# Association of Posttransplant Kidney Function With Patient Reported Outcomes: A Single Center's Experience Over Nearly Two Decades

## TL;DR

Poor kidney function after a transplant is linked to lower quality of life and more depression and anxiety symptoms in patients.

## Contribution

This study shows a strong link between declining kidney transplant function and worsened physical and mental health outcomes in patients.

## Key findings

- Lower eGFR is associated with a 1.5 times higher likelihood of depression and anxiety symptoms.
- Higher eGFR correlates with better physical and mental health-related quality of life.
- Long-term monitoring shows that improved graft function leads to better patient-reported outcomes.

## Abstract

Impaired kidney function in the non‐transplant chronic kidney disease (CKD) population has been shown to negatively affect patients’ health related quality of life (HRQOL). The relationship between posttransplant graft function, as measured by estimated glomerular filtration rate (eGFR), and patient‐reported outcomes (PRO) remains poorly understood. This study evaluates the associations between eGFR and PRO in kidney transplant recipients to inform clinical strategies aimed at optimizing both physical and psychological well‐being.

Longitudinal data were collected using previously‐described procedures and a multi‐survey PRO battery. Logistic regression models evaluated relationships, at the last follow‐up point, between eGFR strata, time posttransplant, age at PRO, whether there had been a previous kidney transplant or the donor was deceased or living, and the likelihood of physical or mental HRQOL being substantive low and of symptoms of depression or anxiety being reported. Parallel multivariable mixed effects models, that included all longitudinal data points for each participant, examined relationships between eGFR and continuous PRO scores and their temporal trajectories.

The study included 2116 adult kidney transplant recipients and over 9500 unique multi‐survey observation points over a 19‐year period. After adjusting for age (p < 0.001), donor type, time posttransplant, and prior kidney transplantation, there was a statistically significant association between eGFR/CKD strata and the likelihood of physical HRQOL being substantively low (p < 0.001) at the last PRO assessment. CKD stage 4 or 5 was independently associated with a 1.5 times increased likelihood of reporting symptoms of depression (OR: 1.50; 95% CI 1.16, 1.95) and anxiety (OR = 1.48; 95%CI: 1.14, 1.92) compared to those with eGFR ≥ 60 mL/min/1.73m2. Longitudinal analyses comprising all data points demonstrated that increased eGFR was associated with better physical and mental HRQOL and reduced symptoms of depression and anxiety.

Impaired graft function is significantly associated with decreased physical HRQOL and increased symptoms of depression and anxiety in kidney transplant recipients. These findings underscore the importance of close monitoring and early interventions targeting physical and psychological well‐being as graft function declines.