Predialysis chronic kidney disease: Evaluation of quality of life in clinic patients receiving comprehensive anemia care

Background: Anemia is common in chronic kidney disease (CKD), and suboptimal management of anemia can lead to serious health complications and poor quality of life (QOL). Objectives: (1) To describe health-related and overall QOL among patients entering a clinic focused on anemia management; (2) to compare their baseline QOL with other relevant populations; (3) to explore predictors of QOL before anemia management; and (4) to explore changes in QOL over 1 year for patients managed in the clinic. Methods: The Kidney Disease Quality of Life questionnaire-short form (KDQOL-SF (TM), Rand Corporation, Santa Monica, CA) was used to measure kidney disease specific and overall QOL in a cohort of predialysis CKD patients (n = 79) enrolled in the clinic from January 2003 to September 2004. Baseline measures were compared to previously published measurements. The influence of demographic and clinical characteristics on baseline QOL was explored. Changes in QOL were evaluated over time. Results: Patients with CKD entering the clinic had lower overall QOL compared with estimates from the general U.S. population (physical composite 35.7 vs 48.4 and mental composite 46.0 vs 50.2, respectively). Clinic patients had better kidney disease-specific scores than patients with end-stage kidney disease (ESRD). General QOL scores were similar regardless of kidney disease severity, with the exception of physical functioning which was lowest for patients with end-stage disease. Hemoglobin was the only factor predictive of QOL. Over time, QOL improved among patients managed in the CKD clinic, with statistically significant improvements in sleep (change of 6.2 +/- 15.2; P < .05) and social function (change of 11.6 +/- 27.7; P < .05). Conclusions: Patients with anemia of CKD reported reduced QOL compared to Populations Without kidney disease, but better QOL compared to populations with ESRD on dialysis. QOL generally improved among patients managed in the multidisciplinary anemia clinic. (C) 2009 Elsevier Inc. All rights reserved.