Health-related quality of life in patients with autosomal dominant polycystic kidney disease and CKD stages 1-4: A cross-sectional study

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) > 20 mL/min/1.73 m2. Predictors (1) eGFR, (2) height-adjusted TKV (htTKV) in patients with eGFR > 60 mL/min/1.73 m2. 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 > 60 mL/min/1.73 m2), there was no association between pain and htTKV, except in patients with large kidneys (htTKV > 1,000 mL/m). Comparing across eGFR levels and including patients with eGFRs < 60 mL/min/1.73 m 2, patients with eGFRs of 20-44 mL/min/1.73 m2 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 ≥60 mL/min/1.73 m2. 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 < 60 mL/min/1.73 m2. The number of patients with eGFRs < 30 mL/min/1.73 m2 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 > 60 mL/min/1.73 m2), 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, 20-45 mL/min/1.73 m2) 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. © 2014 by the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.