A Study on the Impact of Anaemia on Quality of Life of Patients with Chronic Kidney Disease in a Tertiary Care Hospital

Abstract

Introduction:  Chronic kidney disease is defined as a kidney damage for >3 months as defined by structural or functional abnormalities of the kidney, with or without decreased GFR manifested by either pathological abnormalities or markers of kidney damage including abnormalities in the composition of the blood or urine or abnormalities in the imaging tests. The kidney damage can result from various factors: Diabetes mellitus, Hypertension, Glomerulonephritis, Proteinuria, Obesity, Hyperlipidemia, Lead exposure, Illicit Drug Use, Smoking. The major complication of CKD are anaemia, hypertension, mineral and bone disorder, weakened immune system etc. Anaemia is the major complication with a significant impact on QOL, increasing morbidity and mortality. The main reason of anemia in CKD patients is a decrease in production of erythropoietin hormone by the nephron progenitor cell, where 90% of production generally happen. Treatment aims for reduction of symptoms, prevention of complications, slowing down the disease progression. The hypothesis being tested is that quality of life of CKD patients with anaemic disease is poorer than quality of life of CKD patients without anaemic disease.

Objectives:  The study aims to measure the quality of life (QOL) of chronic kidney disease with anaemic disorder in comparison to chronic kidney disease with non-anaemic disorder

Methods: A prospective observational study was conducted in a 450 bedded tertiary care hospital for a period of 6 months. Both male and female chronic kidney disease patients with or without anaemic disease of age 18 years old and patients diagnosed with CKD stages of I to Ⅴ. The study population is 123 patients. Data collected using these study tools such as Data entry forms, Questionnaire (CKD-AQ, FACT-An), Patient consent form. Quality of life was evaluated using CKD-AQ questionnaire & FACT-An questionnaire and score. The documented data were analyzed by statistical and graphical method.

Results: A total of 123 patients were included in this study.the study participants comprised 71 and   52 chronic kidney disease patients with or without anaemia respectively. Majority of anaemic and non-anaemic CKD patients were under 61-80 years and most of them are males in both categories. By assessing the social history most of them had a history of smoking and alcoholism. Frequent hospital visits were due to dialysis and general weakness, with Hypertension, Diabetes mellitus and cardiovascular disease contributing to be a main risk factor and complication. The quality of life was analyzed using CKD-AQ and FACT-An questionnaire which shows that anaemic CKD patients had a poor QOL. Major decline in physical and emotional functioning as evidenced from FWB score(11.4+ 5.13 Vs 21.28+4.76) and EWB score(13.07+4.38 Vs 20.63+2.47)from FACT-AN questionnaire and physical and functional domains from CKD-AQ questionnaire.The drug utilization evaluation among anaemic CKD patients revealed that the most often used agents were Erythropoietin stimulating agents [Erythropoietin (39.5%) and Darbepoetin (60.6%)]. Most of the patients received combination therapy (dual: 47.9%, triple: 32.4%) with subcutaneous and oral administration as the preferred route of administrations.

Conclusions: The study revealed that the major risk factor and complication of chronic kidney disease was hypertension and diabetes mellitus.The most commonly used treatment regimen for anaemic CKD was combination therapy, in which ESA was the frequently used drug. The study highlights that there is considerable worsening of quality of life in chronic kidney disease patients especially when anaemia is present, emphasizing the urgent need to manage the anaemia, so lifestyle modifications and emotional supports are recommended and patients who are at a risk of low heamoglobin level are to be identified to avoid progression to anaemia.