M WYLD1,2, RL MORTON3, K POLKINGHORNE4, S CHADBAN1,2
1Royal Prince Alfred Hospital, Camperdown, Australia, 2Sydney Medical School, University of Sydney, Sydney, Australia, 3NHMRC Clinical Trials Centre, University of Sydney, Australia, 4Monash Medical Centre and Monash University, , Australia
Aim: To explore how diabetes and chronic kidney disease (CKD) interact to influence quality-of-life in a community-based setting.
Background: Quality-of-life is an important outcome for clinical care. Both CKD and diabetes are associated with poorer quality-of-life. Less well understood is the joint impact of both diseases.
Methods: A prospective, longitudinal cohort study of community-based Australians aged ≥25yr who participated in the Australian Diabetes, Obesity and Lifestyle study. Quality-of-life was measured by SF-36 its physical(PCS) and mental(MCS) sub-scores. Univariate and multivariate linear mixed effect regressions were performed.
Results: Of the 11,247 participants at baseline 841 had CKD, 737 had diabetes and 271 had both. Those with both had significantly lower PCS (mean PCS 38(±12) compared to 44(±11) for CKD, and 45(±11) for diabetes (p<0.001)). We found the combined impact of both diseases is greater for those with eGFR >60(p=0.04). There was no difference in MCS between groups (mean MCS 50(±10) for all). The PCS components most impaired for those with CKD and diabetes (compared with either disease alone) were physical functioning and vitality (p<0.001 for both). Those with diabetes at baseline who subsequently developed CKD had lower baseline PCS than those who did not (difference in PCS of -3.8(95%CI:-0.9,-6.8,p=0.01). In our adjusted linear mixed effects models, baseline PCS was lower for those with both CKD and diabetes compared to either disease alone(p<0.001). Follow-up data was suggestive of a more rapid decline in PCS in this population, however lacked power to detect a significant difference.
Conclusions: The combination of CKD and diabetes has a powerful adverse impact on quality-of-life, and participants with both diseases had significantly poorer quality-of-life than those with just one condition.
Melanie Wyld is a renal advanced trainee and PhD candidate at Royal Prince Alfred Hospital in Sydney, Australia. She has an MBBS, MPH and B.Economics (Hons 1 and University Medal) from the University of Sydney, Australia and an MBA from Stanford University, USA.