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Characterizing the relationship between health utility and renal function after kidney transplantation in UK and US: a cross-sectional study.

Neri L, McEwan P, Sennfält K, Baboolal K - Health Qual Life Outcomes (2012)

Bottom Line: The adjusted median disutility associated to CKD stage 5 compared to CKD stage 1-2 for the whole sample was 0.18 (p<0.01, quantile regression).Center effect was not statistically significant.Impaired renal function is associated with reduced health-related quality of life independent of possible confounders, center-effect and analytic framework.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dipartimento di Scienze Mediche e di Comunità, Università degli Studi di Milano, Milano, Italy. luca.neri@unimi.it

ABSTRACT

Background: Chronic allograft nephropathy (CAN) occurs in a large share of transplant recipients and it is the leading cause of graft loss despite the introduction of new and effective immunosuppressants. The reduction in renal function secondary to immunologic and non-immunologic CAN leads to several complications, including anemia and calcium-phosphorus metabolism imbalance and may be associated to worsening Health-Related Quality of Life. We sought to evaluate the relationship between kidney function and Euro-Qol 5 Dimension Index (EQ-5Dindex) scores after kidney transplantation and evaluate whether cross-cultural differences exist between UK and US.

Methods: This study is a secondary analysis of existing data gathered from two cross-sectional studies. We enrolled 233 and 209 subjects aged 18-74 years who received a kidney transplant in US and UK respectively. For the present analysis we excluded recipients with multiple or multi-organ transplantation, creatinine kinase ≥200 U/L, acute renal failure, and without creatinine assessments in 3 months pre-enrollment leaving 281 subjects overall. The questionnaires were administered independently in the two centers. Both packets included the EQ-5Dindex and socio-demographic items. We augmented the analytical dataset with information abstracted from clinical charts and administrative records including selected comorbidities and biochemistry test results. We used ordinary least squares and quantile regression adjusted for socio-demographic and clinical characteristics to assess the association between EQ-5Dindex and severity of chronic kidney disease (CKD).

Results: CKD severity was negatively associated with EQ-5Dindex in both samples (UK: ρ= -0.20, p=0.02; US: ρ= -0.21, p=0.02). The mean adjusted disutility associated to CKD stage 5 compared to CKD stage 1-2 was Δ= -0.38 in the UK sample, Δ= -0.11 in the US sample and Δ= -0.22 in the whole sample. The adjusted median disutility associated to CKD stage 5 compared to CKD stage 1-2 for the whole sample was 0.18 (p<0.01, quantile regression). Center effect was not statistically significant.

Conclusions: Impaired renal function is associated with reduced health-related quality of life independent of possible confounders, center-effect and analytic framework.

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Health Related Quality of Life across CKD stages in the whole sample.
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Figure 1: Health Related Quality of Life across CKD stages in the whole sample.

Mentions: The trend in EQ-5Dindex across CKD stages evaluated with Spearman’s partial correlation was ρ= −0.18 (p<0.01; pooled sample) , ρ= −0.20 (p<0.01; UK sample) , ρ= −0.18 (p<0.01; US sample) after adjustment for age, gender, center of enrollment, diabetes, cardiovascular diseases, anxiety or depression, hypertension, ALT, AST, months since transplant. The mean adjusted disutility associated to CKD stage 5 compared to CKD stage 1–2 was Δ= −0.38 in the UK sample and Δ= −0.11 in the US sample (Figure 1 and Table 2). After removing the 14 patients on dialysis, only 3 patients remained in CKD stage 5 and the association between CKD severity and HRQOL in the UK sample was not statistically significant (not shown). No significant interaction between age, gender, and eGFR was observed. After including mean serum hemoglobin, albumin and phosphorus in the regression models the association between CKD severity and EQ-5Dindex was strongly attenuated and lost statistical significance. The interaction term between center of enrollment and CKD severity was not significant in any model.


Characterizing the relationship between health utility and renal function after kidney transplantation in UK and US: a cross-sectional study.

Neri L, McEwan P, Sennfält K, Baboolal K - Health Qual Life Outcomes (2012)

Health Related Quality of Life across CKD stages in the whole sample.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539915&req=5

Figure 1: Health Related Quality of Life across CKD stages in the whole sample.
Mentions: The trend in EQ-5Dindex across CKD stages evaluated with Spearman’s partial correlation was ρ= −0.18 (p<0.01; pooled sample) , ρ= −0.20 (p<0.01; UK sample) , ρ= −0.18 (p<0.01; US sample) after adjustment for age, gender, center of enrollment, diabetes, cardiovascular diseases, anxiety or depression, hypertension, ALT, AST, months since transplant. The mean adjusted disutility associated to CKD stage 5 compared to CKD stage 1–2 was Δ= −0.38 in the UK sample and Δ= −0.11 in the US sample (Figure 1 and Table 2). After removing the 14 patients on dialysis, only 3 patients remained in CKD stage 5 and the association between CKD severity and HRQOL in the UK sample was not statistically significant (not shown). No significant interaction between age, gender, and eGFR was observed. After including mean serum hemoglobin, albumin and phosphorus in the regression models the association between CKD severity and EQ-5Dindex was strongly attenuated and lost statistical significance. The interaction term between center of enrollment and CKD severity was not significant in any model.

Bottom Line: The adjusted median disutility associated to CKD stage 5 compared to CKD stage 1-2 for the whole sample was 0.18 (p<0.01, quantile regression).Center effect was not statistically significant.Impaired renal function is associated with reduced health-related quality of life independent of possible confounders, center-effect and analytic framework.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dipartimento di Scienze Mediche e di Comunità, Università degli Studi di Milano, Milano, Italy. luca.neri@unimi.it

ABSTRACT

Background: Chronic allograft nephropathy (CAN) occurs in a large share of transplant recipients and it is the leading cause of graft loss despite the introduction of new and effective immunosuppressants. The reduction in renal function secondary to immunologic and non-immunologic CAN leads to several complications, including anemia and calcium-phosphorus metabolism imbalance and may be associated to worsening Health-Related Quality of Life. We sought to evaluate the relationship between kidney function and Euro-Qol 5 Dimension Index (EQ-5Dindex) scores after kidney transplantation and evaluate whether cross-cultural differences exist between UK and US.

Methods: This study is a secondary analysis of existing data gathered from two cross-sectional studies. We enrolled 233 and 209 subjects aged 18-74 years who received a kidney transplant in US and UK respectively. For the present analysis we excluded recipients with multiple or multi-organ transplantation, creatinine kinase ≥200 U/L, acute renal failure, and without creatinine assessments in 3 months pre-enrollment leaving 281 subjects overall. The questionnaires were administered independently in the two centers. Both packets included the EQ-5Dindex and socio-demographic items. We augmented the analytical dataset with information abstracted from clinical charts and administrative records including selected comorbidities and biochemistry test results. We used ordinary least squares and quantile regression adjusted for socio-demographic and clinical characteristics to assess the association between EQ-5Dindex and severity of chronic kidney disease (CKD).

Results: CKD severity was negatively associated with EQ-5Dindex in both samples (UK: ρ= -0.20, p=0.02; US: ρ= -0.21, p=0.02). The mean adjusted disutility associated to CKD stage 5 compared to CKD stage 1-2 was Δ= -0.38 in the UK sample, Δ= -0.11 in the US sample and Δ= -0.22 in the whole sample. The adjusted median disutility associated to CKD stage 5 compared to CKD stage 1-2 for the whole sample was 0.18 (p<0.01, quantile regression). Center effect was not statistically significant.

Conclusions: Impaired renal function is associated with reduced health-related quality of life independent of possible confounders, center-effect and analytic framework.

Show MeSH
Related in: MedlinePlus