Health-Related Quality of Life, Depressive Symptoms, and Kidney Transplant Access in Advanced CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Abstract Rationale & Objective Among individuals with chronic kidney disease (CKD), poor self-reported health is associated with adverse outcomes including hospitalization and death. We sought to examine the association between health-related quality-of-life (HRQOL) and depressive symptoms in late-stage CKD and subsequent access to the kidney transplant waiting list. Study Design Prospective cohort study. Setting & Population 1,676 Chronic Renal Insufficiency Cohort Study (CRIC) participants with an estimated glomerular filtration rate (eGFR) of ≤30 mL/min/1.73m2 at study entry or during follow-up. Exposures HRQOL, ascertained by five scales of the Kidney Disease Quality of Life-36 Survey (Physical Component Summary [PCS], Mental Component Summary, Symptoms, Burdens and Effects), with higher scores indicating better HRQOL, and depressive symptoms, ascertained by the Beck Depression Inventory (BDI). Outcomes Time to kidney transplant wait-listing and time to pre-emptive wait-listing. Analytic Approach Time-to-event analysis using Cox proportional hazards regression Results During a median follow-up of 5.1 years, 652 participants (39%) were wait-listed, of which 304 were pre-emptively wait-listed. Adjusted for demographics, comorbidities, eGFR slope and cognitive function, participants with the highest scores on the Burden and Effects scales, respectively, had lower rates of wait-listing than those with the lowest scores on the Burden (wait-listing adjusted Hazard Ratio [aHR] 0.70, 95% Confidence Interval [CI] 0.57-0.85, p Limitations Unmeasured confounders Conclusions Self-reported health in late-stage CKD may influence the timing of kidney transplantation.