Symptom Burden and Patient-Reported Outcomes in Kidney Transplant Recipients: Results From the TransplantLines Biobank and Cohort Studies
Year: 2025
Type: article
Study design: Observational Study
Abstract: Rationale & Objective A multitude of symptoms may contribute to low health-related quality of life (HRQoL) in kidney transplant recipients (KTR). We aimed to identify the most occurring and distressing symptoms, to explore potential determinants of symptom burden, and to examine associations with patient-reported outcomes in KTR. Study Design A cross-sectional retrospective patient-reported outcome measures study. Setting & Participants Stable KTR ≥1 year after transplantation participating in the TransplantLines Biobank and Cohort Studies. Predictors Clinical variables, including sex, age, and time after transplantation. Outcomes Symptom occurrence/distress/burden, medication adherence, symptoms of depression/anxiety, societal participation, and HRQoL. Analytical Approach Symptoms were evaluated using ridit analyses. A burden score was calculated to explore determinants of symptom burden and its associations with other patient-reported outcomes. Results We included 936 KTR (38.8% female; mean ± SD age, 55.6 ± 13.0 years) at a median [IQR] of 2.0 [1.0-9.0] years after transplantation. Based on ridit scores, most occurring symptoms were tiredness [0.724], bruises [0.718], and lack of energy [0.688]; most distressful symptoms were menstrual problems [0.679], impotence [0.654], and joint pain [0.611]. Worse nutritional status ( P < 0.001), being female ( P < 0.001), cyclosporine use ( P = 0.005), and proton pomp inhibitor use ( P < 0.001) were associated with higher symptom burden. Higher symptom burden was associated with medication nonadherence, symptoms of depression and anxiety, lower societal participation, and lower physical and mental HRQoL (st.β = –0.53, 95% CI –0.59 to –0.47, P <0.001 and st.β=-0.53, 95% CI –0.60 to –0.46, P < 0.001, respectively). Limitations No causality can be established because of the cross-sectional design. Conclusions The most occurring symptoms were tiredness, bruises, and lack of energy, and the most distressing symptoms were menstrual problems, impotence, and joint pain. The strongest determinants of symptom burden were female sex, malnutrition, cyclosporine use, and proton pump inhibitor use. The associations of symptom burden with patient-related outcomes underline the importance of addressing symptom status after transplant. Plain-language Summary Symptom burden of immunosuppressive medication may cause lower health-related quality of life (HRQoL) in kidney transplant recipients (KTR). Therefore, we aimed to assess (1) symptom occurrence and distress, (2) determinants of symptom burden, and (3) associations of symptom burden with HRQoL and other patient-reported outcomes. In 936 KTR, the most occurring symptoms were tiredness, bruises, and lack of energy, and the most distressing symptoms were menstrual problems, impotence, and joint pain. Being female, having malnutrition, using cyclosporine, and using proton pump inhibitors were determinants of high symptom burden. Furthermore, a higher symptom burden was associated with more medication nonadherence, more symptoms of anxiety/depression, lower societal participation, and lower physical and mental HRQoL. These findings may help improve patient-centered health care.
Source: Kidney Medicine
Authors: Niels L. Riemersma, Tim J. Knobbe, Daan Kremer, Svea Nolte, Ute Bültmann, Coby Annema, Naser B.N. Shehab, Michele F. Eisenga, Stefan P. Berger, Stephan J.L. Bakker, C. Annema, S.J.L. Bakker, S.P. Berger, H. Blokzijl, F.A.J.A. Bodewes, M.T. de Boer, Damman, M.H. de Borst, A. Diepstra, G. Dijkstra, R.M. Douwes, C.S.E. Doorenbos, M.F. Eisenga, M.E. Erasmus, C.T. Gan, A.W.Gomes Neto, A.M. Posthumus, E. Hak, B.G. Hepkema, J. Jonker, F. Klont, T.J. Knobbe, D. Kremer, H.G.D. Leuvenink, W.S. Lexmond, V.E. de Meijer, G.J. Nieuwenhuis-Moeke, H.G.M. Niesters, L.J. van Pelt, R.A. Pol, A.V. Ranchor, J.S.F. Sanders, M.J. Siebelink, R.J.H.J.A. Slart, J.C. Swarte, D.J. Touw, M.C. van den Heuvel, C. van Leer-Buter, M. van Londen, Charlotte A. te Velde-Keyzer, E.A.M. Verschuuren, M.J. Vos, R.K. Weersma
Institutions: University Medical Center Groningen, University of Groningen
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,590
OpenAlex ID: W4415755547