In Advanced CKD Cases, Women Have Higher Symptom Burden but Progression of Disease Faster in Men: Study
Netherlands: Among older adults with advanced chronic kidney disease (CKD), women experienced a greater overall symptom burden than men; however, men demonstrated a more rapid worsening of symptoms over time and with declining kidney function.
The study published in Nephrology Dialysis Transplantation by Nicholas C. Chesnaye and colleagues from Amsterdam UMC sheds light on how symptom burden changes over time in older adults with advanced chronic kidney disease, highlighting key sex-based differences with implications for patient-centered care.
The researchers conducted a prospective cohort analysis within the European QUALity (EQUAL) study, including 1,135 adults aged 65 years or older with newly diagnosed advanced CKD (eGFR <20 mL/min/1.73 m²), none of whom were on dialysis at baseline. Of these, 775 were men. Participants were followed for up to 5 years or until the initiation of kidney replacement therapy, whichever occurred first.
Symptom burden was assessed using the Dialysis Symptom Index, a validated patient-reported outcome measure covering 30 symptoms. Data were collected every 3 to 6 months, along with clinical and laboratory parameters.
During follow-up, 4,730 symptom assessments were recorded. Overall, symptom progression was gradual, with the number of symptoms increasing by an average of 0.47 per year. Symptom burden also rose with worsening kidney function, increasing by 0.75 symptoms for every 5 mL/min/1.73 m² decline in eGFR.
The study led to the following findings:
- Women reported a higher number of symptoms than men at baseline and throughout follow-up, with average counts of 13.6 compared to 10.9.
- The rate of increase in symptom burden over time was faster in men than in women.
- Men experienced an average increase of 0.58 symptoms per year.
- Women showed a slower increase, with an average of 0.24 symptoms per year.
- Symptom burden increased with declining kidney function in both sexes.
- In men, symptom burden rose by nearly one additional symptom for every 5 mL/min/1.73 m² decrease in eGFR.
- In women, the increase in symptom burden with declining eGFR was smaller.
- The relationship between worsening kidney function and symptom burden was non-linear.
- A sharper rise in symptom number and severity was observed at lower eGFR levels, especially in men.
The authors emphasize that while women tend to report a higher overall symptom load, men may require closer monitoring due to the faster pace of symptom progression. They also highlight the variability in individual symptom experiences, underscoring the importance of routinely incorporating patient-reported outcome measures into nephrology practice.
These findings reinforce the need for personalized care strategies and improved communication between patients and clinicians, particularly as CKD advances and symptom burden intensifies.
Reference:
Chesnaye, N. C., Wrackefeldt, J., Caskey, F. J., Dekker, F. W., Torino, C., Szymczak, M., Drechsler, C., Wanner, C., Vilasi, A., Meuleman, Y., Pippias, M., Stel, V. S., Jager, K. J., Evans, M., Schneider, A., Torp, A., Iwig, B., Perras, B., Marx, C., . . . Kuan, Y. The evolution of symptom burden in older men and women with advanced CKD. Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfag045
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