Physical, cognitive and emotional factors contributing to quality of life, functional health and participation in community dwelling in chronic kidney disease

PLoS One. 2014 Mar 10;9(3):e91176. doi: 10.1371/journal.pone.0091176. eCollection 2014.


Background: Quality of life (QoL) impairment is a well-known consequence of chronic kidney disease (CKD). The factors influencing QoL and late life functional health are poorly examined.

Methods: Using questionnaires combined with neuropsychological examinations, we prospectively evaluated physical, cognitive, and emotional factors influencing QoL, functional health and participation in community dwelling in 119 patients with CKD stages 3-5 including hemodialysis (61.5±15.7years; 63% men) and 54 control patients of the same age without CKD but with similar cardiovascular risk profile.

Results: Compared with control patients, CKD patients showed impairment of the physical component of QoL and overall function, assessed by the SF-36 and LLFDI, whereas disability, assessed by LLFDI, was selectively impaired in CKD patients on hemodialysis. Multivariable linear regressions (forced entry) confirmed earlier findings that CKD stage (β = -0.24; p = 0.012) and depression (β = -0.30; p = 0.009) predicted the QoL physical component. Hitherto unknown, CKD stage (β = -0.23; p = 0.007), cognition (β = 0.20; p = 0.018), and depression (β = -0.51; <0.001) predicted disability assessed by the LLFDI, while age (β = -0.20; p = 0.023), male gender (B = 5.01; p = 0.004), CKD stage (β = -0.23; p = 0.005), stroke history (B = -9.00; p = 0.034), and depression (β = -0.41; p<0.001) predicted overall function. Interestingly, functional health deficits, cognitive disturbances, depression, and anxiety were evident almost only in CKD patients with coronary heart disease (found in 34.2% of CKD patients). The physical component of QoL and functional health decreased with age and depressive symptoms, and increased with cognitive abilities.

Conclusions: In CKD, QoL, functional health, and participation in community dwelling are influenced by physical, cognitive, and emotional factors, most prominently in coronary heart disease patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Affect
  • Case-Control Studies
  • Cognition*
  • Cohort Studies
  • Community Participation*
  • Depression / psychology
  • Emotions*
  • Female
  • Health*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / pathology
  • Myocardial Infarction / physiopathology
  • Quality of Life*
  • Renal Dialysis
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / physiopathology*
  • Residence Characteristics*

Grant support

This work was supported by the Federal Ministry of Education and Research (BMBF/NGFN 01GR0807), the Heinz Nixdorf Foundation, and Dr. Werner Jackstädt Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.