When people with varying degrees of chronic kidney disease who were not on dialysis answered annual questionnaires about their symptoms, the researchers found that one-third could be classified as having a “worsening symptom score and worsening trajectory” of symptoms. As reported in CJASN, these patients were at particularly high risk of requiring further dialysis and of dying before the start of dialysis.
For the study, Moustapha Faye, MD (CHRU Nancy, Université Cheikh Anta Diop de Dakar) and colleagues, investigators of the CKD-REIN cohort study, assessed symptoms annually using the Quality of Life Questionnaire life of kidney disease-36 which was completed by 2,787. adults in France with CKD who were not on dialysis.
The prevalence of each symptom ranged from 24% (chest pain) to 83% (fatigue) and 98% of participants reported at least one symptom. After a median follow-up of 5.3 years, 690 participants started renal replacement therapy (KRT) such as dialysis, and 490 died before KRT. The team identified two profiles of symptom trajectories: a “Worse symptom score and worsening trajectory” in 31% of participants, characterized by a low baseline symptom score that worsened by more than 10 points (on a scale 0 to 100) over time, and a “Better Symptom Score and Stable Trajectory” in 69% of participants, characterized by a high initial score that remained stable over time.
Participants in the “Worse symptom score and worsening trajectory” category had more risk factors for CKD progression at baseline, worse quality of life, and a higher risk of CRT and death before CRT than other participants .
In addition to already existing classifications of CKD, it is possible to actively monitor symptoms and classify patients according to their progression. This follow-up must involve professionals and patients. This active monitoring of symptoms will allow early therapeutic interventions to be planned to help manage different symptoms.”
Dr. Moustapha Faye, MD (CHRU Nancy, Cheikh Anta Diop University of Dakar)
An accompanying editorial notes that “in addition to disease management, Faye et al. provide further evidence for the need to care for the unpleasant symptoms that cause suffering and affect the well-being of patients with advanced CKD.”
Source:
American Society of Nephrology
Journal reference:
Faye, M. et al. (2022) Five-year symptom trajectories in non-dialysis-dependent CKD patients. Clinical Journal of the American Society of Nephrology. doi.org/10.2215/CJN.06140522.