Determinants of Symptom Burden in Non-Dialysis-Dependent Chronic Kidney Disease: A Cross-Sectional Cohort Study

Understanding symptoms experienced by people with non-dialysis-dependent chronic kidney disease (NDD-CKD) may improve person-centered outcomes. We characterized symptom burden in individuals with NDD-CKD by clinical and sociodemographic characteristics. We conducted a cross-sectional analysis of electronic health record (EHR) data of patients with NDD-CKD who completed the Kidney Disease Symptom Survey (KDSS), a patient-reported outcome measure based on the Kidney Disease Quality-of-Life 36 (KDQoL-36), during routine nephrology care in a U.S. academic nephrology practice between 2022 and 2024. We considered four KDSS domains [quality of life (QoL), general health, composite physical symptoms, and composite mental health], for which lower scores indicated worse self-perceived health status. 955 individuals with NDD-CKD were included. Patients were an average of 66 years old and had a mean eGFR of 36 ml/min/1.73m 2 at the time of KDSS response. Average KDSS scores were: 7/10 for QoL; 3/5 for general health; 89/100 for physical symptoms, and 67/100 for mental health. Compared with individuals with G3a NDD-CKD, individuals with G4 and G5 NDD-CKD reported more impairments to general health, physical symptoms, and mental health. Compared to those with G3a NDD-CKD, individuals with G5 NDD-CKD had a 4.1 lower physical symptom score (95% CI -7.9, -0.27) and a 5.8 lower mental health score (95% CI -11, -0.6). QoL, general health, physical symptoms, and mental health were also worse for individuals with diabetes, heart disease, or mental health disorders, as well as for females compared to males. Individuals living in regions of greater socioeconomic deprivation reported significantly worse general health, compared to those living in regions of less deprivation. Individuals with NDD-CKD commonly experience symptoms, with a higher prevalence of symptoms reported by individuals with G4-G5 NDD-CKD, females, and those with comorbid conditions. Routine symptom monitoring is warranted in these populations to inform patient-centered care.