A survey on the association between patient activation and quality of life among patients with chronic kidney disease in Japan.

Abstract

Background: Little is known about the association of health-related quality of life (HRQOL) with, and level of, patient activation among patients with chronic kidney disease (CKD) in Japan.

Methods: We conducted a cross-sectional observational study using a questionnaire targeting patients with CKD across Japan from 2021 to 2023. The primary outcome was low HRQOL assessed using the short form 8 (SF-8). The risk of low HRQOL was evaluated by patient activation (using the Patient Activation Measure 13 (PAM-13)).

Results: In total, 1427 patients with CKD were included in this study. Mean age was 61.9 (standard deviation (SD) 12.7) years and 891 (62.4%) were men. Among the participants, 948 (66.4%) were treated without dialysis or kidney transplantation, 304 (21.3%) underwent hemodialysis, 72 (5.1%) underwent peritoneal dialysis, and 103 (7.2%) underwent kidney transplantation. Regarding patient activation, those belonging to higher activation groups were less likely to have low physical HRQOL compared with those belonging to lower activation groups (adjusted odds ratio (OR) 0.73, 95% confidence interval (CI) 0.55-0.96 for medium; adjusted OR 0.53, 95% CI 0.41-0.70 for high; adjusted OR 0.42, 95% CI 0.29-0.61 for the highest activation group). When stratified by type of treatment for CKD, among participants with kidney transplantation the highest activation group tended to have more low mental HRQOL participants compared with the low activation group (adjusted OR 2.44, 95% CI 0.51-12.5).

Conclusion: Among Japanese patients with CKD, lower patient activation is associated with lower physical and mental HRQOL in a dose-dependent manner. However, the highest activation may be associated with low mental HRQOL among patients undergoing kidney transplantation.