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PubMed ID:
35246460
Public Release Type:
Journal
Publication Year: 2022
Affiliation: 1 Nephrology Division, Massachusetts General Hospital, Boston, Massachusetts
2 Department of Medicine, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
3 Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
4 Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
5 Department of Population Health, Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS
6 Department of Physiology and Biophysics, University of Mississippi Medical Center School of Medicine, Jackson, MS
DOI:
https://doi.org/10.1080/01605682.2022.2118630
Authors:
Wulczyn KE,
Zhao SH,
Rhee EP,
Kalim S,
Shafi T
Request IDs:
23104
Studies:
Chronic Renal Insufficiency Cohort Study
Background and objectives: Uremic symptoms, including fatigue, anorexia, pruritus, nausea, paresthesia, and pain, are attributed to the accumulation of organic waste products normally cleared by the kidneys, but whether kidney function is the primary driver of changes in symptom severity over time is not known. The goal of our study was to evaluate the association between changes in kidney function and changes in uremic symptom severity in patients with chronic kidney disease (CKD). Design, setting, participants, and measurements: We identified 3,504 participants with CKD not on dialysis in the prospective, observational Chronic Renal Insufficiency Cohort (CRIC) Study with at least two measurements of estimated glomerular filtration rate (eGFR) and uremic symptom severity, assessed by separate questions on the Kidney Disease Quality of Life-36 instrument (0- to 100-point scale). The longitudinal association between changes in eGFR and uremic symptom severity was examined employing linear mixed effects models with random intercepts and random slopes, using backwards stepwise selection to identify significant covariates. Results: The most prevalent symptoms at baseline were pain (56%), fatigue (51%), paresthesia (44%), and pruritus (41%). In fully adjusted models, there was a non-linear association between change in eGFR and change in uremic symptom severity (P<0.01). A decrease in eGFR of 5 mL/min/1.73 m2 per year was associated with a worsening of the symptom severity score by only 1.5 points or less for each uremic symptom. Greater symptom severity at the baseline visit, presence of depressive symptoms, polypharmacy, and use of antidepressants or opioids were significantly associated with increased uremic symptom severity. Conclusions: Our data demonstrate a high prevalence of uremic symptoms in CKD, but marked declines in eGFR are associated with clinically insignificant worsening of uremic symptoms. These findings suggest that eGFR may not capture all facets of solute clearance and that factors other than eGFR may have a greater impact on patients’ perception of uremic symptoms.
