title: Association of anemia and mineral and bone disorder with health-related quality of life in Asian pre-dialysis patients.
abstract: BACKGROUND
  Patients with chronic kidney disease (CKD) have poor health-related quality of life (HRQoL). The association of CKD-related complications such as anemia and mineral and bone disorders (MBD) with HRQoL in pre-dialysis patients is not well-studied. As such, this study aimed to determine the association of anemia and MBD with HRQoL in pre-dialysis patients.
  
  
  METHODS
  This was a cross-sectional study involving 311 adult pre-dialysis patients with stage 3-5 CKD from an acute-care hospital in Singapore. Patients' HRQoL were assessed using Kidney Disease Quality of Life Short Form (KDQOL-SF™) and EuroQol 5 Dimensions-3 levels (EQ5D-3L). HRQoL between patients with and without anemia or MBD were compared by separate hierarchical multiple linear regression analyses using various HRQoL scales as dependent variables, adjusted for sociodemographic, clinical and psychosocial variables.
  
  
  RESULTS
  After adjusting for MBD, anemia was associated with lower HRQoL scores on work status (WS), physical functioning (PF) and role physical [β (SE): -10.9 (4.18), p = 0.010; -3.0 (1.28), p = 0.018; and -4.2 (1.40), p = 0.003, respectively]. However, significance was lost after adjustments for sociodemographic variables. Patients with MBD had poorer HRQoL with respect to burden of kidney disease, WS, PF and general health [(β (SE): -7.9 (3.88), p = 0.042; -9.5 (3.99), p = 0.018; -3.0 (1.22) p = 0.014; -3.6 (1.48), p = 0.015, respectively]. Although these remained significant after adjusting for sociodemographic variables, significance was lost after adjusting for clinical variables, particularly pill burden. This is of clinical importance due to the high pill burden of CKD patients, especially from medications for the management of multiple comorbidities such as cardiovascular and mineral and bone diseases.
  
  
  CONCLUSIONS
  Neither anemia nor MBD was associated with HRQoL in our pre-dialysis patients. Instead, higher total daily pill burden was associated with worse HRQoL. Medication reconciliation should therefore be routinely performed by clinicians and pharmacists to reduce total daily pill burden where possible.
authors.affiliation: Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, 18 Science Drive 4, Singapore, 117543, Singapore.|Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Hwee-Lin
authors.initials: HL
authors.lastname: Wee
authors.affiliation: Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, 18 Science Drive 4, Singapore, 117543, Singapore.
authors.forename: Benjamin Jun Jie
authors.initials: BJ
authors.lastname: Seng
authors.affiliation: Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, 18 Science Drive 4, Singapore, 117543, Singapore.
authors.forename: Jia Jia
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, 18 Science Drive 4, Singapore, 117543, Singapore.
authors.forename: Kok Joon
authors.initials: KJ
authors.lastname: Chong
authors.affiliation: Department of Medicine (Division of Nephrology), National University Hospital, Singapore, Singapore.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Tyagi
authors.affiliation: Department of Medicine (Division of Nephrology), National University Hospital, Singapore, Singapore.
authors.forename: Anantharaman
authors.initials: A
authors.lastname: Vathsala
authors.affiliation: Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, 18 Science Drive 4, Singapore, 117543, Singapore. priscillahow@nus.edu.sg.|Department of Medicine (Division of Nephrology), National University Hospital, Singapore, Singapore. priscillahow@nus.edu.sg.
authors.forename: Priscilla
authors.initials: P
authors.lastname: How
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology / Q000523:psychology*; D001851:Bone Diseases, Metabolic / Q000209:etiology / Q000523:psychology*; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000523:psychology*; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology; D012044:Regression Analysis; D006435:Renal Dialysis / Q000523:psychology; D012846:Singapore
keywords: Anemia; Health-related quality of life; Mineral and bone disorder; Pill burden; Pre-dialysis