title: Physical, cognitive and emotional factors contributing to quality of life, functional health and participation in community dwelling in chronic kidney disease.
abstract: BACKGROUND
  Quality of life (QoL) impairment is a well-known consequence of chronic kidney disease (CKD). The factors influencing QoL and late life functional health are poorly examined.
  
  
  METHODS
  Using questionnaires combined with neuropsychological examinations, we prospectively evaluated physical, cognitive, and emotional factors influencing QoL, functional health and participation in community dwelling in 119 patients with CKD stages 3-5 including hemodialysis (61.5±15.7years; 63% men) and 54 control patients of the same age without CKD but with similar cardiovascular risk profile.
  
  
  RESULTS
  Compared with control patients, CKD patients showed impairment of the physical component of QoL and overall function, assessed by the SF-36 and LLFDI, whereas disability, assessed by LLFDI, was selectively impaired in CKD patients on hemodialysis. Multivariable linear regressions (forced entry) confirmed earlier findings that CKD stage (β = -0.24; p = 0.012) and depression (β = -0.30; p = 0.009) predicted the QoL physical component. Hitherto unknown, CKD stage (β = -0.23; p = 0.007), cognition (β = 0.20; p = 0.018), and depression (β = -0.51; <0.001) predicted disability assessed by the LLFDI, while age (β = -0.20; p = 0.023), male gender (B = 5.01; p = 0.004), CKD stage (β = -0.23; p = 0.005), stroke history (B = -9.00; p = 0.034), and depression (β = -0.41; p<0.001) predicted overall function. Interestingly, functional health deficits, cognitive disturbances, depression, and anxiety were evident almost only in CKD patients with coronary heart disease (found in 34.2% of CKD patients). The physical component of QoL and functional health decreased with age and depressive symptoms, and increased with cognitive abilities.
  
  
  CONCLUSIONS
  In CKD, QoL, functional health, and participation in community dwelling are influenced by physical, cognitive, and emotional factors, most prominently in coronary heart disease patients.
authors.affiliation: Department of Neurology, University Hospital Essen, Essen, Germany.
authors.forename: Ulla K
authors.initials: UK
authors.lastname: Seidel
authors.affiliation: Department of Neurology, University Hospital Essen, Essen, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Gronewold
authors.affiliation: Department of Nephrology, University Hospital Essen, Essen, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Volsek
authors.affiliation: Department of Neurology, University Hospital Essen, Essen, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Todica
authors.affiliation: Department of Nephrology, University Hospital Essen, Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kribben
authors.affiliation: Department of Nephrology, University Hospital Essen, Essen, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Bruck
authors.affiliation: Department of Neurology, University Hospital Essen, Essen, Germany.
authors.forename: Dirk M
authors.initials: DM
authors.lastname: Hermann
mesh_terms: D000339:Affect; D016022:Case-Control Studies; D003071:Cognition; D015331:Cohort Studies; D003256:Community Participation; D003863:Depression / Q000523:psychology; D004644:Emotions; D005260:Female; D006262:Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D011788:Quality of Life; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D012111:Residence Characteristics