S CHAN1, C CAO1, E PASCOE2,3, D JOHNSON1,2,3, A SHAH3,4,5, G HOLTMANN3,4,5, S CAMPBELL1,2,3, R FRANCIS1,2,3, N ISBEL1,2,3, C HAWLEY1,2,3
1Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia, 2Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia, 3Translational Research Institute, Brisbane, Australia, 4Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia, 5The University of Queensland, Faculty of Medicine, and Faculty of Health and Behavioural Sciences, Brisbane, Australia
Background: There has been limited study of the prevalence of gastrointestinal symptoms and their impact on the quality of life (QOL) in kidney transplant recipients (KTR). The aim of this study was to examine the prevalence and predictors of gastrointestinal symptoms and the association with QOL in KTR.
Methods: All chronic KTR at the Princess Alexandra Hospital were provided with three questionnaires, the Gastrointestinal Quality of Life Index (GIQLI), the Gastrointestinal Symptoms Rating Scale (GSRS) and Structured Assessment of Gastrointestinal Symptoms (SAGIS) scale to ascertain quality of life impairment and to screen gastrointestinal symptom severity. Linear regression was used to determine the predictors of gastrointestinal quality of life and gastrointestinal symptom severity.
Results: Of the 343 participants, the median age was 47 (interquartile range [IQR 36-55) years, 58% were males, 79% were Caucasian, 39% had chronic glomerulonephritis, 83% had received their first graft, and median time since transplant was 6.3 (IQR 1.8-13.1) years. Using GSRS, 88% of participants reported at least one gastrointestinal symptom, most commonly indigestion (57%) and diarrhoea (54%). Using GIQLI, 42% and 38% of participants reported mild and moderate QOL impairment, respectively. Gastrointestinal symptoms were predicted by female sex (coefficient -0.11, 95% CI -0.21 to -0.02) and mycophenolate (co-efficient 0.0001, 95% 0.0001 to 0.0002), and were associated with poorer QOL (co-efficient -0.38, 95% CI -0.45 to -0.30). Similar findings were observed using SAGIS for gastrointestinal symptoms.
Conclusions: Gastrointestinal symptoms are frequent in KTR, particularly in females and those receiving mycophenolate, and are strongly associated with poorer QOL.
Samuel Chan is a nephrologist and PhD candidate working at the Princess Alexandra Hospital, Brisbane. His PhD is supported by the NHMRC postgraduate scholarship, and is centred around investigating and managing infections in kidney transplantation recipients.