Disease progression in pre-dialysis patients: renal function, symptoms, and health-related quality of life

This thesis investigated the effect of several risk factors on objectively assessed disease progression (renal function decline and time until the start of renal replacement therapy) and subjectively assessed disease progression (disease-related symptoms and health-related quality of life) in patients with chronic kidney disease on specialized pre-dialysis care. Furthermore, we explored (un)known mechanisms that may determine renal function decline in pre-dialysis patients. The conclusions are: low blood pressure, low proteinuria levels, and low cholesterol levels are associated with a slower objectively assessed disease progression. However, in elderly patients low blood pressure is a marker for an earlier start of renal replacement therapy. Concerning subjectively assessed disease progression, only in young patients treated with anemia-medication, high hemoglobin levels are associated with a better health-relate d quality of life. Furthermore, symptoms increase and health-related quality of life decreases during pre-dialysis care. Therefore, these markers are good candidates for defining the optimal moment to start with dialysis. This thesis also showed that black patients experience a faster renal function decline than white patients. A possible explanation could be the stronger negative consequences of diabetes mellitus in black patients. Finally, at middle-age, renal function is higher in longevity families, revealing possible new genetic mechanisms