Quality of Life in Pre-Dialysis Chronic Kidney Disease: Influence of Gender, Stage, Symptom Burden, and Comorbidities

Abstract

Introduction. Chronic kidney disease (CKD) negatively affects health-related quality of life (HRQoL) even in the pre-dialysis stages. However, data regarding gender- and stage-related differences in Eastern European CKD populations remain sparse compared to major international cohorts like CRIC and DOPPS. In this study, Low quality of life (low QoL) was defined as a Physical Component Summary (PCS) score below the 25th percentile of the cohort distribution. Materials and Methods. This cross-sectional study included 989 adults with CKD stages I–V undergoing conservative management. HRQoL was evaluated using the KDQOL-36™ questionnaire. We performed gender and CKD stage comparisons, Pearson correlations, and multivariate logistic regression to identify predictors of low QoL. Symptom burden was assessed via structured patient interviews, complemented by the KDQOL-36™ symptom domain to ensure standardized reporting. Results. The mean patient age was 58.3 ± 12.5 years, and 52.8% were male. The mean PCS and Mental Component Summary (MCS) scores were 40.2 ± 10.8 and 43.5 ± 11.2, respectively. Women had lower PCS scores than men (38.0 vs. 41.0; p < 0.05) and a higher prevalence of fatigue (95.0% vs. 85.0%) and dysuria (70.8% vs. 52.6%; p < 0.001). QoL declined progressively with advancing CKD stage (PCS 44.2 in stages I–II vs. 34.5 in stages IV–V; p < 0.001), and PCS correlated positively with eGFR (r ≈ 0.45; p < 0.001). Independent predictors of low QoL included advanced CKD stage (OR 2.72), diabetes (OR 1.94), anemia (OR 1.80), hypoalbuminemia (OR 1.70), a disease duration of >5 years (OR 1.50), and female sex (OR 1.38). Conclusions. HRQoL is substantially impaired in pre-dialysis CKD, particularly among women and patients with advanced disease, highlighting the need for targeted, patient-centered interventions.