Characterizing the relationship between health utility and renal function after kidney transplantation in UK and US: a cross-sectional study

Health and Quality of Life Outcomes

Kesh Baboolal³  Karin Sennfält⁴  Phil McEwan¹  Luca Neri² 

[1] Cardiff Research Consortium, Cardiff, United Kingdom;Dipartimento di Medicina del Lavoro, “L. Devoto”, quarto piano, Via San Barnaba, 8, Milano, Italy;University Hospital of Wales Heath Park, Cardiff, United Kingdom;HEOR Europe, Bristol-Myers Squibb, Rueil-Malmaison, Paris, France

关键词: I18;    Self-reported outcomes;    Kidney function;    Quality-adjusted life years;    Chronic kidney disease;    Kidney transplantation;   

Others  :  824874
DOI  :  10.1186/1477-7525-10-139

 received in 2012-06-15, accepted in 2012-09-26,  发布年份 2012

【 摘 要 】

Background

Chronic allograft nephropathy (CAN) occurs in a large share of transplant recipients and it is the leading cause of graft loss despite the introduction of new and effective immunosuppressants. The reduction in renal function secondary to immunologic and non-immunologic CAN leads to several complications, including anemia and calcium-phosphorus metabolism imbalance and may be associated to worsening Health-Related Quality of Life. We sought to evaluate the relationship between kidney function and Euro-Qol 5 Dimension Index (EQ-5D_index) scores after kidney transplantation and evaluate whether cross-cultural differences exist between UK and US.

Methods

This study is a secondary analysis of existing data gathered from two cross-sectional studies. We enrolled 233 and 209 subjects aged 18–74 years who received a kidney transplant in US and UK respectively. For the present analysis we excluded recipients with multiple or multi-organ transplantation, creatinine kinase ≥200 U/L, acute renal failure, and without creatinine assessments in 3 months pre-enrollment leaving 281 subjects overall. The questionnaires were administered independently in the two centers. Both packets included the EQ-5D_index and socio-demographic items. We augmented the analytical dataset with information abstracted from clinical charts and administrative records including selected comorbidities and biochemistry test results. We used ordinary least squares and quantile regression adjusted for socio-demographic and clinical characteristics to assess the association between EQ-5D_index and severity of chronic kidney disease (CKD).

Results

CKD severity was negatively associated with EQ-5D_index in both samples (UK: ρ= −0.20, p=0.02; US: ρ= −0.21, p=0.02). The mean adjusted disutility associated to CKD stage 5 compared to CKD stage 1–2 was Δ= −0.38 in the UK sample, Δ= −0.11 in the US sample and Δ= −0.22 in the whole sample. The adjusted median disutility associated to CKD stage 5 compared to CKD stage 1–2 for the whole sample was 0.18 (p<0.01, quantile regression). Center effect was not statistically significant.

Conclusions

Impaired renal function is associated with reduced health-related quality of life independent of possible confounders, center-effect and analytic framework.

【 授权许可】

   
2012 Neri et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]U.S. Renal Data System. Chapter VII, Transplantation. USRDS 2005: Annual Data Report: Atlas of End-Stage Renal Disease in the United States,National Institutes of Health. Bethesda: National Institute of Diabetes and Digestive and Kidney Diseases; 2005. http://www.usrds.org/atlas05.aspx webcite
• [2]Webb L, Casula A, Ravanan R, Tomson CRV: UK renal registry 2009. 12th Annual report of the renal association, chapter 5. Nephron Clin Pract 2010, 115(1):c117-c144.
• [3]U.S. Renal Data System. Reference Table: Transplant Outcomes. USRDS: Annual Data Report: Atlas of End-Stage Renal Disease in the United States,National Institutes of Health. Bethesda: National Institute of Diabetes and Digestive and Kidney Diseases; 2006.
• [4]Ansell D, Roderick P, Steenkamp R, Tomson CRV: UK renal registry 2009. 12th Annual report of the renal association, chapter 7. Nephron Clin Pract 2010, 115(1):c117-c144.
• [5]Joostene SA, Sijpkens IWJ, Van Kooten C, Paul LC: Chronic renal allograft rejection: pathophysiologic considerations. Kidney Int 2005, 68:1-13.
• [6]Burdmann EA, Andoh TF, Yu L, Bennett WM: Cyclosporine nephrotoxicity. Semin Nephrol 2003, 23(5)):465.
• [7]Miller LW: Cardiovascular toxicities of immunosuppressive agents. Am J Transplant 2002, 2(9):807.
• [8]Nankivell BJ, Borrows RJ, Fung CL, O'Connell PJ, Allen RD, Chapman JR: The natural history of chronic allograft nephropathy. N Engl J Med 2003, 349(24):2326.
• [9]Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK: Long-term survival in renal transplant recipients with graft function. Kidney Int 2000, 57(1):307.
• [10]Neri L, Dukes J, Brennan DC, Salvalaggio PR, Seelam S, Desiraju S, Schnitzler M: Impaired renal function is associated with worse self-reported outcomes after kidney transplantation. Qual Life Res 2011, 20(10):1689-1698. Apr 11, 2011. [Epub ahead of print]
• [11]Kopec JA, Williams JI, To T, Austin PC: Cross-cultural comparisons of health status in Canada using the health utilities index. Ethn Health 2001, 6(1):41-50.
• [12]Buck D, Jacoby A, Baker GA, Ley H, Steen N: Cross-cultural differences in health-related quality of life of people with epilepsy: findings from a european study. Qual Life Res 1999, 8(8):675-685.
• [13]de Haes JCJM, Olschewski M: Quality of life assessment in a cross-cultural context: use of the rotterdam symptom checklist in a multinational randomised trial comparing cmf and zoladex (goserlin) treatment in early breast cancer. Ann Oncol 1998, 9:745-750.
• [14]Cleemput I, et al.: The construct and concurrent validity of the EQ-5D in a renal transplant population. Value Health 2004, 7(4):499-509.
• [15]Shaw JW, Johnson JA, Coons SJ: US valuation of the eq-5d health states: development and testing of the D1 valuation model. Medical Care 2005, 43(3):203-220.
• [16]Dolan P: Modeling valuation for EuroQol health states. Medical Care 1997, 35:1095-1108.
• [17]Hsu CY: Clinical evaluation of kidney function. 4th ed. Primer on kidney disease, ed. A. Greenberg. Philadelphia: Elsevier-Saunders; 2005:20-24.
• [18]Quan H, et al.: Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005, 43:1130-1139.
• [19]Li B, Evans D, Faris P, Dean S, Quan H: Risk adjustment performance of charlson and elixhauser comorbidities in ICD-9 and ICD-10 administrative databases. Bmc Health Serv Res 2008, 8:12. BioMed Central Full Text
• [20]Duan N: Smearing estimate: a nonparametric retransformation method. J Am Stat Assoc 1983, 78(383):605-610.
• [21]Austin PC: A comparison of methods for analyzing health related quality-of-life measures. Value Health 2002, 5:329-337.
• [22]Koenker R, Hallock KF: Quantile regression. J Econ Perspect 2001, 15(4):143-156.
• [23]Walters SJ, Brazier JE: What is the relationship between the minimally important difference and health state utility values? the case of the SF-6D. Health Qual Life Outcomes 2003., 1(4)
• [24]Franks P, Hanmer J, Fryback DG: Relative disutilities of 47 risk factors and conditions assessed with seven preference-based health status measures in a national U.S. sample: toward consistency in cost-effectiveness analyses. Med Care 2006, 44(5):478-485.
• [25]Horsman J, Furlong W, Feeny D, Torrance GW: The health utility index (HUI): concepts, measurement, properties and applications. Health Qual Life Outcomes 2003, 1:54. BioMed Central Full Text
• [26]Gorodetskaya I, et al.: Health-related quality of life and estimates of utility in chronic kidney disease. Kidney Int 2005, 68(6):2801-2808.
• [27]Peterson JJ, Lowe JB, Peterson NA, Janz KF: The relationship between active living and health-related quality of life: income as a moderator. Health Educ Res 2006, 21(1):146-156.
• [28]Wiczinski E, Döring A, John J, von Lengerke T, KORA Study Group: Obesity and health-related quality of life: does social support moderate existing associations? Br J Health Psychol 2009, 14(4):717-734.
• [29]Pedersen SS, Denollet J: Type d personality, cardiac events, and impaired quality of life: a review. Eur J Cardiovasc Prev Rehabil 2003, 10:241-248.
• [30]Devins GM, Bezjak A, Mah K, Loblaw DA, Gotowiec AP: Context moderates illness-induced lifestyle disruptions across life domains: a test of the illness intrusiveness theoretical framework in six common cancers. Psychooncology 2006, 15(3):221-233.
• [31]Ansell D, Udayaraj UP, Steenkamp R, Dudley CR: Chronic renal failure in kidney transplant recipients. do they receive optimum care? data from the UK renal registry. Am J Transplant 2007, 7(5):1167-1176. Epub 2007 Mar 12
• [32]Caskey FJ, Schober-Halstenberg HJ, Roderick PJ, Edenharter G, Ansell D, Frei U, Feest TG: Exploring the differences in epidemiology of treated ESRD between Germany and England and Wales. Am J Kidney Dis 2006, 47(3):445-454.