Anemic CKD Patients Have Lower Health-Related Quality of Life

Anemia was associated with impaired activity levels at CKD stages 3, 4, and dialysis.
Anemia was associated with impaired activity levels at CKD stages 3, 4, and dialysis.

Chronic kidney disease (CKD) patients with anemia have lower health-related quality of life (HRQoL) than those without anemia, a new European study confirms.

Daniel Eriksson, of Quantify Research, Stockholm, Sweden, and colleagues examined reports from 1873 stage 3 or 4 nondialysis CKD patients and 1025 dialysis patients, as well as their treating nephrologists and endocrinologists. Survey responses were collected in 2012 during the Adelphi CKD Disease-Specific Programme that ran in France, Germany, Italy, Spain, and the United Kingdom. Several HRQoL tools were employed, primarily the EuroQol Group's generic utility score (EQ-5D-3 L), with additional information from the Kidney Disease and Quality of Life Instrument (KDQOL-36). For the EQ-5D-3 L, patients assessed their mobility, self-care, usual activities, pain/discomfort, and anxiety/depression with 3 possible responses: no problems, some or moderate problems, or extreme problems.

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Anemia was defined by hemoglobin level or by current use of erythropoiesis-stimulating agents. Physicians documented anemia symptoms observed in patients, including tiredness/low energy, lethargy, and fatigue, and other pertinent disease information.

Anemic patients reported greater HRQoL impairment across all tools, according to results published in BMC Nephrology. For example, lower EQ-5D index values were reported by anemic patients: 0.72 vs 0.83. In addition, patient tiredness, as observed by physicians, was associated with disease burden across CKD stages. The EQ-5D index value was 0.70 vs 0.81 for patients reporting tiredness vs no tiredness, respectively.

Self-reports from anemic patients also confirmed impaired physical activity across CKD stages. Anemia was associated with impaired activity levels at CKD stages 3 (37.5% vs 28.4%, respectively) and 4 (48.1% vs 39.9%), and dialysis (52% vs 45%).

“This indicates that correcting anaemia [sic] is particularly important for reducing burden in non-dialysis patients,” Dr Eriksson, and colleagues wrote. “In patients receiving dialysis, anaemia may already be well controlled, but being on dialysis itself contributes to overall disease burden, requiring a different treatment focus compared to non-dialysis patients.”

In their discussion of study limitations, the investigators acknowledged that they could not determine the potential contributions of some other relevant factors, such as high inflammation, hypertension, or vascular calcification.

Dr Eriksson, and colleagues further noted that anemic CKD patients may experience a decrease in HRQoL similar to patients with diabetes, epilepsy, or some cancers such as metastatic colorectal cancer.

The study was funded by Astellas Pharma.

Source

1. Eriksson D, Goldsmith D, Teitsson S, Jackson J, van Nooten F. Cross-sectional survey in CKD patients across Europe describing the association between quality of life and anaemia. BMC Nephrol. 2016 Jul 26;17(1):97. doi: 10.1186/s12882-016-0312-9.

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