Self-rated health, quality of life and appetite as predictors of initiation of dialysis and mortality in patients with chronic kidney disease stages 4-5: A prospective cohort study

Abstract

Objective: Patient-reported health status, including symptom burden, functional status and quality of life, are important measures of health in patients with chronic kidney disease. We aimed to investigate patient-reported outcomes (PRO) on self-rated health, appetite, quality of life and their associations with clinical outcomes. We conducted a prospective observational cohort study. Data was collected at baseline using a PRO questionnaire. The primary outcomes were initiation of dialysis, transplantation and mortality. Kaplan-Meier curves and multivariable Cox proportional hazards regression analyses were used. Results: A total of 126 patients with chronic kidney disease with an eGFR of ≤ 25 mL/min/1.73 m2 were followed for a median of 321 (range 10-523) days. Poor appetite was associated with mortality (hazard ratio 20.9, 95% CI 3.7-129.8). Initiation of dialysis was associated with low self-rated health (hazard ratio 5.2, 95% CI 1.2-24.0). Mean decline in estimated glomerular filtration rate was - 0.9 mL/min/1.73 m2 (95% CI - 1.6 to - 0.2). Decline in self-rated health (p = 0.001) and appetite (p = 0.002) were correlated with reduction in renal function.