Predictors of Health-Related Quality of Life in Patients with Co-Morbid Diabetes and Chronic Kidney Disease

Edward Zimbudzi; Clement Lo; Sanjeeva Ranasinha; Martin Gallagher; Gregory Fulcher; Peter G Kerr; Grant Russell; Helena Teede; Tim Usherwood; Rowan Walker; Sophia Zoungas

doi:10.1371/journal.pone.0168491

Predictors of Health-Related Quality of Life in Patients with Co-Morbid Diabetes and Chronic Kidney Disease

PLoS One. 2016 Dec 19;11(12):e0168491. doi: 10.1371/journal.pone.0168491. eCollection 2016.

Authors

Edward Zimbudzi^{1

2}, Clement Lo^{2

3}, Sanjeeva Ranasinha², Martin Gallagher^{4

5}, Gregory Fulcher^{6

7}, Peter G Kerr¹, Grant Russell⁸, Helena Teede^{2

3}, Tim Usherwood^{9

10}, Rowan Walker¹¹, Sophia Zoungas^{2

3

9}

Affiliations

¹ Department of Nephrology, Monash Health, Melbourne, Australia.
² Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
³ Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Melbourne, Australia.
⁴ Concord Clinical School, University of Sydney, Sydney, Australia.
⁵ The George Institute for Global Health, Sydney, Australia.
⁶ Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, Sydney, Australia.
⁷ Northern Clinical School, University of Sydney, Royal North Shore Hospital, Sydney, Australia.
⁸ Southern Academic Primary Care Research Unit. School of Primary Health Care, Monash University, Melbourne, Australia.
⁹ The George Institute for Global Health, University of Sydney, Sydney, Australia.
¹⁰ Department of General Practice, Sydney Medical School Westmead, Sydney, Australia.
¹¹ Department of Renal Medicine, the Alfred Hospital, Melbourne, Australia.

Abstract

Background: People living with diabetes and chronic kidney disease (CKD) experience compromised quality of life. Consequently, it is critical to identify and understand factors influencing their health-related quality of life (HRQoL). This study examined factors associated with HRQoL among patients with diabetes and CKD.

Methods: A cross sectional study among adults with comorbid diabetes and CKD (eGFR <60 mL/min/1.73m2) recruited from renal and diabetes clinics of four large tertiary referral hospitals in Australia was performed. Each participant completed the Kidney Disease Quality of Life (KDQoL ™ -36) questionnaire, which is comprised of two composite measures of physical and mental health and 3 kidney disease specific subscales with possible scores ranging from 0 to 100 with higher values indicating better HRQoL. Demographic and clinical data were also collected. Regression analyses were performed to determine the relationship between HRQoL and potential predictor factors.

Results: A total of 308 patients were studied with a mean age of 66.9 (SD = 11.0) years and 70% were males. Mean scores for the physical composite summary, mental composite summary, symptom/problem list, effects of kidney disease and burden of kidney disease scales were 35.2, 47.0, 73.8, 72.5 and 59.8 respectively. Younger age was associated with lower scores in all subscales except for the physical composite summary. Female gender, obese or normal weight rather than overweight, and smoking were all associated with lower scores in one or more subscales. Scores were progressively lower with more advanced stage of CKD (p<0.05) in all subscales except for the mental composite summary.

Conclusion: In patients with diabetes and CKD, younger age was associated with lower scores in all HRQoL subscales except the physical composite summary and female gender, obese or normal weight and more advanced stages of CKD were associated with lower scores in one or more subscales. Identifying these factors will inform the timely implementation of interventions to improve the quality of life of these patients.

Publication types

Clinical Trial
Multicenter Study

MeSH terms

Adult
Age Factors
Aged
Comorbidity
Cross-Sectional Studies
Diabetic Nephropathies / therapy*
Female
Humans
Male
Mental Health*
Middle Aged
Obesity
Quality of Life*
Renal Insufficiency, Chronic / therapy*
Risk Factors
Sex Factors
Smoking

Grants and funding

This study was supported by a National Health and Medical Research Council, Australia (NHMRC) Partnership Grant (ID 1055175) between the following health services, research institutes and national consumer stakeholder groups – Alfred Health; Concord Hospital; Royal North Shore Hospital; Monash Health; Monash Centre for Health Research and Implementation, Monash University; The George Institute for Global Health, University of Sydney; Diabetes Australia; and Kidney Health Australia. CL was supported by an Australian Postgraduate Award Scholarship. HT was supported by a NHMRC, Australia Fellowship. SZ was supported by a National Heart Foundation of Australia Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.