The Impact of Health-Related Quality of Life and Comorbidities in Chronic Kidney Disease: A Hospital-Based Cross-Sectional Study
Abstract
Background: Chronic kidney disease (CKD) is a primary global health concern, often progressing silently and leading to severe complications in later stages.
Methods: A hospital-based cross-sectional study was conducted over six months among 196 CKD patients (stages 3–5D) at a tertiary care hospital. Health-related quality of life (HRQoL) was assessed using the validated Malayalam version of the KDQOL-SF™ 1.3 questionnaire. Sociodemographic, clinical, and biochemical data were collected, and CKD staging was based on the CKD-EPI equation. The impact of 12 common comorbidities was analyzed using patient history, clinical evaluation, and laboratory data. Statistical analysis included ANOVA, chi-square tests, Pearson’s correlation, and logistic regression, with p < 0.05 considered statistically significant.
Results: Quality of life (QOL) declined notably as CKD progressed from stage 3 to stage 5, with stage 5 patients exhibiting higher creatinine, lower hemoglobin, and increased serum uric acid and urea levels. HRQoL scores, measured by KDQOL-SF 1.3, worsened across all dimensions, with stage 3 patients having higher SF-36 scores than those in stages 4 and 5. Comorbidities such as hypertension, diabetes, hyperlipidemia, and heart issues were prevalent and significantly impacted CKD progression. Regression analysis highlighted that age above 55, proteinuria, hyperuricemia, unhealthy BMI, and lower GFR were linked to having multiple comorbidities in CKD patients, accelerating progression to stage 5 and increasing treatment burdens.
Conclusion: Chronic kidney disease (CKD) significantly impairs health-related quality of life, with the impact intensifying in advanced stages and in the presence of multiple comorbidities.
Keywords: chronic kidney disease, diabetes, hypertension, quality of life
Keywords:
chronic kidney disease, diabetes , hypertension, quality of lifeDOI
https://doi.org/10.22270/jddt.v15i7.7268References
1. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet2020
2. Jha V, Modi G. Uncovering the rising kidney failure deaths in India. Lancet Glob Health. 2017;5:e14-5. doi: 10.1016/S2214-109X(16)30299-6. https://doi.org/10.1016/S2214-109X(16)30299-6 PMid:27955771
3. G. Eknoyan, N. Lameire, K. Eckardt, B. Kasiske, D. Wheeler, A. Levin et al., "KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease," Kidney International Supplements, vol. 3, no. 1, pp. 5-14, 2013.
4. Singh, A.K.; Farag, Y.M.; Mittal, B.V.; Subramanian, K.K.; Reddy, S.R.K.; Acharya, V.N.; Almeida, A.F.; Channakeshavamurthy, A.; Ballal, H.S.; Gaccione, P.; et al. Epidemiology and risk factors of chronic kidney disease in India-Results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol. 2013, 14, 114. https://doi.org/10.1186/1471-2369-14-114 PMid:23714169 PMCid:PMC3848478
5. Sharma S, Kalra D, Rashid I, et al. Assessment of Health-Related Quality of Life in Chronic Kidney Disease Patients: A Hospital-Based Cross-Sectional Study. Medicina (Kaunas). 2023;59(10):1788. Published 2023 Oct 8. https://doi.org/10.3390/medicina59101788 PMid:37893506 PMCid:PMC10608694
6. Health-related quality of life for pediatric patients with end-stage kidney disease: A systematic review and meta-analysis of the Pediatric Quality of Life Inventory (PedsQL)
7. Jung, HY., Jeon, Y., Park, Y. et al. Better Quality of Life of Peritoneal Dialysis compared to Hemodialysis over a Two-year Period after Dialysis Initiation. Sci Rep 9, 10266 (2019). https://doi.org/10.1038/s41598-019-46744-1 PMid:31312004 PMCid:PMC6635359
8. Jha V., Wang A.Y.-M., and Wang H. The impact of CKD identification in large countries: the burden of illness. Nephrol Dial Transplant. 2012. 27(suppl 3): p. iii32-iii38. https://doi.org/10.1093/ndt/gfs113 PMid:23115140
9. Manju L, Joseph J, Beevi N. Validation of kidney disease quality of life short form 36 (KDQOL-SFTM) in Malayalam among patients undergoing haemodialysis in South Kerala. Indian J Nephrol. 2020;30(5):316-320 https://doi.org/10.4103/ijn.IJN_139_19 PMid:33707818 PMCid:PMC7869649
10. Levey A. S., Stevens L. A., Schmid C. H., et al. A new equation to estimate glomerular filtration rate. Annals of Internal Medicine. 2009;150(9):604-612. https://doi.org/10.7326/0003-4819-150-9-200905050-00006 PMid:19414839 PMCid:PMC2763564
11. Hays RD, Kallich JD, Mapes DL, et al. Kidney Disease Quality of Life Short Form (KDQOL-SFTM), Version 1.3: A Manual for Use and Scoring. St Monica Rand; 1997:7994.
12. Fletcher BR, Damery S, Aiyegbusi OL, et al. Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis. PLoS Med. 2022;19(4):e1003954. Published 2022 Apr 6. https://doi.org/10.1371/journal.pmed.1003954 PMid:35385471 PMCid:PMC8985967
13. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023.
14. Manavalan M, Majumdar A, Harichandra Kumar KT, Priyamvada PS. Assessment of health-related quality of life and its determinants in patients with chronic kidney disease. Indian J Nephrol. 2017;27(1):37-43. https://doi.org/10.4103/0971-4065.179205 PMid:28182041 PMCid:PMC5255988
15. Kefale B, Alebachew M, Tadesse Y, Engidawork E. Quality of life and its predictors among patients with chronic kidney disease: A hospital-based cross sectional study. PLoS One. 2019;14(2):e0212184. Published 2019 Feb 27. https://doi.org/10.1371/journal.pone.0212184 PMid:30811447 PMCid:PMC6392259
16. Cruz MC, Andrade C, Urrutia M, Draibe S, Nogueira-Martins LA, Sesso Rde C. Quality of life in patients with chronic kidney disease. Clinics (Sao Paulo). 2011;66(6):991-995. https://doi.org/10.1590/S1807-59322011000600012 PMid:21808864 PMCid:PMC3130152
17. Effectiveness of education and exercise on quality of life among patients undergoing hemodialysis Lazarus, Eilean Rathinasamy, Clinical Epidemiology and Global Health, Volume 7, Issue 3, 402 – 408 https://doi.org/10.1016/j.cegh.2018.07.003
18. Drew D.A., Weiner D.E., Sarnak M.J. Cognitive impairment in CKD: Pathophysiology, management, and prevention. Am. J. Kidney Dis. 2019;74:782-790. https://doi.org/10.1053/j.ajkd.2019.05.017 PMid:31378643 PMCid:PMC7038648
19. Ramesh, Shewta & Tomy, Chitra & Nair, Rajesh & Olickal, Jeby & Joseph, Joseph & Kavumpurath, Raman & Thankappan,. (2024). Correlation of self-management and social support with quality of life in patients with chronic kidney disease undergoing hemodialysis: A cross-sectional study from Kerala, India. Clinical Epidemiology and Global Health. 29. https://doi.org/10.1016/j.cegh.2024.101731
20. Pandiyambakkam Rajendran, K., Anbazhagan, R., Ramalingam, S. et al. A cross-sectional study to assess the health-related quality of life of patients on haemodialysis in Chennai. Egypt J Intern Med 36, 89 (2024). https://doi.org/10.1186/s43162-024-00356-y
21. Marin AE, Redolat R, Gil-Gómez JA, Mesa-Gresa P. Addressing Cognitive Function and Psychological Well-Being in Chronic Kidney Disease: A Systematic Review on the Use of Technology-Based Interventions. Int J Environ Res Public Health. 2023;20(4):3342. Published 2023 Feb 14. https://doi.org/10.3390/ijerph20043342 PMid:36834042 PMCid:PMC9961918
22. Yang M, Fox CH, Vassalotti J, Choi M. Complications of progression of CKD. Adv Chronic Kidney Dis. 2011;18(6):400-405. https://doi.org/10.1053/j.ackd.2011.10.001 PMid:22098657
23. Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Prim Care. 2008 Jun;35(2):329-44, vii. https://doi.org/10.1016/j.pop.2008.01.008 PMid:18486718 PMCid:PMC2474786
24. MacRae C, Mercer SW, Guthrie B, Henderson D. Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care. Br J Gen Pract. 2021;71(704):e243-e249. Published 2021 Feb 25. https://doi.org/10.3399/bjgp20X714125 PMid:33558333 PMCid:PMC7888754
25. Lau DCW, Shaw E, McMullen S, et al. Acute and chronic complication profiles among patients with chronic kidney disease in Alberta, Canada: a retrospective observational study. BMC Nephrol. 2024;25(1):244. Published 2024 Jul 29. https://doi.org/10.1186/s12882-024-03682-z PMid:39080608 PMCid:PMC11288078
26. Li, Y., Barve, K., Cockrell, M. et al. Managing comorbidities in chronic kidney disease reduces utilization and costs. BMC Health Serv Res 2023;23:1418. https://doi.org/10.1186/s12913-023-10424-8 PMid:38102650 PMCid:PMC10722800
27. Tonelli M, Wiebe N, Guthrie B, et al. Comorbidity as a driver of adverse outcomes in people with chronic kidney disease. Kidney Int. 2015;88(4):859-866. https://doi.org/10.1038/ki.2015.228 PMid:26221754
28. Carmine Zoccali, Francesca Mallamaci, Marcin Adamczak, Rodrigo Bueno de Oliveira, Ziad A Massy, Pantelis Sarafidis, Rajiv Agarwal, Patrick B Mark, Peter Kotanko, Charles J Ferro, Christoph Wanner, Michel Burnier, Raymond Vanholder, Andrzej Wiecek, Cardiovascular complications in chronic kidney disease: a review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association, Cardiovascular Research, 2023;119(11):2017-2032, https://doi.org/10.1093/cvr/cvad083 PMid:37249051 PMCid:PMC10478756
Published
Abstract Display: 531 
PDF Downloads: 410 PDF Downloads: 58 How to Cite
Issue
Section
Copyright (c) 2025 Blessy Biju , Adlin D’cruz, Sneha Jiby , Melvin Devassy , Rosmin Jacob
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
How to Cite
.