RATIONALE & OBJECTIVE Health-related quality of life (HRQoL) is a major outcome measure increasingly used in patients with chronic kidney disease (CKD). We evaluated the association between different stages of CKD and the physical and mental health domains of HRQoL. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS 2,693 outpatients with moderate (stage 3, estimated glomerular filtration rate [eGFR], 30-60mL/min/1.73m2) or advanced (stages 4-5, estimated glomerular filtration rate<30mL/min/1.73m2, not on kidney replacement therapy [KRT]) CKD under the care of a nephrologist at 1 of 40 nationally representative facilities, 1,658 patients with a functioning kidney transplant, 1,251 patients on maintenance dialysis randomly selected from the national Renal Epidemiology and Information Network registry, and 20,574 participants in the French Decennial Health Survey, representative of the general population. PREDICTOR Severity of kidney disease (moderate CKD, advanced CKD, maintenance dialysis as KRT, and functioning kidney transplant as KRT), compared with a sample of the general population. OUTCOMES HRQoL scores assessed using the Medical Outcomes Study 36-Item Short Form Health Survey or the Kidney Disease Quality of Life 36 scale. ANALYTICAL APPROACH Age- and sex-standardized (to the general population) prevalence of poor or fair health status was estimated for each study kidney disease group. Analysis of variance was used to estimate adjusted differences in mean physical and mental health scores between the kidney disease subgroups and the general population. RESULTS Mean age was 67.2±12.6 (SD) years for patients with non-KRT-requiring CKD, 69.3±17.7 years for dialysis patients, and 55.3±14.2 years for those with functioning kidney transplants; 60% were men. Age- and sex-standardized health status was perceived as fair or poor in 27% of those with moderate CKD,>40% of those with advanced CKD or receiving dialysis, 12% with a functioning transplant, and 3% of the general population sample. HRQoL physical scores (adjusted for age, sex, education, obesity, and diabetes) were significantly lower in patients in all CKD subgroups than in the general population. For patients receiving dialysis, the magnitude of the difference in physical score versus the general population exceeded 4.5 points, the minimal clinically important difference for this score in this study; for both kidney transplant recipients and patients with advanced CKD, the magnitude of the difference was close to this threshold. For mental score, only dialysis patients had a score that differed from that of the general population by more than the minimal clinically important difference. LIMITATIONS Cross-sectional study design for each subpopulation. CONCLUSIONS This study highlights the degree to which perceived physical health is lower in the setting of CKD than in the general population, even in the absence of kidney failure, and calls for greater attention to CKD-related quality of life.

中文翻译：

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CKD患者（包括肾衰竭患者）的感知健康和生活质量：法国国家调查的结果。

理性与目标健康相关的生活质量（HRQoL）是一项主要的结局指标，越来越多地用于慢性肾脏病（CKD）患者。我们评估了CKD不同阶段与HRQoL身心健康领域之间的关联。研究设计横断面研究。地点和参与者2,693名中度（第3阶段，估计肾小球滤过率[eGFR]，30-60mL / min / 1.73m2）或晚期（第4-5阶段，估计肾小球滤过率<30mL / min / 1.73m2，未开放）的门诊患者肾脏替代疗法（KRT））在40名国家代表机构中的1名由肾脏科医生的护理下进行CKD，有1658例功能正常的肾脏移植患者，1,251例接受透析的患者从国家肾脏流行病学和信息网络注册中心随机选择，还有20例，法国十年期健康调查的574名参与者，代表了总人口。预测者与一般人群的样本相比，肾脏疾病的严重程度（中度CKD，晚期CKD，维持性透析为KRT，肾移植功能为KRT）。结局HRQoL得分使用《医学成果研究36项简短健康调查》或《肾脏疾病生活质量36量表》进行评估。分析方法对于每个研究的肾脏疾病组，估计年龄和性别标准化的（对一般人群而言）健康状况较差或中等的患病率。方差分析用于估计肾脏疾病亚组和一般人群之间平均身体和心理健康得分的调整差异。结果非需要KRT的CKD患者的平均年龄为67.2±12.6（SD）岁，为69岁。透析患者为3±17.7岁，肾移植功能患者为55.3±14.2岁；60％是男人。年龄和性别标准化的健康状况在27％的中度CKD患者，> 40％的CKD或接受透析的患者，> 12％的移植患者以及3％的普通人群中被认为是公平或较差。所有CKD亚组患者的HRQoL身体得分（针对年龄，性别，教育程度，肥胖和糖尿病进行了调整）均明显低于一般人群。对于接受透析的患者，身体得分与一般人群的差异幅度超过了4.5分，这是该研究中该得分在临床上的最小差异；对于肾脏移植受者和晚期CKD患者，差异的大小接近此阈值。对于精神评分，只有透析患者的评分与一般人群的评分相差超过最小的临床重要差异。局限性每个亚群的横断面研究设计。结论本研究强调了即使在没有肾功能衰竭的情况下，CKD患者的感知健康状况也要比普通人群低，并且需要更多地关注与CKD相关的生活质量。