Researchers have discovered that one-third of people with various degrees of chronic renal disease who were not receiving dialysis who responded to annual questionnaires about their symptoms may be labelled as having a ‘Worse symptom score and deteriorating trajectory’ of symptoms. These patients had particularly significant risks of subsequently needing dialysis and of passing away before starting treatment, as reported in CJASN.
The Kidney Disease Quality of Life-36 questionnaire was completed by 2,787 persons in France who had CKD but weren’t receiving dialysis for the study by Moustapha Faye, MD (CHRU Nancy, Universite Cheikh Anta Diop de Dakar), and his colleagues. 98 per cent of participants reported experiencing at least one symptom, with the prevalence of each symptom ranging from 24 per cent (chest discomfort) to 83 per cent (fatigue). 690 people began kidney replacement therapy (KRT), such as dialysis, after a median follow-up of 5.3 years, while 490 participants passed away before KRT.
The team found two types of symptom trajectory profiles: a ‘worse symptom score and worsening trajectory’ in 31 per cent of participants, which was defined by a low initial symptom score that got worse by more than 10 points (on a scale of 0-100) over time, and a ‘better symptom score and stable trajectory’ in 69 per cent of participants, which was defined by a high initial score that stayed stable over time.
Participants in the ‘Worse symptom score and worsening trajectory’ category had more risk factors for CKD progression at baseline, worse quality of life, and a higher risk of KRT and death before KRT than other participants. ‘In addition to the existing classifications of CKD, it is possible to monitor symptoms actively and classify patients according to their progression. This monitoring should involve practitioners and patients,’ said Dr Faye. ‘This active symptom tracking will allow early therapeutic interventions to be planned to help manage different symptoms.’
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