Quality of Life and Risk of Cardiac Events, ESRD, and Death in African Americans with Renal Disease

Health-related quality of life (HRQOL) has been associated with increased risk for hospitalizations and mortality in patients with end stage renal disease (ESRD), but has not been evaluated as a predictor of adverse outcomes in patients with chronic kidney disease (CKD). A longitudinal analysis examining baseline HRQOL with health outcomes during five years of follow-up was performed, involving 639 African Americans with hypertensive CKD from the African American Study of Kidney Disease and Hypertension (AASK) Cohort Study. Quality of life, including mental health (MHC) and physical health composite (PHC), was assessed at study baseline using the Short Form-36 (SF-36). The association between MHC and PHC and the outcomes of kidney disease progression (defined as doubling of serum creatinine or development of ESRD), cardiovascular events, and all-cause mortality was examined. At baseline, mean (± standard deviation) participant SF-36 (MHC and PHC scores were 46.3 ± 10.5 and 40.4 ± 10, respectively. In adjusted analyses, lower baseline PHC score (per 5 unit decrements) was significantly associated with an increased risk of cardiovascular events [1.11 (95% CI 1.00-1.23)] and all-cause mortality [1.13 (95% CI 1.02-1.26)]. There was no independent association between baseline MHC scores and any of the outcomes, nor for baseline PHC scores and the endpoint of kidney disease progression. Lower baseline SF-36 PHC but not MHC was associated with an increased risk of cardiovascular events and death. Neither PHC nor MHC scores were associated with progression of kidney disease. Future work will need to focus on mechanisms underlying the association between PHC scores and adverse outcomes.