Health-related quality-of-life differences in men and women with advanced kidney disease

In a CJASN study of older men and women with advanced kidney disease, women had lower health-related quality of life at the start, but men experienced a more rapid decline over time.

To examine differences in physical and mental aspects of quality of life in older men and women with chronic kidney disease (CKD), Nicholas C. Chesnaye, Ph.D. (Amsterdam Public Health Research Institute) and his colleagues analyzed questionnaire responses from the European QUALity Study on treatment in advanced CKD (EQUAL). This study included patients aged 65 years and older with advanced CKD not on dialysis who were receiving routine medical care in Germany, Italy, the Netherlands, Poland, Sweden, and the United Kingdom.

"It is increasingly being accepted that the patient's health-related quality of life is as equally important as other clinical outcomes when assessing a patient's health status," said Dr. Chesnaye. "Very few studies have investigated the interdependence of health-related quality of life and sex over time in older patients with advanced CKD. CKD is highly prevalent in this age group, and given the rising life expectancy, efforts to improve health-related quality of life in the elderly should remain in focus."

Responses from 1,421 patients revealed that at the start of the study, women had considerably lower average physical and mental health scores compared with men. During follow-up, however, both physical and mental scores declined approximately twice as fast in men than in women.

This difference was partly lessened after adjusting for factors such as kidney function decline (suggesting an explanatory role for decreasing kidney function, which occurred at a faster rate in men in the study). Higher phosphate and lower hemoglobin levels in the blood and the presence of pre-existing diabetes were associated with lower physical and mental scores in men, but to a lesser extent in women.

"An understanding of sex-specific health-related quality of life over the course of pre-dialysis CKD, as well as the potential mechanisms underlying any differences, may provide insights into a patient's health and needs, and aid sex-specific clinical monitoring, decisions related to kidney replacement therapy, and patient-centered care," said Dr. Chesnaye.

The article is titled "Health-Related Quality-of-Life Trajectories over Time in Older Men and Women with Advanced Chronic Kidney Disease."