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Research article
James Jackson
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ORCiD: https://orcid.org/0000-0002-4171-5390
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Background Reductions in health-related quality of life (HRQoL) in patients with chronic kidney disease (CKD) are thought to be exacerbated by the low hemoglobin (Hb) levels that define anemia, a common complication of CKD. The current analysis evaluated the impact of anemia on HRQoL and work productivity in patients with non-dialysis dependent and dialysis-dependent CKD using real-world data. Methods Data were collected in France, Germany, Italy, Spain, the UK, the USA and China in 2012–2018 in the Adelphi Real World Disease Specific Programme™ for CKD, a large, cross-sectional, survey of physicians and their patients. Patients completed three patient-reported outcomes (PRO) instruments: the EuroQol 5-Dimension 3-level (EQ-5D-3L), the Kidney Disease Quality of Life (KDQOL-36) instrument and the Work Productivity and Activity Impairment questionnaire. PROs were assessed by CKD stage and Hb levels, and regression analyses were performed with CKD stage and Hb level as independent variables and PROs as outcome variables, while adjusting for age, sex, CKD stage, comorbidities and cardiovascular risk. Results Overall, 5276 patients participated in the survey, including 28% stage 4 and 36% dialysis patients. Patients with lower Hb levels more often reported problems/issues on all EQ-5D-3L domains (p<0.0001). Regression analyses showed significant associations between lower Hb levels and the probability of low (<0.8) EQ-5D-3L utility scores (p<0.0001) and low visual analog scale scores (p<0.05), indicating poorer health status. Associations were seen even when adjusting for CKD stage and other potential confounding factors. Significant associations were observed between Hb level and the 12-Item Short-Form Health Survey (SF-12) Physical Component Summary, SF-12 Mental Component Summary and the three KDQOL-36 subscales (all p<0.0001), and were confirmed using linear regression analyses adjusting for CKD stage and other potential confounders. Numerically greater work productivity losses and greater activity impairment were observed with lower Hb levels. Conclusions Lower Hb levels worsen the impact of CKD on HRQoL, and are associated with lower work productivity in patients with CKD. Assessment and treatment of anemia should be recognized as a key component of integral CKD management throughout all stages of the disease.
Keywords
anemia; chronic kidney disease; EQ-5D-3L; health-related quality of life; KDQOL-36; patient-reported outcomes; real-world
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View the published article at BMC Nephrology.
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Editorial decision: Accept
On 27 Feb, 2020
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On 20 Feb, 2020
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On 19 Feb, 2020
Editor invited
On 19 Feb, 2020
Version 2
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Editorial decision: Minor revision
On 18 Feb, 2020
Review #1 received
Received 11 Feb, 2020
Reviewer #2 agreed
On 10 Feb, 2020
Review #2 received
Received 10 Feb, 2020
Editor assigned
On 07 Feb, 2020
Reviewers invited
Invitations sent on 07 Feb, 2020
Reviewer #1 agreed
On 07 Feb, 2020
Submission checks complete
On 06 Feb, 2020
Editor invited
On 06 Feb, 2020
No comments provided
Editorial decision: Major revision
On 14 Jan, 2020
Review #2 received
Received 16 Dec, 2019
Reviewer #2 agreed
On 06 Dec, 2019
Review #1 received
Received 16 Sep, 2019
Reviewer #1 agreed
On 01 Sep, 2019
Reviewers invited
Invitations sent on 29 Aug, 2019
Editor assigned
On 08 Aug, 2019
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On 07 Aug, 2019
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Subject Areas
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
James Jackson
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4171-5390
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Nephrology.
No community comments so far
Editorial decision: Accept
On 27 Feb, 2020
Editor assigned
On 20 Feb, 2020
Submission checks complete
On 19 Feb, 2020
Editor invited
On 19 Feb, 2020
Version 2
Posted 10 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 18 Feb, 2020
Review #1 received
Received 11 Feb, 2020
Reviewer #2 agreed
On 10 Feb, 2020
Review #2 received
Received 10 Feb, 2020
Editor assigned
On 07 Feb, 2020
Reviewers invited
Invitations sent on 07 Feb, 2020
Reviewer #1 agreed
On 07 Feb, 2020
Submission checks complete
On 06 Feb, 2020
Editor invited
On 06 Feb, 2020
No comments provided
Editorial decision: Major revision
On 14 Jan, 2020
Review #2 received
Received 16 Dec, 2019
Reviewer #2 agreed
On 06 Dec, 2019
Review #1 received
Received 16 Sep, 2019
Reviewer #1 agreed
On 01 Sep, 2019
Reviewers invited
Invitations sent on 29 Aug, 2019
Editor assigned
On 08 Aug, 2019
Submission checks complete
On 07 Aug, 2019
Editor invited
On 07 Aug, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Urology & Nephrology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Nephrology.
Background Reductions in health-related quality of life (HRQoL) in patients with chronic kidney disease (CKD) are thought to be exacerbated by the low hemoglobin (Hb) levels that define anemia, a common complication of CKD. The current analysis evaluated the impact of anemia on HRQoL and work productivity in patients with non-dialysis dependent and dialysis-dependent CKD using real-world data. Methods Data were collected in France, Germany, Italy, Spain, the UK, the USA and China in 2012–2018 in the Adelphi Real World Disease Specific Programme™ for CKD, a large, cross-sectional, survey of physicians and their patients. Patients completed three patient-reported outcomes (PRO) instruments: the EuroQol 5-Dimension 3-level (EQ-5D-3L), the Kidney Disease Quality of Life (KDQOL-36) instrument and the Work Productivity and Activity Impairment questionnaire. PROs were assessed by CKD stage and Hb levels, and regression analyses were performed with CKD stage and Hb level as independent variables and PROs as outcome variables, while adjusting for age, sex, CKD stage, comorbidities and cardiovascular risk. Results Overall, 5276 patients participated in the survey, including 28% stage 4 and 36% dialysis patients. Patients with lower Hb levels more often reported problems/issues on all EQ-5D-3L domains (p<0.0001). Regression analyses showed significant associations between lower Hb levels and the probability of low (<0.8) EQ-5D-3L utility scores (p<0.0001) and low visual analog scale scores (p<0.05), indicating poorer health status. Associations were seen even when adjusting for CKD stage and other potential confounding factors. Significant associations were observed between Hb level and the 12-Item Short-Form Health Survey (SF-12) Physical Component Summary, SF-12 Mental Component Summary and the three KDQOL-36 subscales (all p<0.0001), and were confirmed using linear regression analyses adjusting for CKD stage and other potential confounders. Numerically greater work productivity losses and greater activity impairment were observed with lower Hb levels. Conclusions Lower Hb levels worsen the impact of CKD on HRQoL, and are associated with lower work productivity in patients with CKD. Assessment and treatment of anemia should be recognized as a key component of integral CKD management throughout all stages of the disease.
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
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