Supplementary Material for: Evolution of Quality of Life in Chronic Kidney Disease Stage 4–5 Patients Transitioning to Dialysis and Transplantation

<b><i>Introduction:</i></b> Chronic kidney disease (CKD) has a profound effect on patients’ health-related quality of life (QoL). Longitudinal studies on QoL in CKD are scarce and have explored selected patients on renal replacement therapy (RRT). We studied the evolution of QoL in patients with advanced CKD transitioning to dialysis and transplantation in a prospective follow-up study. <b><i>Methods:</i></b> A total of 100 participants of the Chronic Arterial Disease, Quality of Life, and Mortality in Chronic Kidney Injury (CADKID) study were enrolled in the study. Kidney Disease Quality of Life Short Form, biochemistry, and echocardiography were obtained at baseline and after a median interval of 33 (range 12–85) months. <b><i>Results:</i></b> At the time of the follow-up QoL assessment, 32 patients were not receiving RRT, 30 were on hemodialysis (HD), 19 on peritoneal dialysis (PD), and 19 had received a kidney transplant. Among kidney transplant recipients (KTRs), “Burden of Kidney Disease” and “General Health” domains improved compared to patients who initiated HD (<i>p</i> &lt; 0.0001 and <i>p</i> = 0.007, respectively), PD (<i>p</i> = 0.0005 and <i>p</i> = 0.03, respectively), or remained in predialysis care (<i>p</i> = 0.009 and <i>p</i> = 0.003, respectively) while “Effects of Kidney Disease” improved compared to those who started HD (<i>p</i> = 0.004) or PD (<i>p</i> = 0.002). The change in Short Form-36 (SF-36) Physical Component Summary was not different between patients on different treatment modalities. Higher plasma albumin and cholesterol levels were associated with improved QoL in “Symptoms/Problems” (<i>r</i> = 0.28, <i>p</i> = 0.005, and <i>r</i> = 0.30, <i>p</i> = 0.004, respectively) and “Effects of Kidney Disease” (<i>r</i> = 0.27, <i>p</i> = 0.008, and <i>r</i> = 0.24, <i>p</i> = 0.03, respectively). <b><i>Conclusion:</i></b> QoL improved in KTRs in kidney disease-specific domains compared to patients initiating dialysis or those without RRT. Plasma albumin and lipids were associated with QoL over time.

**引言：** 慢性肾脏病（Chronic Kidney Disease, CKD）对患者的健康相关生活质量（Health-Related Quality of Life, QoL）具有深远影响。目前针对慢性肾脏病患者生活质量的纵向研究较为匮乏，且现有研究多仅纳入接受肾脏替代治疗（Renal Replacement Therapy, RRT）的特定人群。本研究为一项前瞻性随访研究，旨在探讨进展期慢性肾脏病患者在过渡至透析与肾移植阶段的生活质量变化轨迹。

**研究方法：** 本研究纳入了慢性动脉疾病、慢性肾损伤患者的生活质量与死亡率（Chronic Arterial Disease, Quality of Life, and Mortality in Chronic Kidney Injury, CADKID）队列共100名受试者。在基线访视及中位间隔33个月（范围12~85个月）的随访时点，分别采集受试者的肾脏病生活质量简明量表（Kidney Disease Quality of Life Short Form）检测结果、生化指标与超声心动图数据。

**研究结果：** 在本次随访生活质量评估时，32名患者未接受肾脏替代治疗，30名接受血液透析（Hemodialysis, HD），19名接受腹膜透析（Peritoneal dialysis, PD），另有19名已完成肾移植。与起始血液透析、腹膜透析或维持透析前治疗的患者相比，肾移植受者（Kidney Transplant Recipients, KTRs）的「肾脏病负担」与「总体健康」维度评分均显著改善（分别对应p<0.0001与p=0.007；p=0.0005与p=0.03；p=0.009与p=0.003）；而「肾脏病影响」维度评分仅较起始血液透析（p=0.004）与腹膜透析患者（p=0.002）显著提升。不同治疗方式患者的简明健康调查量表36（Short Form-36, SF-36）躯体成分总分变化无统计学差异。血浆白蛋白与胆固醇水平较高的患者，其「症状/问题」维度（相关系数r分别为0.28、0.30，对应p值分别为0.005、0.004）与「肾脏病影响」维度（r分别为0.27、0.24，对应p值分别为0.008、0.03）的生活质量评分更优。

**结论：** 相较于起始透析治疗或未接受肾脏替代治疗的患者，肾移植受者在肾脏病特异性生活质量维度上的表现得到显著改善。随着随访时间推移，血浆白蛋白与血脂水平与患者的生活质量显著相关。