Practice standards and health-related quality of life in kidney disease.
Thaxton S, Rouen P, Groh C, Li J, and Peterson E. Practice standards and health-related quality of life in kidney disease. Am J Kidney Dis 2017; 69(4):A97-A97.
Am J Kidney Dis
The effects of disease on a patient’s daily life may be measured by health-related quality of life (HRQOL) indicators and their relation to standardized clinical indicators of care. This relationship has not been examined among chronic kidney disease (CKD) patients not receiving hemodialysis. This study aimed to evaluate the relationship between perceived HRQOL and the national CKD practice standards for CKD patients not receiving dialysis. This cross-sectional study enrolled 100 non-hemodialysis CKD outpatients at an urban medical center in 2015. Eligibility criteria included ages 40-85 years, CKD stages 1-5, not on dialysis, able to speak/read English, and receiving treatment for CKD in the clinic for at least 6 months. Kidney Disease Outcomes Quality Initiative (KDOQI) clinical indicators for standards of CKD care (e.g., blood pressure, hemoglobin, calcium, parathyroid hormone, vitamin D, and phosphorus) were extracted from electronic health records (EHRs).Perceived HRQOL outcomes were based on the Kidney Disease Quality of Life short form-36, Generalized Anxiety Disorder-7, Patient Health questionnaire-9, and the Duke-UNC Functional Social Support questionnaire. Spearman and Pearson correlations and Wilcoxon signed-rank testswere used to determine associations. Most subjects were African American (83%)women (61%) with stages 3-4 CKD (86%).Hemoglobin was the only practice standard that showed a direct correlation to HRQOL. Those with hemoglobin values at goal had greater perceived mental health (p=0.026), higher CKD effects scores (p=0.023), and the level of perceived burden from CKD was directly related to hemoglobin (r=0.26; p=0.010) when compared to subjects who did not meet the standard. This study shows a strong relationship between achievement of hemoglobin targeted goals and improvement in HRQOL, but little relationship to the other recommended clinical parameters that measure physiologic stability in non-hemodialysis CKD patients.