Health-Related Quality of Life in Patients With Autosomal Dominant Polycystic Kidney Disease and CKD Stages 1-4: A Cross-sectional Study

作者：Miskulin Dana C^*; Abebe Kaleab Z; Chapman Arlene B; Perrone Ronald D; Steinman Theodore I; Torres Vicente E; Bae K Ty; Braun William; Winklhofer Franz T; Hogan Marie C; Rahbari Oskoui Fred; Moore Charity G; Flessner Michael F; Schrier Robert W

来源：American Journal of Kidney Diseases, 2014, 63(2): 214-226.

DOI：10.1053/j.ajkd.2013.08.017

• Autosomal dominant polycystic kidney disease (ADPKD)
• quality of life (QoL)
• chronic kidney disease (CKD)
• patient-reported outcomes
• extrarenal symptoms
• renal disease
• activities of daily life

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 m(2).
Predictors: (1) eGFR, (2) height-adjusted TKV (htTKV) in patients with eGFR > 60 mL/min/1.73 m(2).
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 m(2)), 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 m(2) 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 m(2). 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 m(2). The number of patients with eGFRs < 30 mL/min/1.73 m(2) 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 m(2)), 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 m(2)) 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.

• 出版日期2014-2