title: Predictors of Health-Related Quality of Life in Patients with Co-Morbid Diabetes and Chronic Kidney Disease.
abstract: BACKGROUND
  People living with diabetes and chronic kidney disease (CKD) experience compromised quality of life. Consequently, it is critical to identify and understand factors influencing their health-related quality of life (HRQoL). This study examined factors associated with HRQoL among patients with diabetes and CKD.
  
  
  METHODS
  A cross sectional study among adults with comorbid diabetes and CKD (eGFR <60 mL/min/1.73m2) recruited from renal and diabetes clinics of four large tertiary referral hospitals in Australia was performed. Each participant completed the Kidney Disease Quality of Life (KDQoL ™ -36) questionnaire, which is comprised of two composite measures of physical and mental health and 3 kidney disease specific subscales with possible scores ranging from 0 to 100 with higher values indicating better HRQoL. Demographic and clinical data were also collected. Regression analyses were performed to determine the relationship between HRQoL and potential predictor factors.
  
  
  RESULTS
  A total of 308 patients were studied with a mean age of 66.9 (SD = 11.0) years and 70% were males. Mean scores for the physical composite summary, mental composite summary, symptom/problem list, effects of kidney disease and burden of kidney disease scales were 35.2, 47.0, 73.8, 72.5 and 59.8 respectively. Younger age was associated with lower scores in all subscales except for the physical composite summary. Female gender, obese or normal weight rather than overweight, and smoking were all associated with lower scores in one or more subscales. Scores were progressively lower with more advanced stage of CKD (p<0.05) in all subscales except for the mental composite summary.
  
  
  CONCLUSIONS
  In patients with diabetes and CKD, younger age was associated with lower scores in all HRQoL subscales except the physical composite summary and female gender, obese or normal weight and more advanced stages of CKD were associated with lower scores in one or more subscales. Identifying these factors will inform the timely implementation of interventions to improve the quality of life of these patients.
authors.affiliation: Department of Nephrology, Monash Health, Melbourne, Australia.|Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Edward
authors.identifier: http://orcid.org/0000-0002-2423-9193
authors.initials: E
authors.lastname: Zimbudzi
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.|Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Melbourne, Australia.
authors.forename: Clement
authors.initials: C
authors.lastname: Lo
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Sanjeeva
authors.initials: S
authors.lastname: Ranasinha
authors.affiliation: Concord Clinical School, University of Sydney, Sydney, Australia.|The George Institute for Global Health, Sydney, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Gallagher
authors.affiliation: Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, Sydney, Australia.|Northern Clinical School, University of Sydney, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Fulcher
authors.affiliation: Department of Nephrology, Monash Health, Melbourne, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kerr
authors.affiliation: Southern Academic Primary Care Research Unit. School of Primary Health Care, Monash University, Melbourne, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Russell
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.|Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Melbourne, Australia.
authors.forename: Helena
authors.initials: H
authors.lastname: Teede
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.|Department of General Practice, Sydney Medical School Westmead, Sydney, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Usherwood
authors.affiliation: Department of Renal Medicine, the Alfred Hospital, Melbourne, Australia.
authors.forename: Rowan
authors.initials: R
authors.lastname: Walker
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.|Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Melbourne, Australia.|The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009765:Obesity; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking