October 28, 2022
2 min read
Symptom prevalence ranged among patients with non-dialysis chronic kidney disease, with 24% reporting chest pain and 83% reporting fatigue, according to data published in the Clinical Journal of the American Society of Nephrology.
Further, patients who reported worse symptoms at a worsening trajectory were at an increased risk for needing dialysis and of dying before starting.
“Other than the prevalence of symptoms, their classification into clusters, and their associated factors, we have limited knowledge about how symptoms evolve in patients with different stages of CKD,” Moustapha Faye, MD, from CHRU Nancy, Université Cheikh Anta Diop de Dakar, and colleagues wrote. They added, “For this purpose, we used longitudinal data from the French CKD-Renal Epidemiology and Information Network (CKD-REIN) cohort study to identify subgroups within the 5-year trajectories of symptom evolution in patients with CKD and to describe patient characteristics and outcomes in each subgroup identified.”
Using data from the CKD-REIN cohort study, researchers examined 2,787 patients with CKD in France who were not on dialysis and had an eGFR of less than 60 mL/min per 1.73 m2. Patients were enrolled in the CKD-REIN study between July 2013 and May 2016 and following enrollment, they completed an annual questionnaire regarding health-related-quality of life (QoL) and CKD symptoms. Symptoms recorded were muscle pain and soreness, chest pain, cramps, itchy skin, dry skin, shortness of breath, faintness and dizziness, lack of appetite, fatigue, numbness in hands or feet, nausea or upset stomach.
Faye and colleagues measured the symptoms reported by patients during this time and until December 2020 using the Kidney Disease Quality of Life-36 (KDQoL-36). Patients reported a total of 9,121 measures, and all patients had symptoms scored for at least one time point. To determine profiles of symptom trajectories, researchers utilized a joint latent class-mixed model.
Overall, 98% of patients reported experiencing at least one symptom. Further, 24% reported chest pain, 83% reported fatigue, 82% reported muscle pain and soreness, 72% reported cramps, 60% reported dry skin and 68% reported shortness of breath.
After a median of 5.3 years, 690 patients started kidney replacement therapy (KRT) and 490 died before starting. Researchers applied two profiles of symptom trajectories to patients. Thirty-one percent of patients fit the “worse symptom score and worsening trajectory,” and 69% fit the “better symptom score and stable trajectory.” Those in the worse symptom score showed more risk factors for CKD progression at baseline, worse QoL and a higher risk for KRT and death before KRT than other patients.
“In addition to the already existing classifications of CKD, it is possible to actively monitor symptoms and classify patients according to their progression. This monitoring should involve practitioners and patients,” Faye said in a press release. “This active symptom tracking will allow early therapeutic interventions to be planned to help manage different symptoms.”