Predictors for persistent somatic symptoms in patients with chronic kidney disease
Seven out of ten people with chronic kidney disease (CKD) experience burdensome persistent somatic symptoms (PSS) in earlier stages of CKD. Despite its prevalence and importance for quality of life, disease progression and mortality, PSS in CKD is poorly understood and often remains untreated. Growing evidence shows that a biopsychosocial perspective can best explain the pathogenesis of PSS in earlier stages of kidney disease. Only an integrated anaylsis of biomedical, treatment-related and psychosocial risk factors can identify etiological mechanisms and modifiable predictors of somatic symptom burden in earlier stages of CKD.
Our overarching aim is to deepen the understanding of the development and maintenance of PSS in CKD. Therefore, we will investigate biopsychosocial risk factors of PSS and their interactions in a multivariate prognostic prediction model. We will analyse unfavourable symptom trajectories, their predictors and causal relations over time. In the embedded mixed-methods study with newly diagnosed patients with CKD, we will investigate experimentally mechanisms of symptom perception and qualitatively mechanisms of symptom development.
A mixed-methods cohort study with three assessment points (Baseline, 6 and 12 months) examines multivariate predictors for PSS in 330 patients with CKD stadium 2-4. Primary endpoint is CKD specific somatic symptom burden, secondary endpoint includes CKD related quality of life, general symptom burden and functionality. Predictors based on the adapted biopsychosocial working model of FOR SOMACROSS, include biomedical (e.g. epigenetic mechanisms and biomarker suPAR), treatment-related (e.g. side effects) and psychosocial variables (e.g. expectations).
The interdisciplinary biopsychosocial focus of subjective symptom burden will expand our understanding of PSS in CKD. We will identify the relative meaning of risk factors, explore new variables such as epigenetic mechanisms, suPAR and expectations and examine the interaction of these factors in the development and maintenance of PSS in CKD. Our results contribute to the overall aim of RU SOMACROSS which is to identify risk factors and mechanisms of PSS across various diseases. We strive to develop process based, targeted interventions to reduce symptom burden in CKD in future.