ADDITIVE INTERACTION BETWEEN LOW ESTIMATED GLOMERULAR FILTRATION RATE AND ANEMIA FOR HEALTH-RELATED QUALITY OF LIFE IN THE GENERAL POPULATION: THE KOREA NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (KNHANES) 2012

Abstract

Introduction and Aims: Few studies have explored the relationship between chronic kidney disease and health-related quality of life (HRQoL) in general population. The aim of this study was to investigate additive interaction between low estimated glomerular filtration rate (eGFR) and anemia for HRQoL in the general population.

Methods: The study population consisted of 4,980 Korea National Health and Nutrition Examination Survey (KNHANES) 2012 participants aged 19 years or older. The eGFR values were calculated by IDMS-traceable MDRD study equation. Low eGFR was defined as <60 mL/min/1.73 m2. HRQoL was determined by Korean version of EuroQol 5 Dimensions (EQ-5D)-3 levels. The logistic regression models were used to study the association between the EQ-5D and low eGFR. The odds ratios (ORs) of the lowest quartile of EQ-5D were calculated after adjusting for demographic factors (age, gender and body mass index), socioeconomic factors (marital status, household income, occupations, education level and area of residence), health-related behaviors (smoking and physical activities) and comorbidities (hypertension, diabetes mellitus, stroke, ischemic heart disease, and depression). To examine additive interaction between low eGFR and anemia for HRQoL, relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S) were calculated. RERI >0, AP >0, or S >1 indicates additive interaction.

Results: Prevalence of low eGFR was 3%. After adjusting for demographic factors, socioeconomic factors, health-related behaviors, and comorbidities, OR for the lowest quartile of EQ-5D in low eGFR group is 1.52 folds higher than that in normal eGFR group (P=0.036).

Conclusions: These findings suggest that low eGFR and anemia may reduce synergistically HRQoL in the general population.