Original Investigations: Pathogenesis and Treatment of Kidney Disease and Hypertension
Health-related quality of life in Australian adults with renal insufficiency: A population-based study*,**,*

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Abstract

Background: Health-related quality of life is increasingly recognized as an important outcome in clinical research and patient care. Although there are a large number of reports of quality of life in the setting of end-stage renal disease, the impact of lesser degrees of renal impairment in the general population has not been described. Methods: Data relating to quality of life measured by the Medical Outcomes Study 36-Item Short Form (SF-36) was available for 10,525 participants (93.6%) of the Australian Diabetes, Obesity and Lifestyle Study, a randomly selected representative sample of the Australian population aged 25 years or older. Results are examined by category of renal function (Cockcroft-Gault estimated glomerular filtration rate: normal, ≥60 mL/min/1.73 m2; renal insufficiency, <60 mL/min/1.73 m2). Results: Significant impairment in health-related quality of life was seen with renal insufficiency for all SF-36 scales except Vitality and Mental Health. Adjusting for the substantial comorbidity associated with renal insufficiency, scores for Physical Functioning, Role-Physical, General Health, Vitality, and Role-Emotional were significantly lower. Examination of age-specific effects on health-related quality of life showed that mental health was particularly impaired in the younger age group, and Physical Functioning, in the older age group with renal insufficiency. Patterns of impairment were similar in men and women. Conclusion: Results from this study indicate that the current emphasis on clinical interventions aimed at preserving renal function are likely to improve the negative impact of kidney disease on health-related quality of life; however, prospective studies are needed to confirm these findings. Am J Kidney Dis 41:596-604. © 2003 by the National Kidney Foundation, Inc.

Section snippets

Survey methods

The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) was a nationally representative population-based survey undertaken between May 1999 and December 2000 to determine the prevalence of diabetes mellitus, obesity, and cardiovascular disease risk factors in people 25 years and older. Information on kidney function and indicators of kidney disease also were collected. Details of survey methods have been published elsewhere.8 In short, survey design was based on a stratified cluster

Participants

Of 20,257 eligible people contacted for participation in the AusDiab, 11,247 people (55.3%) attended the physical examination. Information relating to glomerular filtration rate and the SF-36 was available for 10,525 participants (93.6%).

Mean glomerular filtration rate for the population was 85.6 mL/min/1.73 m2 (95% confidence interval, 83.6 to 87.6) and ranged from 9.4 to 193.0 mL/min/1.73 m2. Glomerular filtration rate was less than 60 mL/min/1.73m2 in 11.2% (95% confidence interval, 8.6% to

Discussion

This is the first population-based report that examines effects of renal impairment on health-related quality of life among adults. Moderate renal insufficiency affects both physical and mental components of health-related quality of life, even after accounting for the high burden of associated comorbid disease, indicating that renal insufficiency itself contributes to the observed impairment in health-related quality of life. A differential effect of age is seen, with the largest effect of

Acknowledgements

The authors thank the participants, Survey Team, and Steering Committee of the AusDiab Study.

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    *

    The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) was supported by the Commonwealth Department of Health and Aged Care; State Governments of Queensland, South Australia, Tasmania, Western Australia, and Victoria; Territory Health Services; the Australian Kidney Foundation; Diabetes Australia (Northern Territory); International Diabetes Institute; Eli Lilly (Australia); Janssen-Cilag (Australia); Knoll Australia; Merck Lipha sa Alphapharm; Merck Sharp & Dohme (Australia); Pharmacia and Upjohn; Roche Diagnostics; Servier Laboratories (Australia); SmithKline Beecham Int; BioRad Laboratories; HITECH Pathology; and Qantas Airways.

    **

    Address reprint request to Esther Briganti, MBBS, MClinEpi, Department of Epidemiology and Preventive Medicine, Central and Eastern Clinical School, Alfred Hospital, Commercial Rd, Prahran 3181, Australia. E-mail: [email protected]

    *

    0272-6386/03/4103-0008$30.00/0

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