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Health-related quality of life in patients with autosomal dominant polycystic kidney disease and CKD stages 1-4: a cross-sectional study.
Am J Kidney Dis. 2014 Feb; 63(2):214-26.AJ

Abstract

BACKGROUND

In people with early autosomal dominant polycystic kidney disease (ADPKD), average total kidney volume (TKV) is 3 times normal and increases by an average of 5% per year despite a seemingly normal glomerular filtration rate (GFR). We hypothesized that increased TKV would be a source of morbidity and diminished quality of life that would be worse in patients with more advanced disease.

STUDY DESIGN

Cross-sectional.

SETTING & PARTICIPANTS

1,043 patients with ADPKD, hypertension, and a baseline estimated GFR (eGFR)> 20mL/min/1.73m(2).

PREDICTORS

(1) eGFR, (2) height-adjusted TKV (htTKV) in patients with eGFR> 60mL/min/1.73m(2).

OUTCOMES

36-Item Short Form Health Survey (SF-36) and the Wisconsin Brief Pain Survey.

MEASUREMENTS

Questionnaires were self-administered. GFR was estimated from serum creatinine using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. htTKV was measured by magnetic resonance imaging.

RESULTS

Back pain was reported by 50% of patients, and 20% experienced it "often, usually, or always." In patients with early disease (eGFR> 60mL/min/1.73m(2)), there was no association between pain and htTKV, except in patients with large kidneys (htTKV> 1,000mL/m). Comparing across eGFR levels and including patients with eGFRs< 60mL/min/1.73m(2), patients with eGFRs of 20-44mL/min/1.73m(2) were significantly more likely to report that pain impacted on their daily lives and had lower SF-36 scores than patients with eGFRs of 45-60 and ≥60mL/min/1.73m(2). Symptoms relating to abdominal fullness were reported by 20% of patients and were related significantly to lower eGFRs in women, but not men.

LIMITATIONS

TKV and liver volume were not measured in patients with eGFR < 60mL/min/1.73m(2). The number of patients with eGFRs< 30mL/min/1.73m(2) is small. Causal inferences are limited by cross-sectional design.

CONCLUSIONS

Pain is a common early symptom in the course of ADPKD, although it is not related to kidney size in early disease (eGFR> 60mL/min/1.73m(2)), except in individuals with large kidneys (htTKV> 1,000 mL/m). Symptoms relating to abdominal fullness and pain are greater in patients with more advanced (eGFR, 20-45mL/min/1.73m(2)) disease and may be due to organ enlargement, especially in women. More research about the role of TKV in quality of life and outcomes of patients with ADPKD is warranted.

Authors+Show Affiliations

Tufts Medical Center, Boston, MA. Electronic address: dmiskulin@tuftsmedicalcenter.org.University of Pittsburgh School of Medicine, Pittsburgh, PA.Emory University School of Medicine, Atlanta, GA.Tufts Medical Center, Boston, MA.Beth Israel Deaconess Medical Center, Boston, MA.Mayo Clinic College of Medicine, Rochester, MN.University of Pittsburgh School of Medicine, Pittsburgh, PA.Cleveland Clinic, Cleveland, OH.Kansas University Medical Center, Kansas City, KS.Mayo Clinic College of Medicine, Rochester, MN.Emory University School of Medicine, Atlanta, GA.University of Pittsburgh School of Medicine, Pittsburgh, PA.National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.University of Colorado Health Sciences Center, Denver, CO.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24183837

Citation

Miskulin, Dana C., et al. "Health-related Quality of Life in Patients With Autosomal Dominant Polycystic Kidney Disease and CKD Stages 1-4: a Cross-sectional Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 63, no. 2, 2014, pp. 214-26.
Miskulin DC, Abebe KZ, Chapman AB, et al. Health-related quality of life in patients with autosomal dominant polycystic kidney disease and CKD stages 1-4: a cross-sectional study. Am J Kidney Dis. 2014;63(2):214-26.
Miskulin, D. C., Abebe, K. Z., Chapman, A. B., Perrone, R. D., Steinman, T. I., Torres, V. E., Bae, K. T., Braun, W., Winklhofer, F. T., Hogan, M. C., Rahbari-Oskoui, F., Moore, C. G., Flessner, M. F., & Schrier, R. W. (2014). Health-related quality of life in patients with autosomal dominant polycystic kidney disease and CKD stages 1-4: a cross-sectional study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 63(2), 214-26. https://doi.org/10.1053/j.ajkd.2013.08.017
Miskulin DC, et al. Health-related Quality of Life in Patients With Autosomal Dominant Polycystic Kidney Disease and CKD Stages 1-4: a Cross-sectional Study. Am J Kidney Dis. 2014;63(2):214-26. PubMed PMID: 24183837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Health-related quality of life in patients with autosomal dominant polycystic kidney disease and CKD stages 1-4: a cross-sectional study. AU - Miskulin,Dana C, AU - Abebe,Kaleab Z, AU - Chapman,Arlene B, AU - Perrone,Ronald D, AU - Steinman,Theodore I, AU - Torres,Vicente E, AU - Bae,K Ty, AU - Braun,William, AU - Winklhofer,Franz T, AU - Hogan,Marie C, AU - Rahbari-Oskoui,Fred, AU - Moore,Charity G, AU - Flessner,Michael F, AU - Schrier,Robert W, AU - ,, Y1 - 2013/11/01/ PY - 2013/01/19/received PY - 2013/08/26/accepted PY - 2013/11/5/entrez PY - 2013/11/5/pubmed PY - 2014/3/19/medline KW - Autosomal dominant polycystic kidney disease (ADPKD) KW - activities of daily life KW - chronic kidney disease (CKD) KW - extrarenal symptoms KW - patient-reported outcomes KW - quality of life (QoL) KW - renal disease SP - 214 EP - 26 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 63 IS - 2 N2 - BACKGROUND: In people with early autosomal dominant polycystic kidney disease (ADPKD), average total kidney volume (TKV) is 3 times normal and increases by an average of 5% per year despite a seemingly normal glomerular filtration rate (GFR). We hypothesized that increased TKV would be a source of morbidity and diminished quality of life that would be worse in patients with more advanced disease. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: 1,043 patients with ADPKD, hypertension, and a baseline estimated GFR (eGFR)> 20mL/min/1.73m(2). PREDICTORS: (1) eGFR, (2) height-adjusted TKV (htTKV) in patients with eGFR> 60mL/min/1.73m(2). OUTCOMES: 36-Item Short Form Health Survey (SF-36) and the Wisconsin Brief Pain Survey. MEASUREMENTS: Questionnaires were self-administered. GFR was estimated from serum creatinine using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. htTKV was measured by magnetic resonance imaging. RESULTS: Back pain was reported by 50% of patients, and 20% experienced it "often, usually, or always." In patients with early disease (eGFR> 60mL/min/1.73m(2)), there was no association between pain and htTKV, except in patients with large kidneys (htTKV> 1,000mL/m). Comparing across eGFR levels and including patients with eGFRs< 60mL/min/1.73m(2), patients with eGFRs of 20-44mL/min/1.73m(2) were significantly more likely to report that pain impacted on their daily lives and had lower SF-36 scores than patients with eGFRs of 45-60 and ≥60mL/min/1.73m(2). Symptoms relating to abdominal fullness were reported by 20% of patients and were related significantly to lower eGFRs in women, but not men. LIMITATIONS: TKV and liver volume were not measured in patients with eGFR < 60mL/min/1.73m(2). The number of patients with eGFRs< 30mL/min/1.73m(2) is small. Causal inferences are limited by cross-sectional design. CONCLUSIONS: Pain is a common early symptom in the course of ADPKD, although it is not related to kidney size in early disease (eGFR> 60mL/min/1.73m(2)), except in individuals with large kidneys (htTKV> 1,000 mL/m). Symptoms relating to abdominal fullness and pain are greater in patients with more advanced (eGFR, 20-45mL/min/1.73m(2)) disease and may be due to organ enlargement, especially in women. More research about the role of TKV in quality of life and outcomes of patients with ADPKD is warranted. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/24183837/Health_related_quality_of_life_in_patients_with_autosomal_dominant_polycystic_kidney_disease_and_CKD_stages_1_4:_a_cross_sectional_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(13)01203-1 DB - PRIME DP - Unbound Medicine ER -