Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: analysis of multinational real-world data
Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: analysis of multinational real-world data
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DOI：
10.1186/s12882-020-01746-4
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发表时间：
2020-03-07
期刊：
影响因子：
2.3
通讯作者：
Moon, Rebecca
中科院分区：
文献类型：
--
作者：
van Haalen, Heleen;Jackson, James;Moon, Rebecca
背景慢性肾脏病（CKD）患者的健康相关生活质量（HRQoL）降低被认为是由低血红蛋白（Hb）水平加剧的，低血红蛋白（Hb）水平定义了贫血，这是CKD的常见并发症。当前分析使用真实世界数据评价了贫血对非透析依赖性和透析依赖性CKD患者HRQoL和工作效率的影响。方法2012-2018年在法国、德国、意大利、西班牙、英国、美国和中国的Adelphi真实的世界CKD疾病特异性计划（TM）中收集数据，这是一项针对医生及其患者的大型横断面调查。患者完成了三个患者报告结局（PRO）工具：EuroQol五维3水平（EQ-5D-3 L）、肾脏疾病生活质量（KDQOL-36）工具和工作效率和活动障碍问卷。通过CKD分期和Hb水平评估PRO，并以CKD分期和Hb水平为自变量，PRO为结局变量进行回归分析，同时调整年龄、性别、CKD分期、合并症和心血管风险。结果共有5276例患者参与了调查，其中包括28%的4期患者和36%的透析患者。Hb水平较低的患者更常报告所有EQ-5D-3 L领域的问题/问题（p < 0.0001）。回归分析显示，较低的Hb水平与低（< 0.8）EQ-5D-3 L效用评分（p < 0.0001）和低视觉模拟量表评分（p < 0.05）的概率之间存在显著相关性，表明健康状况较差。即使调整CKD分期和其他潜在混杂因素，也观察到相关性。观察到Hb水平与12项健康调查简表（SF-12）身体健康总评、SF-12精神健康总评和3个KDQOL-36分量表之间存在显著相关性（所有p < 0.0001），并使用线性回归分析对CKD分期和其他潜在混杂因素进行了调整。数值更大的工作效率损失和更大的活动障碍，观察到较低的血红蛋白水平。结论较低的Hb水平加重了CKD对HRQoL的影响，并与CKD患者的工作效率降低有关。贫血的评估和治疗应被视为CKD所有阶段综合管理的关键组成部分。
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 (TM) 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-3 L), 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-3 L domains (p < 0.0001). Regression analyses showed significant associations between lower Hb levels and the probability of low (< 0.8) EQ-5D-3 L 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.