title: Impairment of kidney function and reduced quality-of-life in older people: a cross-sectional study.
abstract: OBJECTIVE
  to assess the association of kidney function with quality-of-life in community-dwelling older adults aged 75 years or more in the UK.
  
  
  METHODS
  cross-sectional study.
  
  
  METHODS
  primary care; 12 UK general practices participating in a cluster trial of health screening.
  
  
  METHODS
  estimated glomerular filtration rate (eGFR, ml/min/1.73 m(2)) using the four-variable modified diet in renal disease equation was derived in 1,195 men and 1,772 women with available bloods, these were 92% of 3,211 study participants who consented to interviews and 73% of those invited into the original cluster trial of health screening.
  
  
  METHODS
  interviews by trained fieldworker using the Sickness Impact Profile (home management, mobility, self-care, social interaction), and the Philadelphia Geriatric Morale Scale. Higher scores imply worse quality-of-life in a given domain.
  
  
  RESULTS
  in age- and co-morbidity-adjusted analyses there was an association of eGFR <45 and the highest scores (defined as ≥median) of mobility (men: odds ratio (OR) 2.91, 95% confidence interval (CI) 1.56-5.41; women: OR 1.73, 95% CI 1.02-2.94), home management (men: OR 1.49, 95% CI 1.09-2.04; women: OR 3.50, 95% CI 1.18-10.35), social interaction (men: OR 3.34, 95% CI 1.73-6.45; women: 2.64, 95% CI 1.61-4.33) when compared with those with eGFR ≥60 and who reported no problems. Men with eGFR <45 had low morale (OR 2.45, 95% CI 1.02-5.87) but this was not found for women (OR 1.40, 95% CI 0.65-3.04), whereas women (but not men) with eGFR <45 reported problems with body care (women: OR 1.68; 95% CI 1.25-2.27: men: OR 0.89, 95% CI 0.55-1.46).
  
  
  CONCLUSIONS
  an eGFR <45 is associated with poorer quality-of-life at older age. More research is needed to identify modifiable causes to improve quality-of-life in older people with such a degree of kidney function impairment.
authors.affiliation: Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. dorothea.nitsch@lshtm.ac.uk
authors.forename: Dorothea
authors.initials: D
authors.lastname: Nitsch
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Mann
authors.forename: Christopher
authors.initials: C
authors.lastname: Bulpitt
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Roderick
authors.forename: Astrid
authors.initials: A
authors.lastname: Fletcher
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006304:Health Status; D006801:Humans; D007674:Kidney Diseases / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D011788:Quality of Life; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D006113:United Kingdom