Impact of chronic kidney disease
Chronic kidney disease (CKD) is a serious disease that has a substantial impact on individuals, families and the Australian health system.
This section comments on the quality of life of people living with CKD, and presents 2 key measures of impact:
Quality of life has no agreed definition but is often described in terms of subjective well-being and life satisfaction. When applied to health, it refers to the effects of disease, injury or treatments as perceived and reported by the individuals themselves (Morton and Webster 2014).
CKD can affect a person’s quality of life in many ways. Symptoms such as fatigue, fluid retention, bone pain, peripheral neuropathy or sleep disturbance as well as side effects from medication or kidney replacement therapy (KRT) can adversely affect daily living (Eranga Yapa et al. 2021). CKD diagnosis and progression may have an impact on mental health, most commonly through experiencing grief, anxiety or depression. Limitations on diet and travel for those on dialysis, satisfaction with care or unmet needs for information and support services, financial demands, and spiritual well-being can also affect quality of life.
Quality of life declines as a person’s kidney damage and loss of function increases (Morton and Webster 2014). Each stage of CKD from diagnosis – through decline of kidney function, KRT with dialysis or transplantation, to end-of-life care – can have a negative impact (Bonner et al. 2018). For some people with CKD, quality of life becomes a more important consideration than length of life, and they may decide to end their dialysis treatment in favour of end-of-life care.
In 2011–12, adults with biomedical signs of CKD were more likely to rate their health as fair/poor, than adults without biomedical signs of CKD (23% and 12%) (AIHW analysis of ABS 2013). CKD has a greater impact on the quality of life of younger people than older people (Francis et al. 2019, Tong et al. 2013). The combination of CKD and diabetes also has an adverse impact – people with both diseases have substantially poorer quality of life than those with only one of these diseases (Wyld et al. 2021).
ABS (Australian Bureau of Statistics) (2013) Microdata: Australian Health Survey, 2011–12, AIHW analysis of detailed microdata, accessed 1 October 2021.
Bonner A, Chambers S, Healy H, Hoy W, Mitchell G, Kark A et al. (2018) ‘Tracking patients with advanced kidney disease in the last 12 months of life’, Journal of Renal Care, 44:115–122, doi: 10.1111/jorc.12239.
Eranga Yapa H, Purtell L, Chambers S and Bonner A (2021) Alterations in symptoms and health-related quality of life as kidney function deteriorates: a cross-sectional study, Journal of Clinical Nursing, 30:1787–1796, doi: 10.1111/jocn.15738.
Francis A, Didsbury MS, van Zwieten A, Chen K, James LJ, Kim S et al. (2019) Quality of life of children and adolescents with chronic kidney disease: a cross-sectional study, Archives of Disease in Childhood, 104: 134–140, doi:10.1136/archdischild-2018-314934.
Morton RL and Webster AC (2014) Quality of life in chronic kidney disease, in Merici M (ed.) Management of chronic kidney disease: a clinician’s guide, Springer, Berlin, doi: 10.1007/978-3-642-54637-2_37.
Tong A, Wong G, McTaggart S, Henning P, Mackie F, Carroll RP et al. (2013) Quality of life of young adults and adolescents with chronic kidney disease, The Journal of Paediatrics, 163:1179–85.e5, doi: 10.1016/j.jpeds.2013.04.066.
Wyld MLR, Morton RL, Aouad L, Magliano D, Polkinghorne KR and Chadban S (2021) The impact of comorbid chronic kidney disease and diabetes on health-related quality-of-life: a 12-year community cohort study, Nephrology Dialysis Transplantation, 36:1048–1056, doi: 10.1093/ndt/gfaa031.