Gender Differences for Health-Related QOL Detected Among Patients With Advanced Kidney Disease

Despite women with chronic kidney disease (CKD) presenting with a lower health-related quality of life at the onset of a recent study, men were found to have their quality of life decline more rapidly over time, investigators concluded.

Although the study, published in the Clinical Journal of the American Society of Nephrology, showed declines in in physical and mental aspects of quality of life in both men and women diagnosed with advanced kidney disease, it revealed the stark differences in the speed at which the declines may occur.

“It is increasingly being accepted that the patient's health-related quality of life is as equally important as other clinical outcomes when assessing a patient’s health status….Very few studies have investigated the interdependence of health-related quality of life and sex over time in older patients with advanced CKD. CKD is highly prevalent in this age group, and given the rising life expectancy, efforts to improve health-related quality of life in the elderly should remain in focus,” said Nicholas Chesnaye, PhD, the lead study author from the Amsterdam Public Health Research Institute, in a statement.

The researchers analyzed responses to questionnaires collected as part of the European Quality Study on treatment in patients with advanced CKD, which included patients aged 65 years and older with advanced CKD who were not receiving hemodialysis therapy. The patients had to be receiving routine medical care in Germany, Italy, the Netherlands, Poland, Sweden, or the United Kingdom.

Responses from 1421 patients were utilized in the analysis. At baseline, women were reported to have considerably lower physical and mental health scores on average compared with their male counterparts. However, during the follow-up period, the investigators found that the physical (2.5 per year; 95% CI, 1.8-3.1) and mental (2.7 per year; 95% CI, 2.0-3.4) scores for men declined about twice as fast compared with women (physical: 1.1 per year; 95% CI, 0.1 to 2.0; mental: 1.6 per year; 95% CI, 0.7 to 2.6).

After adjusting for confounding factors, including kidney function decline, the differences were lessened somewhat, suggesting that the faster declines in men could be explained by gender differences. The association between men and women remained when adjusting for potential informative censoring due to mortality (23% vs 22%, respectively) or dialysis initiation (38% vs 31%, respectively).

Higher phosphate levels and lower hemoglobin levels were found to have an association with lower physical and mental scores in men. Additionally, pre-existing diabetes was associated with lower scores in men. These associations were also detected in women but to a lesser extent.

“An understanding of sex-specific health-related quality of life over the course of pre-dialysis CKD, as well as the potential mechanisms underlying any differences, may provide insights into a patient’s health and needs, and aid sex-specific clinical monitoring, decisions related to kidney replacement therapy, and patient-centered care,” said Chesnaye.

Reference

Chesnaye NC, Meuleman Y, de Rooji ENM, et al. Health-related quality-of-life trajectories over time in older men and women with advanced chronic kidney disease. Clin J Am Soc Nephrol. January 24, 2022;17(1): doi: 10.2215/CJN.08730621