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Abstract: FR-PO267

The Prevalence of Uremic Symptoms and Their Association with Adverse Outcomes in CKD

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Shafi, Tariq, Johns Hopkins University, Baltimore, Maryland, United States
  • Rhee, Eugene P., Massachusetts General Hospital, Newton, Massachusetts, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
  • Raj, Dominic S., George Washington University, Washington, District of Columbia, United States
  • Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
  • Jaar, Bernard G., Johns Hopkins University, Baltimore, Maryland, United States
  • Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States
  • Kusek, John W., NIDDK, Bethesda, Maryland, United States
  • Fink, Jeffrey C., University of Maryland, Baltimore, Maryland, United States
  • Sondheimer, James H., Wayne State University School of Medicine, Detroit, Michigan, United States
  • Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Guallar, Eliseo, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

Group or Team Name

  • CRIC Study

Fatigue, anorexia, and pruritus are important patient-reported symptoms of CKD. Their prevalence and association with adverse outcomes in patients with non-dialysis dependent CKD have not been well established or characterized.


Among 3,639 participants of the ongoing Chronic Renal Insufficiency Cohort Study (CRIC), we assessed fatigue, anorexia, and pruritus using the KDQOL-36, administered at baseline and then annually. We calculated a uremic symptom score (U-Score) by averaging the 3 symptom scores for each person. We determined the time-varying association of each symptom and the U-Score with the risk of CKD progression (50% reduction in eGFR or ESRD), death and first cardiovascular disease (CVD) events, using Cox models adjusted for demographic, clinical, and laboratory variables, including eGFR and albuminuria.


At baseline, mean age was 58 yrs and eGFR was 45 ml/min/1.73m2. The prevalence of fatigue was 52%, anorexia, 21%, and pruritus, 42%; each were associated with lower eGFR (p<0.001). During a median follow-up of 6.1 yrs, a higher U-Score (more symptoms) was significantly and positively associated with all outcomes (Table). Each individual symptom was associated with the risk of CKD progression; anorexia and fatigue were associated with death; none of the individual symptoms was associated with first CVD event.


A uremic symptom score, derived from three commonly reported symptoms, is associated with adverse outcomes in patients with non-dialysis dependent CKD. Our findings highlight the importance of patient-reported symptoms and underscore the need for unraveling their pathogenesis.

Association of Uremic Symptoms with Outcomes
 CKD ProgressionDeathFirst CVD Event
 HR (95% CI)pHR (95% CI)pHR (95% CI)p
U-Score11.05 (1.02-1.08)0.0031.07 (1.03-1.10)<0.0011.04 (1.01-1.08)0.02
Individual Symptoms2
Fatigue1.20 (1.06-1.36)0.011.15 (1.00-1.32)0.051.09 (0.95-1.25)0.2
Anorexia1.17 (1.03-1.34)0.021.31 (1.13-1.51)<0.0011.09 (0.94-1.26)0.2
Pruritus1.15 (1.02-1.29)0.021.06 (0.92-1.21)0.41.07 (0.94-1.22)0.3

1HR per 10-point higher score (more symptoms). 2HR for presence vs. absence of symptoms. Adjusted: age, sex, race, income, education, marital status, smoking, alcohol use, DM, HTN, CVD, BMI, eGFR, BUN, albumin, cholesterol, urine albumin


  • NIDDK Support