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Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis

BACKGROUND: The importance of patient-reported outcome measurement in chronic kidney disease (CKD) populations has been established. However, there remains a lack of research that has synthesised data around CKD-specific symptom and health-related quality of life (HRQOL) burden globally, to inform f...

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Autores principales: Fletcher, Benjamin R., Damery, Sarah, Aiyegbusi, Olalekan Lee, Anderson, Nicola, Calvert, Melanie, Cockwell, Paul, Ferguson, James, Horton, Mike, Paap, Muirne C. S., Sidey-Gibbons, Chris, Slade, Anita, Turner, Neil, Kyte, Derek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8985967/
https://www.ncbi.nlm.nih.gov/pubmed/35385471
http://dx.doi.org/10.1371/journal.pmed.1003954
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author Fletcher, Benjamin R.
Damery, Sarah
Aiyegbusi, Olalekan Lee
Anderson, Nicola
Calvert, Melanie
Cockwell, Paul
Ferguson, James
Horton, Mike
Paap, Muirne C. S.
Sidey-Gibbons, Chris
Slade, Anita
Turner, Neil
Kyte, Derek
author_facet Fletcher, Benjamin R.
Damery, Sarah
Aiyegbusi, Olalekan Lee
Anderson, Nicola
Calvert, Melanie
Cockwell, Paul
Ferguson, James
Horton, Mike
Paap, Muirne C. S.
Sidey-Gibbons, Chris
Slade, Anita
Turner, Neil
Kyte, Derek
author_sort Fletcher, Benjamin R.
collection PubMed
description BACKGROUND: The importance of patient-reported outcome measurement in chronic kidney disease (CKD) populations has been established. However, there remains a lack of research that has synthesised data around CKD-specific symptom and health-related quality of life (HRQOL) burden globally, to inform focused measurement of the most relevant patient-important information in a way that minimises patient burden. The aim of this review was to synthesise symptom prevalence/severity and HRQOL data across the following CKD clinical groups globally: (1) stage 1–5 and not on renal replacement therapy (RRT), (2) receiving dialysis, or (3) in receipt of a kidney transplant. METHODS AND FINDINGS: MEDLINE, PsycINFO, and CINAHL were searched for English-language cross-sectional/longitudinal studies reporting prevalence and/or severity of symptoms and/or HRQOL in CKD, published between January 2000 and September 2021, including adult patients with CKD, and measuring symptom prevalence/severity and/or HRQOL using a patient-reported outcome measure (PROM). Random effects meta-analyses were used to pool data, stratified by CKD group: not on RRT, receiving dialysis, or in receipt of a kidney transplant. Methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data, and an exploration of publication bias performed. The search identified 1,529 studies, of which 449, with 199,147 participants from 62 countries, were included in the analysis. Studies used 67 different symptom and HRQOL outcome measures, which provided data on 68 reported symptoms. Random effects meta-analyses highlighted the considerable symptom and HRQOL burden associated with CKD, with fatigue particularly prevalent, both in patients not on RRT (14 studies, 4,139 participants: 70%, 95% CI 60%–79%) and those receiving dialysis (21 studies, 2,943 participants: 70%, 95% CI 64%–76%). A number of symptoms were significantly (p < 0.05 after adjustment for multiple testing) less prevalent and/or less severe within the post-transplantation population, which may suggest attribution to CKD (fatigue, depression, itching, poor mobility, poor sleep, and dry mouth). Quality of life was commonly lower in patients on dialysis (36-Item Short Form Health Survey [SF-36] Mental Component Summary [MCS] 45.7 [95% CI 45.5–45.8]; SF-36 Physical Component Summary [PCS] 35.5 [95% CI 35.3–35.6]; 91 studies, 32,105 participants for MCS and PCS) than in other CKD populations (patients not on RRT: SF-36 MCS 66.6 [95% CI 66.5–66.6], p = 0.002; PCS 66.3 [95% CI 66.2–66.4], p = 0.002; 39 studies, 24,600 participants; transplant: MCS 50.0 [95% CI 49.9–50.1], p = 0.002; PCS 48.0 [95% CI 47.9–48.1], p = 0.002; 39 studies, 9,664 participants). Limitations of the analysis are the relatively few studies contributing to symptom severity estimates and inconsistent use of PROMs (different measures and time points) across the included literature, which hindered interpretation. CONCLUSIONS: The main findings highlight the considerable symptom and HRQOL burden associated with CKD. The synthesis provides a detailed overview of the symptom/HRQOL profile across clinical groups, which may support healthcare professionals when discussing, measuring, and managing the potential treatment burden associated with CKD. PROTOCOL REGISTRATION: PROSPERO CRD42020164737.
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spelling pubmed-89859672022-04-07 Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis Fletcher, Benjamin R. Damery, Sarah Aiyegbusi, Olalekan Lee Anderson, Nicola Calvert, Melanie Cockwell, Paul Ferguson, James Horton, Mike Paap, Muirne C. S. Sidey-Gibbons, Chris Slade, Anita Turner, Neil Kyte, Derek PLoS Med Research Article BACKGROUND: The importance of patient-reported outcome measurement in chronic kidney disease (CKD) populations has been established. However, there remains a lack of research that has synthesised data around CKD-specific symptom and health-related quality of life (HRQOL) burden globally, to inform focused measurement of the most relevant patient-important information in a way that minimises patient burden. The aim of this review was to synthesise symptom prevalence/severity and HRQOL data across the following CKD clinical groups globally: (1) stage 1–5 and not on renal replacement therapy (RRT), (2) receiving dialysis, or (3) in receipt of a kidney transplant. METHODS AND FINDINGS: MEDLINE, PsycINFO, and CINAHL were searched for English-language cross-sectional/longitudinal studies reporting prevalence and/or severity of symptoms and/or HRQOL in CKD, published between January 2000 and September 2021, including adult patients with CKD, and measuring symptom prevalence/severity and/or HRQOL using a patient-reported outcome measure (PROM). Random effects meta-analyses were used to pool data, stratified by CKD group: not on RRT, receiving dialysis, or in receipt of a kidney transplant. Methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data, and an exploration of publication bias performed. The search identified 1,529 studies, of which 449, with 199,147 participants from 62 countries, were included in the analysis. Studies used 67 different symptom and HRQOL outcome measures, which provided data on 68 reported symptoms. Random effects meta-analyses highlighted the considerable symptom and HRQOL burden associated with CKD, with fatigue particularly prevalent, both in patients not on RRT (14 studies, 4,139 participants: 70%, 95% CI 60%–79%) and those receiving dialysis (21 studies, 2,943 participants: 70%, 95% CI 64%–76%). A number of symptoms were significantly (p < 0.05 after adjustment for multiple testing) less prevalent and/or less severe within the post-transplantation population, which may suggest attribution to CKD (fatigue, depression, itching, poor mobility, poor sleep, and dry mouth). Quality of life was commonly lower in patients on dialysis (36-Item Short Form Health Survey [SF-36] Mental Component Summary [MCS] 45.7 [95% CI 45.5–45.8]; SF-36 Physical Component Summary [PCS] 35.5 [95% CI 35.3–35.6]; 91 studies, 32,105 participants for MCS and PCS) than in other CKD populations (patients not on RRT: SF-36 MCS 66.6 [95% CI 66.5–66.6], p = 0.002; PCS 66.3 [95% CI 66.2–66.4], p = 0.002; 39 studies, 24,600 participants; transplant: MCS 50.0 [95% CI 49.9–50.1], p = 0.002; PCS 48.0 [95% CI 47.9–48.1], p = 0.002; 39 studies, 9,664 participants). Limitations of the analysis are the relatively few studies contributing to symptom severity estimates and inconsistent use of PROMs (different measures and time points) across the included literature, which hindered interpretation. CONCLUSIONS: The main findings highlight the considerable symptom and HRQOL burden associated with CKD. The synthesis provides a detailed overview of the symptom/HRQOL profile across clinical groups, which may support healthcare professionals when discussing, measuring, and managing the potential treatment burden associated with CKD. PROTOCOL REGISTRATION: PROSPERO CRD42020164737. Public Library of Science 2022-04-06 /pmc/articles/PMC8985967/ /pubmed/35385471 http://dx.doi.org/10.1371/journal.pmed.1003954 Text en © 2022 Fletcher et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Fletcher, Benjamin R.
Damery, Sarah
Aiyegbusi, Olalekan Lee
Anderson, Nicola
Calvert, Melanie
Cockwell, Paul
Ferguson, James
Horton, Mike
Paap, Muirne C. S.
Sidey-Gibbons, Chris
Slade, Anita
Turner, Neil
Kyte, Derek
Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis
title Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis
title_full Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis
title_fullStr Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis
title_full_unstemmed Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis
title_short Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis
title_sort symptom burden and health-related quality of life in chronic kidney disease: a global systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8985967/
https://www.ncbi.nlm.nih.gov/pubmed/35385471
http://dx.doi.org/10.1371/journal.pmed.1003954
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