Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis

• Published in: PLoS medicine 2022-04, Vol.19 (4), p.e1003954-e1003954
• Main Authors: Fletcher, Benjamin R, Damery, Sarah, Aiyegbusi, Olalekan Lee, Anderson, Nicola, Calvert, Melanie, Cockwell, Paul, Ferguson, James, Horton, Mike, Paap, Muirne C S, Sidey-Gibbons, Chris, Slade, Anita, Turner, Neil, Kyte, Derek
• Format: Article
• Language: English
• Subjects: Adult; Biology and Life Sciences; Chronic kidney failure; Cross-Sectional Studies; Data analysis; Development and progression; Dialysis; Fatigue; Health aspects; Health care; Health surveys; Humans; Kidney diseases; Kidney transplantation; Kidney transplants; Kidneys; Medicine and Health Sciences; Meta-analysis; Patient outcomes; Patients; Peritoneal dialysis; Physical Sciences; Pruritus; Quality of Life; Renal Dialysis; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - therapy; Research and Analysis Methods
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1003954

The importance of patient-reported outcome measurement in chronic kidney disease (CKD) populations has been established. However, there remains a lack of research that has synthesised data around CKD-specific symptom and health-related quality of life (HRQOL) burden globally, to inform focused measurement of the most relevant patient-important information in a way that minimises patient burden. The aim of this review was to synthesise symptom prevalence/severity and HRQOL data across the following CKD clinical groups globally: (1) stage 1-5 and not on renal replacement therapy (RRT), (2) receiving dialysis, or (3) in receipt of a kidney transplant. MEDLINE, PsycINFO, and CINAHL were searched for English-language cross-sectional/longitudinal studies reporting prevalence and/or severity of symptoms and/or HRQOL in CKD, published between January 2000 and September 2021, including adult patients with CKD, and measuring symptom prevalence/severity and/or HRQOL using a patient-reported outcome measure (PROM). Random effects meta-analyses were used to pool data, stratified by CKD group: not on RRT, receiving dialysis, or in receipt of a kidney transplant. Methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data, and an exploration of publication bias performed. The search identified 1,529 studies, of which 449, with 199,147 participants from 62 countries, were included in the analysis. Studies used 67 different symptom and HRQOL outcome measures, which provided data on 68 reported symptoms. Random effects meta-analyses highlighted the considerable symptom and HRQOL burden associated with CKD, with fatigue particularly prevalent, both in patients not on RRT (14 studies, 4,139 participants: 70%, 95% CI 60%-79%) and those receiving dialysis (21 studies, 2,943 participants: 70%, 95% CI 64%-76%). A number of symptoms were significantly (p < 0.05 after adjustment for multiple testing) less prevalent and/or less severe within the post-transplantation population, which may suggest attribution to CKD (fatigue, depression, itching, poor mobility, poor sleep, and dry mouth). Quality of life was commonly lower in patients on dialysis (36-Item Short Form Health Survey [SF-36] Mental Component Summary [MCS] 45.7 [95% CI 45.5-45.8]; SF-36 Physical Component Summary [PCS] 35.5 [95% CI 35.3-35.6]; 91 studies, 32,105 participants for MCS and PCS) than in other CKD populations (patie