Health-Related Quality of Life, Depressive Symptoms, and Kidney Transplant Access in Advanced CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) StudyPlain-Language Summary

• Published in: Kidney medicine 2020-09, Vol.2 (5), p.600-609.e1
• Main Authors: Meera Nair Harhay, Wei Yang, Daohang Sha, Jason Roy, Boyang Chai, Michael J. Fischer, L. Lee Hamm, Peter D. Hart, Chi-yuan Hsu, Yonghong Huan, Anne M. Huml, Radhakrishna Reddy Kallem, Manjula Kurella Tamura, Anna C. Porter, Ana C. Ricardo, Anne Slaven, Sylvia E. Rosas, Raymond R. Townsend, Peter P. Reese, James P. Lash, Sanjeev Akkina, Lawrence J. Appel, MD, MPH, Harold I. Feldman, MD, MSCE, Alan S. Go, MD, Jiang He, MD, PhD, John W. Kusek, PhD, Panduranga Rao, MD, Mahboob Rahman, MD
• Format: Article
• Language: English
• Subjects: depression; Kidney Transplant; quality-of-life; wait-listing
• ISSN: 2590-0595; 2590-0595

Rationale & Objective: Among individuals with chronic kidney disease (CKD), poor self-reported health is associated with adverse outcomes including hospitalization and death. We sought to examine the association between health-related quality-of-life (HRQoL) and depressive symptoms in advanced CKD and subsequent access to the kidney transplant waiting list. Study Design: Prospective cohort study. Setting & Population: 1,676 Chronic Renal Insufficiency Cohort (CRIC) study participants with estimated glomerular filtration rates ≤ 30 mL/min/1.73 m2 at study entry or during follow-up. Exposures: HRQoL ascertained by 5 scales of the Kidney Disease Quality of Life-36 Survey (Physical Component Summary [PCS], Mental Component Summary, Symptoms, Burdens, and Effects), with higher scores indicating better HRQoL, and depressive symptoms ascertained using the Beck Depression Inventory. Outcomes: Time to kidney transplant wait-listing and time to pre-emptive wait-listing. Analytic Approach: Time-to-event analysis using Cox proportional hazards regression. Results: During a median follow-up of 5.1 years, 652 (39%) participants were wait-listed, of whom 304 were preemptively wait-listed. Adjusted for demographics, comorbid conditions, estimated glomerular filtration rate slope, and cognitive function, participants with the highest scores on the Burden and Effects scales, respectively, had lower rates of wait-listing than those with the lowest scores on the Burden (wait-listing adjusted hazard ratio [aHR], 0.70; 95% CI, 0.57-0.85; P