Quality of life and outcomes in African Americans with CKD.
Low health-related quality of life (HRQOL) has been associated with increased risk for hospitalization and death in ESRD. However, the relationship of HRQOL with outcomes in predialysis CKD is not well understood. We evaluated the association between HRQOL and renal and cardiovascular (CV) outcomes in 1091 African Americans with hypertensive CKD enrolled in the African American Study of Kidney Disease and Hypertension (AASK) trial and cohort studies. Outcomes included CKD progression (doubling of serum creatinine/ESRD), CV events/CV death, and a composite of CKD progression or death from any cause (CKD progression/death). We assessed HRQOL, including mental health composite (MHC) and physical health composite (PHC), using the Short Form-36 survey. Cox regression analyses were used to assess the relationship between outcomes and five-point decrements in MHC and PHC scores using measurements at baseline, at the most recent annual visit (time-varying), or averaged from baseline to the most recent visit (cumulative). During approximately 10 years of follow-up, lower mean PHC score was associated with increased risk of CV events/CV death and CKD progression/death across all analytic approaches, but only time-varying and cumulative decrements were associated with CKD progression. Similarly, lower mean MHC score was associated with increased risk of CV events/CV death regardless of analytic approach, while only time-varying and cumulative decrements in mean MHC score was associated with CKD progression and CKD progression or death. In conclusion, lower HRQOL is associated with a range of adverse outcomes in African Americans with hypertensive CKD.
Department of Medicine, University of Illinois Hospital and Health Sciences System and Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; aporte3@uic.edu.
Anna
A
Porter
Department of Medicine, University of Illinois Hospital and Health Sciences System and Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; Center for Management of Complex Chronic Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois;
Michael J
MJ
Fischer
Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio;
Xuelei
X
Wang
Department of Medicine, Medical University of South Carolina, Charleston, South Carolina;
Deborah
D
Brooks
Jackson State University and University of Mississippi Medical Center, Center for Health of Minority Males, Jackson, Mississippi;
Marino
M
Bruce
Department of Medicine, Johns Hopkins University, Baltimore, Maryland;
Jeanne
J
Charleston
Multidisciplinary Research Center, Morehouse School of Medicine, Atlanta, Georgia;
William H
WH
Cleveland
Department of Medicine, Columbia University Medical Center at Harlem Hospital, New York, New York;
Donna
D
Dowie
Department of Medicine, Meharry Medical College, Nashville, Tennessee;
Marquetta
M
Faulkner
Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio;
Jennifer
J
Gassman
Department of Medicine, Ohio State University Medical Center, Columbus, Ohio;
Leena
L
Hiremath
Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio;
Cindy
C
Kendrick
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland;
John W
JW
Kusek
Department of Medicine, Charles R. Drew University, Los Angeles, California;
Keith C
KC
Norris
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and.
Denyse
D
Thornley-Brown
Department of Medicine, University of Utah, Salt Lake City, Utah.
Tom
T
Greene
Department of Medicine, University of Illinois Hospital and Health Sciences System and Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois;
James P
JP
Lash
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000208:ethnology* / Q000401:mortality; D016896:Treatment Outcome
D003404:Creatinine
AASK (African American Study of Kidney Disease and Hypertension); chronic kidney disease; hypertension; quality of life