Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas.
Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, Texas.
Am J Kidney Dis. 2023 Apr;81(4):446-456. doi: 10.1053/j.ajkd.2022.09.016. Epub 2022 Nov 18.
RATIONALE & OBJECTIVE: Quality of life in chronic kidney disease (CKD) is impaired by a large burden of symptoms including some that overlap with the symptoms of heart failure (HF). We studied a group of individuals with CKD to understand the patterns and trajectories of HF-type symptoms in this setting.
Prospective cohort study.
SETTING & PARTICIPANTS: 3,044 participants in the Chronic Renal Insufficiency Cohort (CRIC) without prior diagnosis of HF.
Sociodemographics, medical history, medications, vital signs, laboratory values, echocardiographic and electrocardiographic parameters.
Trajectory over 5.5 years of a HF-type symptom score (modified Kansas City Cardiomyopathy Questionnaire [KCCQ] Overall Summary Score with a range of 0-100 where<75 reflects clinically significant symptoms).
Latent class mixed models were used to model trajectories. Multinomial logistic regression was used to model relationships of predictors with trajectory group membership.
Five trajectories of KCCQ score were identified in the cohort of 3,044 adults, 45% of whom were female, and whose median age was 61 years. Group 1 (41.7%) had a stable high score (minimal symptoms, average score of 96); groups 2 (35.6%) and 3 (15.6%) had stable but lower scores (mild symptoms [average of 81] and clinically significant symptoms [average of 52], respectively). Group 4 (4.9%) had a substantial worsening in symptoms over time (mean 31-point decline), and group 5 (2.2%) had a substantial improvement (mean 33-point increase) in KCCQ score. A majority of group 1 was male, without diabetes or obesity, and this group had higher baseline kidney function. A majority of groups 2 and 3 had diabetes and obesity. A majority of group 4 was male and had substantial proteinuria. Group 5 had the highest proportion of baseline cardiovascular disease (CVD).
No validation cohort available, CKD management changes in recent years may alter trajectories, and latent class models depend on the missing at random assumption.
Distinct HF-type symptom burden trajectories were identified in the setting of CKD, corresponding to different baseline characteristics. These results highlight the diversity of HF-type symptom experiences in individuals with CKD.
慢性肾脏病（CKD）患者的生活质量因大量症状负担而受损，其中一些症状与心力衰竭（HF）的症状重叠。我们研究了一组 CKD 患者，以了解在此背景下 HF 型症状的模式和轨迹。
前瞻性队列研究。
3044 名没有心力衰竭既往诊断的慢性肾脏不全队列（CRIC）参与者。
社会人口统计学、病史、药物、生命体征、实验室值、超声心动图和心电图参数。
5.5 年 HF 型症状评分（改良堪萨斯城心肌病问卷[KCCQ]总总结评分，范围为 0-100，其中<75 反映有临床意义的症状）的轨迹。
使用潜在类别混合模型来模拟轨迹。使用多项逻辑回归来模拟预测因素与轨迹组归属之间的关系。
在 3044 名成年人队列中确定了 5 种 KCCQ 评分轨迹，其中 45%为女性，中位年龄为 61 岁。第 1 组（41.7%）的评分稳定较高（症状最小，平均评分为 96）；第 2 组（35.6%）和第 3 组（15.6%）的评分稳定但较低（轻度症状[平均 81]和有临床意义的症状[平均 52]）。第 4 组（4.9%）的症状随时间明显恶化（平均下降 31 分），第 5 组（2.2%）的 KCCQ 评分明显改善（平均增加 33 分）。第 1 组的大多数为男性，无糖尿病或肥胖症，该组的基线肾功能较高。第 2 组和第 3 组的大多数有糖尿病和肥胖症。第 4 组的大多数为男性，且蛋白尿严重。第 5 组有最高比例的基线心血管疾病（CVD）。
无验证队列，近年来 CKD 管理的变化可能会改变轨迹，潜在类别模型取决于随机缺失假设。
在 CKD 背景下确定了不同的 HF 型症状负担轨迹，对应于不同的基线特征。这些结果突出了 CKD 患者 HF 型症状体验的多样性。
