Abstract

Background: Chronic kidney disease (CKD) is prevalent in older adults and associated with reduced quality of life (QOL). The Taiwan nationwide multidisciplinary care (MDC) program for non-dialysis CKD patients (mainly stage 3b–5) was proven to improve patient outcomes, but its association with intrinsic capacity (IC), activities of daily living (ADL) and QOL remains underexplored. This study aimed to examine the associations between MDC laboratory parameters with QOL, and possible mediation effect.

Methods: A cross-sectional, observational study was conducted in a tertiary hospital in Taiwan. Outpatients enrolled in the MDC program was recruited and underwent assessments of IC (ICOPES-TW), basic ADL, instrumental ADL, frailty, and QOL (WHOQOL-AGE). Routinely monitored laboratory parameters (electrolytes, albumin, hemoglobin) served as MDC effectiveness indicators. Structural equation modeling (SEM) was employed to explore direct and mediating relationships.

Results: The 322 participants were older (mean age 74.1 years) with 81.6% of advanced CKD. Limited mobility (40%) was the most common IC deficit, while the others ranged from 7% to 11%. In linear regressions, IADL was most associated with QOL (p < 0.001); cognition was most associated with IADL (p < 0.001). Levels of phosphate, albumin, and hemoglobin were correlated significantly with QOL in Spearman's correlation analyses. SEM showed the composite of laboratory parameterswere associated with QOL, partially (20.6%) through mediation of instrumental ADL.

Conclusion: Effectiveness of MDC, as monitored by specific laboratory parameters, correlated with the QOL of older, non-dialysis CKD patients, partially through the mediation of IADL. Cognition and mobility also associated with IADL but not our MDC parameters.