal system. This results in reduced exercise tolerance, quality of life and ultimately premature death. We investigated the relationship between subjective measures of health related quality of life and objective, standardised functional measures for cardiovascular and pulmonary health.

Methods: Between April 2010 and January 2013, 143 CKD stage-5 or CKD5d patients (age 46.0±1.1y, 62.2% male), were recruited prospectively. A control group of 83 healthy individuals treated for essential hypertension (HTN; age 53.2±0.9y, 48.22% male) were recruited at random. All patients completed the SF-36 health survey questionnaire, echocardiography, vascular tonometry and cardiopulmonary exercise testing.

Results: Patients with CKD had significantly lower SF-36 scores than the HTN group; for physical component score (PCS; 45.0 vs 53.9, p<0.001) and mental component score (MCS; 46.9 vs. 54.9, p<0.001). CKD subjects had significantly poorer exercise tolerance and cardiorespiratory performance compared with HTN (maximal oxygen uptake; VO2peak 19.9 vs 25.0ml/kg/min, p<0.001). VO2peak was a significant independent predictor of PCS in both groups (CKD: b = 0.35, p = 0.02 vs HTN: b = 0.27, p = 0.001). No associations were noted between PCS scores and echocardiographic characteristics, vascular elasticity and cardiac biomarkers in either group. No associations were noted between MCS and any variable. The interaction effect of study group with VO2peak on PCS was not significant (ΔB = 0.08; 95%CI -0.28-0.45, p = 0.7). However, overall for a given VO2peak, the measured PCS was much lower for patients with CKD than for HTN cohort, a likely consequence of systemic uremia effects.

Conclusion: In CKD and HTN, objective physical performance has a significant effect on quality of life; particularly self-reported physical health and functioning. Therefore, these quality of life measures are indeed a good reflection of physical health correlating highly with objective physical performance measures.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
A. Physical Component Summary Score and breakdown by domain in CKD and HTN cohorts. B. Mental Component Summary Score and breakdown by domain in CKD and HTN cohorts.
Fig 2
Fig 2
A depicts the unadjusted regression of the PCS on VO2peak in the CKD and HTN cohorts. Unadjusted regression of Physical Component Score on VO2peak in the CKD and HTN cohort. b, unstandardized regression coefficient: change in PCS per one unit change of variable. *p–value<0.05. Dash line = HTN, straight line = CKD. B demonstrates the same regression after adjustment for age, sex and BMI. Lack of difference of changes in VO2peak with Physical Component Score between the CKD and HTN cohorts. ΔB is the difference in the parameter estimates between the regression lines for the HTN and CKD groups. Group interaction with VO2peak was adjusted for age, sex, and BMI. Dash line = HTN, straight line = CKD.

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