The evolution of symptom burden in older men and women with advanced CKD

Whether the interdependence of symptom burden and kidney function over time differ by gender remain unknown. Here we aim to describe longitudinal trajectories of symptom burden in older men and women with advanced CKD over time, and in relation to the trajectory of kidney function.

In the prospective, observational multi-center cohort study in Europe; The European QUALity (EQUAL) study on treatment in advanced chronic kidney disease, patients with incident eGFR <20 mL/min per 1.73 m2 not on dialysis, ≥65 years of age were followed for over 5 years, or until initiation of kidney replacement therapy. Symptom number and burden were assessed at 3-6-month intervals using the dialysis symptoms index. The evolution of symptom burden was modelled over time and eGFR for men and women separately, using generalized additive models.

Over the follow-up, 4730 symptoms measurements were collected in 1135 patients. Overall symptom progression was relatively slow. The number of symptoms increased on average by 0.47 (95% CI 0.37-0.58) symptoms per year, and by 0.75 (95% CI 0.58-0.91) symptoms per 5 mL/min/1.73m2 decrease in kidney function. Women reported more symptoms on average than men throughout follow-up, although the increase in symptom number with declining kidney function was almost three times greater in men (0.97 per 5 mL/min/1.73m2, 95% CI 0.78-1.16) than in women (0.34 per 5 mL/min/1.73m2, 95% CI 0.03-0.64). This difference was especially evident towards lower eGFR levels.

Women experience more symptoms on average than men, but symptoms progressed faster in men, relative to kidney decline. Further research should focus on how patient-reported outcome measures (PROMs) can routinely be implemented in nephrology care, and how to use PROMs effectively in patient-nephrologist communication with regards to shared decision making.