TY - JOUR
T1 - Kidney disease symptoms before and after kidney transplantation
AU - Taylor, Kathryn
AU - Chu, Nadia M.
AU - Chen, Xiaomeng
AU - Shi, Zhan
AU - Rosello, Eileen
AU - Kunwar, Sneha
AU - Butz, Paul
AU - Norman, Silas P.
AU - Crews, Deidra C.
AU - Greenberg, Keiko I.
AU - Mathur, Aarti
AU - Segev, Dorry L.
AU - Shafi, Tariq
AU - McAdams-Demarco, Mara A.
N1 - Funding Information:
Funding for this study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases and National Institute on Aging grants K01AG064040 (Principal Investigator [PI]: N.M. Chu), R01AG055781 (PI: M.A. McAdams-DeMarco), R01DK114074 (PI: M.A. McAdams-DeMarco), K23AG053429 (PI: A. Mathur), and K24AI144954 (PI: D.L. Segev). D.C. Crews was supported by National Heart, Lung, and Blood Institute grant K24HL148181. K.I. Greenberg was supported by National Heart, Lung, and Blood Institute grant R01HL132372 and National Institute on Aging grant UH3AG056933. T. Shafi was supported by National Heart, Lung, and Blood Institute grant R01HL132372 and National Institute of Nursing Research grant R01NR017399. K. Taylor was supported by National Center for Advancing Translational Sciences grant TL1TR003100.
Funding Information:
P. Butz reports ownership interest in Clene, Progenity, Spectrum Pharmaceuticals, Vaxart, Veru, and Viking Therapeutics. D.C. Crews reports consultancy agreements with Yale New Haven Health Services Corporation Center for Outcomes Research and Evaluation; receiving research funding from Somatus, Inc.; serving on the editorial boards of CJASN, JASN, and Journal of Renal Nutrition; serving as an associate editor of Kidney360; serving as a cochair of Bayer HealthCare Pharmaceuticals Inc. Patient and Physician Advisory Board Steering Committee for Disparities in Chronic Kidney Disease Project; serving as a scientific advisor or member of the advisory group of the Health Equity Collaborative, Partner Research for Equitable System Transformation after COVID-19, Optum Labs; and other interests/relationships with the Council of Subspecialist Societies of the American College of Physicians, the board of directors of the National Kidney Foundation of Maryland/Delaware, and the Nephrology Board of the American Board of Internal Medicine. A. Mathur reports serving as an editorial board member of Thyroid. S. Norman reports receiving research funding from Allo-Vir, Astellas, and Natera; serving as a scientific advisor or member of the American Kidney Fund Board of Trustees, the Minority Organ and Tissue Transplant Education Program Detroit Foundation Board, and the National Kidney Foundation of Michigan Scientific Advisory Board and Board of Directors; and other interests/relationships with the Mitzvah Circle Foundation. D.L. Segev reports consultancy agreements with, receiving honoraria from, and speakers bureau for CSL Behring, Genzyme/Sanofi, and Novartis. T. Shafi reports consultancy agreements with Siemens; receiving research funding from Baxter (clinical trial); receiving honoraria from Cara Therapeutics, the National Institutes of Health, and Siemens; and serving as a scientific advisor or member of American Journal of Kidney Diseases and
Publisher Copyright:
© 2021 by the American Society of Nephrology.
PY - 2021/7
Y1 - 2021/7
N2 - Background and objectives Patients with kidney failure report a high symptom burden, which likely increases while on dialysis due to physical and mental stressors and decreases after kidney transplantation due to restoration of kidney function. Design, setting, participants, & measurements We leveraged a two-center prospective study of 1298 kidney transplant candidates and 521 recipients (May 2014 to March 2020). Symptom scores (0-100) at evaluation and admission for transplantation were calculated using the Kidney Disease Quality of Life Short-Form Survey, where lower scores represent greater burden, and burden was categorized as very high: 0.0-71.0; high: 71.1-81.0; medium: 81.1-91.0; and low: 91.1-100.0. We estimated adjusted waitlist mortality risk (competing risks regression), change in symptoms between evaluation and transplantation (n5190), and post-transplantation symptom score trajectories (mixed effects models). Results At evaluation, candidates reported being moderately to extremely bothered by fatigue (32%), xeroderma (27%), muscle soreness (26%), and pruritus (25%); 16% reported high and 21% reported very high symptom burden. Candidates with very high symptom burden were at greater waitlist mortality risk (adjusted subdistribution hazard ratio, 1.67; 95% confidence interval, 1.06 to 2.62). By transplantation, 34% experienced an increased symptom burden, whereas 42% remained unchanged. The estimated overall symptom score was 82.3 points at transplantation and 90.6 points at 3 months (10% improvement); the score increased 2.75 points per month (95% confidence interval, 2.38 to 3.13) from 0 to 3 months, and plateaued (20.06 points per month; 95% confidence interval, 20.30 to 0.18) from 3 to 12 months post-transplantation. There were early (first 3 months) improvements in nine of 11 symptoms; pruritus (23% improvement) and fatigue (21% improvement) had the greatest improvements. Conclusions Among candidates, very high symptom burden was associated with waitlist mortality, but for those surviving and undergoing kidney transplantation, symptoms improved.
AB - Background and objectives Patients with kidney failure report a high symptom burden, which likely increases while on dialysis due to physical and mental stressors and decreases after kidney transplantation due to restoration of kidney function. Design, setting, participants, & measurements We leveraged a two-center prospective study of 1298 kidney transplant candidates and 521 recipients (May 2014 to March 2020). Symptom scores (0-100) at evaluation and admission for transplantation were calculated using the Kidney Disease Quality of Life Short-Form Survey, where lower scores represent greater burden, and burden was categorized as very high: 0.0-71.0; high: 71.1-81.0; medium: 81.1-91.0; and low: 91.1-100.0. We estimated adjusted waitlist mortality risk (competing risks regression), change in symptoms between evaluation and transplantation (n5190), and post-transplantation symptom score trajectories (mixed effects models). Results At evaluation, candidates reported being moderately to extremely bothered by fatigue (32%), xeroderma (27%), muscle soreness (26%), and pruritus (25%); 16% reported high and 21% reported very high symptom burden. Candidates with very high symptom burden were at greater waitlist mortality risk (adjusted subdistribution hazard ratio, 1.67; 95% confidence interval, 1.06 to 2.62). By transplantation, 34% experienced an increased symptom burden, whereas 42% remained unchanged. The estimated overall symptom score was 82.3 points at transplantation and 90.6 points at 3 months (10% improvement); the score increased 2.75 points per month (95% confidence interval, 2.38 to 3.13) from 0 to 3 months, and plateaued (20.06 points per month; 95% confidence interval, 20.30 to 0.18) from 3 to 12 months post-transplantation. There were early (first 3 months) improvements in nine of 11 symptoms; pruritus (23% improvement) and fatigue (21% improvement) had the greatest improvements. Conclusions Among candidates, very high symptom burden was associated with waitlist mortality, but for those surviving and undergoing kidney transplantation, symptoms improved.
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U2 - 10.2215/CJN.19031220
DO - 10.2215/CJN.19031220
M3 - Article
C2 - 34597266
AN - SCOPUS:85111243423
VL - 16
SP - 1083
EP - 1093
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
SN - 1555-9041
IS - 7
ER -