A qualidade de vida em pacientes transplantados renais no Brasil: estudo multicêntrico ADERE Brasil

Abstract

The global burden of chronic kidney disease makes it a public health problem, among other things, because it reduces the quality of life (QoL). There are several concepts of QOL, but there seems to be a consensus regarding the multidimensionality and subjectivity of the construct. Measuring QoL is a way of evaluating the results of health interventions, and it is the most commonly used patient-reported outcome measure after kidney transplantation (KTx). There are several available instruments for use both in research and in clinical practice. Although QoL improves after KTx, Brazilian data are scarce. The objectives of this study were to describe the QoL profile of Brazilian kidney transplant patients and to assess the dimensions of QoL defined by the instrument WHOQOL-BREF, according to the demographic variables age, sex and place of residence. It is an observational, cross-sectional, multicenter study that used secondary data from the main ADERE Brazil study. This included, by convenience, 20 transplant centers, using multistage sampling, considering the geographic location and transplant activity, which performed at least 10 KTx/year in the three years prior to the study. The sample size of each center was proportional to the number of patients under follow-up. We randomly selected patients among those who attended regular consultations. Data were collected from Dec/2015 to Jun/2017, in the RedCap program. Socioeconomic and clinical variables were analyzed to characterize the sample. The WHOQOL-BREF was used to assess general QoL and in the 4 domains: physical, psychological, environmental, and social relationships. Data were compared by generalized estimating equations (GEE). A total of 1,105 patients were included, predominantly male (58.5%), white (51.4%), with a mean age of 47.6±12.6 years. The general QoL score was 81±15.1, and, for the domains, they were: 58.6±11.6 for physical, 65.5±11.4 for psychological, 68.3±17.1 for social relationships and 64.2±13.3 environmental.. Men have higher QoL scores in the psychological domains (OR 2.62, CI: 1.29 ̶3.95, p60 years-old, respectively). Regarding access to regions, individuals living in the South/Southeast region (R2) reported higher scores only in the environment domain (OR 3.53, CI: 0.28 ̶6.78, p=0.033) and, a tendency, in the physical domain (OR 2.29, IC: -0.07 ̶4.66, p=0.057). In this large sample of KTx patients, we found the most affected domain is the physical one, and the best scores are in the social relationships domain. The subgroups with lower QoL were women and those older than>45 years old. Based on this profile, we identified which are the most beneficial aspects of KTx reported by patients and the subgroups should be target for interventions