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Kidney Week

Abstract: PO2273

Subtle Changes in Uremic Symptoms with CKD Progression

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Wulczyn, Kendra E., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Kalim, Sahir, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Zhao, Sophia, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Rhee, Eugene P., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Shafi, Tariq, University of Mississippi, University Park, Mississippi, United States
Background

Uremic symptoms are a major contributor to symptom burden in CKD and related to lower quality of life. However, factors associated with uremic symptom progression have not been rigorously examined.

Methods

We included 3,504 participants with CKD not on dialysis from the Chronic Renal Insufficiency Cohort (CRIC) study with at least two assessments of estimated GFR (eGFR) and uremic symptoms. The uremic symptoms fatigue, anorexia, and pruritus were assessed annually by the Kidney Disease Quality of Life instrument. Responses were transformed to a scale from 0-100, with lower scores indicating worse symptom severity. We used multivariate linear mixed effects models with random intercepts and random slopes to estimate the association between eGFR change and the change in uremic symptoms over time.

Results

The mean age of participants was 58 years, 45% were women, 41% Black, and the mean eGFR at baseline was 45 mL/min/1.73m2. Over a median follow-up of 7 years (IQR 3-11), the average annual decline in eGFR was -1.3 mL/min/1.73m2/year. The average annual change in the symptom scores for fatigue, anorexia, and pruritus were -0.27 (95% CI: -0.35, -0.19), -0.26 (95% CI: -0.33, -0.19), and -0.49 (95% CI: -0.59, -0.39), respectively. A 10-unit change in eGFR was significantly associated with worsening fatigue, anorexia, and pruritus (Table 1). The association was stronger for those with eGFR <30 than those with higher eGFR.

Conclusion

Decreasing kidney function is associated with worsening fatigue, anorexia, and pruritus; however, the absolute change in symptom severity scores is small and unlikely to be clinically meaningful. Regular symptom assessment should be incorporated into routine CKD care; however, caution should be used when attributing large changes in symptom severity solely to changes in the level of kidney function.

Change in symptom score per 10-unit decrease in eGFR
 Fatigue*AnorexiaPruritusFatigueAnorexiaPruritus
 eGFR < 30eGFR ≥ 30
Unadjusted-3.15
(-4.47, -1.83)
-2.05
(-3.08, -1.02)
-2.12
(-3.53, -0.72)
-1.46
(-1.75, -1.17)
-0.87
(-1.09, -0.66)
-1.43
(-1.72, -1.14)
Adjusted†-3.36
(-4.60, -2.11)
-1.91
(-2.93, -0.90)
-1.20
(-2.56, 0.17)
-1.20
(-1.47, -0.93)
-0.64
(-0.84, -0.43)
-0.97
(-1.24, -0.70)

*Symptom severity scored from 0-100. Negative sign (-) indicates worsening symptoms †Model adjusted for age, gender, race/ethnicity, baseline symptom score, BMI, employment, cancer history, total number of medications, ACEi/ARB, NSAIDs, antidepressants, opioids, gabapentin, and time.

Funding

  • NIDDK Support