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BackgroundTo assess health- related quality of life (HRQOL) with SF-12 and SF-36 and compare their abilities to predict mortality in chronic dialysis patients, after adjusting for traditional risk factors.MethodsThe Short-Form Health Survey (SF-36) with the embedded SF-12 was applied in 301 dialysis patients cross-sectionally. Physical and mental component summary (PCS-36, MCS-36, PCS-12, and MCS-12) scores were calculated. Clinical and demographic data were collected. Mortality (followed for up to 4.5 years) was analyzed with Kaplan Meier plots and Cox proportional hazards, after censoring for renal transplantation. Exclusion factors were observation time <2 months (n = 21) and missing component summary scores (n = 10 for SF-36; n = 28 for SF-12), thus 252 patient were included in the analyses.ResultsIn 252 patients (60.2 ± 15.5 years, 65.9% males, dialysis vintage 9.0, IQR 5.0-23.0 months), mortality during follow-up was 33.7%.(85 deaths). Significant correlations were observed between PCS-36 and PCS-12 (ρ = 0.93, p < 0.001) and between MCS-36 and MCS-12 (ρ = 0.95, p < 0.001). Mortality rate was highest in patients in the lowest quartile of PCS-12 (χ2 = 15.3, p = 0.002) and PCS-36 (χ2 = 16.7, p = 0.001). MCS was not associated with mortality. Adjusted hazard ratios for mortality were 2.5 (95% CI 1.0-6.3, PCS-12) and 2.7 (1.1 – 6.4, PCS-36) for the lowest compared with the highest (“best perceived”) quartile of PCS.ConclusionCompromised HRQOL is an independent predictor of poor outcome in dialysis patients. The SF-12 provided similar predictions of mortality as SF-36, and may serve as an applicable clinical tool because it requires less time to complete.

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Depressive and anxiety disorders were common in dialysis patients and were associated with impaired HRQoL, while prevalence of somatoform disorders was low. A strong correlation between psychiatric comorbidity, CRP and BMI indicates that special attention should be given to patients with CRP≥6 mmol/L and BMI≤21 kg/m(2).

Health-related quality of life (HRQOL) and depression in chronic dialysis patients, accepted (n = 122) or rejected (n = 93) for renal transplantation (Tx), were compared, whereas dialysis patients with pending acceptance status (n = 86) were followed for a median time of 3.6 years to assess whether HRQOL or depression predicted the likelihood of receiving a transplant. Clinical significant depression was present in 30% of the study patients. Less depression and better HRQOL were associated with being on the waiting list for Tx after adjusting for comorbidity, age, gender and dialysis vintage. During follow-up, 55% of the dialysis patients in the group with pending acceptance were transplanted. The likelihood of receiving a renal graft was based on comorbidity and not on impaired HRQOL or depression. Follow-up studies should investigate whether improved renal health after Tx translates into further improvement of HRQOL and less depression. Whether clinical depression and impaired HRQOL will impact graft survival needs to be explored.

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