{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:48:26Z","timestamp":1786373306028,"version":"build-2736575974"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01-NR017399"],"award-info":[{"award-number":["R01-NR017399"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01DK124453"],"award-info":[{"award-number":["R01DK124453"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32DK007540-34"],"award-info":[{"award-number":["T32DK007540-34"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Uremic symptoms, including fatigue, anorexia, pruritus, nausea, paresthesia, and pain, are attributed to the accumulation of organic waste products normally cleared by the kidneys, but whether kidney function is the primary driver of changes in symptom severity over time is not known. The goal of our study was to evaluate the association between eGFR and uremic symptom severity score in patients with CKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, and measurements<\/jats:title>\n                    <jats:p>We identified 3685 participants with CKD not on dialysis in the prospective, observational Chronic Renal Insufficiency Cohort (CRIC) Study with baseline assessment of eGFR and uremic symptom severity. Symptoms were assessed by separate questions on the Kidney Disease Quality of Life-36 instrument (zero- to 100-point scale). The longitudinal association between eGFR and uremic symptom severity score was examined with multivariable adjusted linear mixed-effects models with random intercepts and random slopes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean\u00b1SD eGFR at baseline was 44\u00b115 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      , and participants had a median of six (interquartile range 3\u201311) simultaneous assessments of eGFR and uremic symptoms over the duration of follow-up. The most prevalent symptoms at baseline were pain (57%), fatigue (52%), paresthesia (45%), and pruritus (42%). In adjusted models, a decrease in eGFR of 5 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      was associated with a worsening of the symptom severity score by two points or less for each uremic symptom (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.01; zero- to 100-point scale). The association between eGFR and uremic symptom severity score was nonlinear. When starting from a lower initial eGFR, a 5 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      decrease in eGFR was associated with a greater magnitude of uremic symptom worsening.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The prevalence of uremic symptoms in CKD is high, with significant variability in patient symptom change over time. Declines in eGFR were associated with worsening of uremic symptom severity, but the magnitude of these changes is small and of uncertain clinical significance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.13010921","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T14:45:13Z","timestamp":1646405113000},"page":"496-506","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":22,"title":["Trajectories of Uremic Symptom Severity and Kidney Function in Patients with Chronic Kidney Disease"],"prefix":"10.2215","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4832-0209","authenticated-orcid":false,"given":"Kendra E.","family":"Wulczyn","sequence":"first","affiliation":[{"name":"Nephrology Division, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia H.","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene P.","family":"Rhee","sequence":"additional","affiliation":[{"name":"Nephrology Division, Massachusetts General Hospital, Boston, Massachusetts"},{"name":"Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1746-5790","authenticated-orcid":false,"given":"Sahir","family":"Kalim","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7222-4666","authenticated-orcid":false,"given":"Tariq","family":"Shafi","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi"},{"name":"Department of Population Health, Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi"},{"name":"Department of Physiology and Biophysics, University of Mississippi Medical Center School of Medicine, Jackson, Mississippi"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,4]]},"reference":[{"key":"B1-20241015","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.2215\/CJN.09990915","article-title":"Predictors and outcomes of health-related quality of life in adults with 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