D'Arrigo Graziella, Gori Mercedes, Marino Carmela, Pizzini Patrizia, Caridi Graziella, Marino Francesco, Parlongo Giovanna, Pitino Annalisa, Bruno Giovanni S F, Tripepi Giovanni, Mallamaci Francesca, Zoccali Carmine
National Research Council of ITALY (CNR), Institute of Clinical Physiology in Reggio Calabria, Reggio Calabria, Italy.
National Research Council of ITALY (CNR), Institute of Clinical Physiology in Rome, Rome, Italy.
Eur J Clin Invest. 2025 Jun 9:e70087. doi: 10.1111/eci.70087.
Chronic kidney disease (CKD) significantly impacts patient well-being, with declining glomerular filtration rate (eGFR) often leading to worsening quality of life (QoL). However, the directionality of the eGFR-QoL relationship remains unclear due to limitations of prior cross-sectional and longitudinal studies.
This study applied cross-lagged analysis to investigate the reciprocal relationship between eGFR and QoL (measured using SF-36 Physical and Mental Component Scores [PCS and MCS]) over 36 months in 422 CKD patients recruited from nephrology units in Southern Italy. Generalized Method of Moments (GMM) models tested two hypotheses: (1) PCS as a determinant of MCS, or vice versa; and (2) eGFR as a determinant of MCS/PCS, or vice versa.
Cross-lagged analysis confirmed that lower eGFR significantly predicted declines in both PCS and MCS in subsequent visits (p < .05). At the same time, the reverse relationship (QoL affecting eGFR) was not statistically significant. Multivariable models, adjusting for potential confounders including demographic factors, comorbidities, and socioeconomic status, confirmed these findings.
Kidney function decline leads to worsening QoL, whereas deterioration in QoL does not impact eGFR decline. These findings support prioritising interventions that slow the progression of CKD as a means to preserve quality of life. This study highlights the utility of cross-lagged analysis in nephrology research and underscores the importance of early chronic kidney disease (CKD) management to maintain patient well-being.
慢性肾脏病（CKD）严重影响患者的健康，肾小球滤过率（eGFR）下降常常导致生活质量（QoL）恶化。然而，由于先前横断面研究和纵向研究的局限性，eGFR与QoL之间关系的方向性仍不明确。
本研究采用交叉滞后分析，在从意大利南部肾脏病科招募的422例CKD患者中，调查36个月内eGFR与QoL（使用SF-36生理和心理成分评分[PCS和MCS]进行测量）之间的相互关系。广义矩估计（GMM）模型检验了两个假设：（1）PCS作为MCS的决定因素，反之亦然；（2）eGFR作为MCS/PCS的决定因素，反之亦然。
交叉滞后分析证实，较低的eGFR显著预测了后续访视中PCS和MCS的下降（p < 0.05）。同时，反向关系（QoL影响eGFR）无统计学意义。调整了包括人口统计学因素、合并症和社会经济状况等潜在混杂因素的多变量模型证实了这些发现。
肾功能下降导致QoL恶化，而QoL恶化并不影响eGFR下降。这些发现支持将减缓CKD进展的干预措施作为维持生活质量的手段予以优先考虑。本研究强调了交叉滞后分析在肾脏病研究中的实用性，并强调了早期慢性肾脏病（CKD）管理对维持患者健康的重要性。
