# Health-related quality of life in nondialysis CKD patients: a comprehensive description of five-year trajectories among the CKD–REIN cohort

## TL;DR

This study identifies different quality-of-life patterns in CKD patients over five years, showing varied physical health trajectories but stable mental health.

## Contribution

The study introduces a novel approach to classify long-term quality-of-life trajectories in nondialysis CKD patients using a joint latent class–mixed model.

## Key findings

- Three distinct physical component summary (PCS) trajectories were identified among CKD patients.
- Mental component summary (MCS) showed a single stable trajectory over time.
- Patients with a high and declining PCS trajectory had faster eGFR decline and less favorable baseline profiles.

## Abstract

Few studies have analyzed the quality-of-life trajectories of CKD patients not receiving kidney replacement therapy, and the results are inconsistent. This study aimed to identify subgroups of long-term trajectories of the physical (PCS) and mental components summary (MCS) of the KDQOL-36 in patients with CKD stages 3–5 and to describe their associations with patient characteristics.

We used a joint latent class–mixed model to identify the PCS and MCS trajectories of 2716 patients with CKD stages 3–5 enrolled in the CKD–Renal Epidemiology and Information Network (CKD–REIN) cohort study. Quality-of-life was assessed annually using the Kidney Disease Quality-of-life-36. All the participants had scores for at least one-time point.

During a median follow-up of 5.56 (4.77–6.16) years, 664 participants started KRT, and 465 died before KRT. We identified three profiles of PCS: a “High and declining PCS trajectory” which included 5.89% of patients, characterized by a higher initial score and a decline of more than 10 points over three years; a “High and stable PCS trajectory” in 50.96%, characterized by a higher initial score that remained stable; and a “Low and stable PCS trajectory” in 43.15%, characterized by a lower initial score that remained stable. For MCS, we identified a single, stable mean trajectory over time. A decline in eGFR was faster in participants with a “High and declining PCS trajectory” (-4.30 mL/min per years). Patients in the high and stable trajectory had a more favorable clinical and biological profile at baseline. The evolution of the specific dimensions of CKD within each PCS trajectory followed a pattern similar to that of the PCS itself.

The study highlights substantial heterogeneity in PCS evolution in patients with CKD, which contrasts with the stability of that for MCS.

The online version contains supplementary material available at 10.1186/s12882-025-04702-2.