Health-related quality of life predicts outcomes but is not affected by peritoneal clearance: The ADEMEX trial

Paniagua, Ramón; Amato, Dante; Vonesh, Edward F.; Guo, Amy; Mujais, Salim

doi:10.1111/j.1523-1755.2005.00175.x

Cited by 100 publications

(98 citation statements)

References 49 publications

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“…Thus initial poor HRQoL is a risk factor for chronic pain following cholecystectomy (13) and lumbar surgery (14). HRQoL is a predictor for work ability and disability for patients with low-back or neck problems (15), a measure with predictive value for dialysis patients' survival and hospitalization (16), a predictor of survival for patients before admission to a intensive care unit (17), and even a predictor for failure of surgical revascularization for critical lower limb ischemia with graft occlusion and amputation (18). Since the present sample of DFU patients has low HRQoLdratings similar to that of, for example, recurrent breast cancer patients (19)dit therefore gives an adequate opportunity to assess the predictive effects of HRQoL for DFU patients.…”

Section: Discussionmentioning

confidence: 99%

Health-Related Quality of Life Predicts Major Amputation and Death, but Not Healing, in People With Diabetes Presenting With Foot Ulcers: The Eurodiale Study

et al. 2014

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Low health-related quality of life (HRQoL) has been consistently reported to be associated with poor prognosis for a variety of health outcomes in various settings. We aimed to evaluate whether HRQoL in patients presenting with new diabetic foot ulcers (DFUs) has prognostic significance for ulcer healing, major amputation, and death. RESEARCH DESIGN AND METHODSWe followed 1,088 patients with new DFUs presenting for treatment at one of the 14 centers in 10 European countries participating in the Eurodiale (European Study Group on Diabetes and the Lower Extremity) study, prospectively until healing (76.9%), major amputation (4.6%), or death (6.4%) up to a maximum of 1 year. At baseline, patient and ulcer characteristics were recorded as well as EQ-5D, a standardized instrument consisting of five domains and a visual analog scale for use as a measure of HRQoL. The prognostic influence of the EQ-5D domains was evaluated in multivariable Cox regression analyses on the time-to-event data, adjusting for baseline clinical characteristics of the ulcer and comorbidities. RESULTSWhile predictive effects of HRQoL, adjusted for possible confounders, were absent for healing, decreased HRQoL, especially in the physical domains, was statistically significant for major amputation (mobility, self-care, usual activities) and death (self-care, usual activities, pain/discomfort). CONCLUSIONSLow HRQoL appears to be predictive for major amputation and death, but high HRQoL does not increase healing. Future studies into the influence of HRQoL on ulcer outcome are important in attempts to decrease treatment failure and mortality.

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Section: Discussionmentioning

confidence: 99%

Health-Related Quality of Life Predicts Major Amputation and Death, but Not Healing, in People With Diabetes Presenting With Foot Ulcers: The Eurodiale Study

et al. 2014

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“…In the Adequacy of Peritoneal Dialysis in Mexico trial of peritoneal dialysis, Paniagua et al (51) reported that increased dialysis clearance had no effect on quality of life (QOL). Dialysis patients often show a decline in healthrelated QOL with time on dialysis (52).…”

Section: Quality-of-life Benefits Of Early Dialysismentioning

confidence: 99%

“…They also have a high prevalence of sleep disorders, depression, pain, and anxiety. A dialysis patient with poor general health perception (low QOL score) will have a much higher risk of death and hospitalization compared with those with higher QOL score (51). Depressive symptoms, common in the dialysis population, double a patient's likelihood of death (53).…”

Section: Quality-of-life Benefits Of Early Dialysismentioning

confidence: 99%

Early Start of Dialysis

Rosansky¹,

Glassock²,

Clark³

2011

Clinical Journal of the American Society of Nephrology

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SummaryIn the US, patients who initiate dialysis "early" (at Modification of Diet in Renal Disease estimated GFR [eGFR]> 10 ml/min per 1.73m 2 ) account for over 50 percent of new dialysis starts. This trend to an early start is based on conventional wisdoms regarding benefits of dialytic clearance, that albumin levels are nutritional markers, and early dialytic therapy is justified to improve nutrition especially in diabetics and that waiting until low levels of eGFR (i.e., <6 ml/min per 1.73m2 ) may be dangerous. In order to justify early dialysis treatment, the therapy must provide a morbidity, mortality, or quality of life benefit. The current review examines whether early dialysis initiation provides any of these benefits and whether the conventional wisdoms that have promoted this early dialysis trend are valid. Utilizing this information and the results of recent large observational studies and the randomized controlled Initiating Dialysis Early and Late (IDEAL) study, we suggest that dialysis initiation is justified at GFR levels of 5-9 ml/min/1.73m 2 , if accompanied by uremia symptoms or fluid management issues.

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“…Furthermore, there has been little progress in improving HRQOL of dialysis patients over the past decade (2), although routine follow-up of HRQOL is mandated by the US Centers for Medical Services. Low HRQOL has been associated with increased rates of hospitalization and death in dialysis patients (3)(4)(5)(6)(7)(8)(9). Among the components of HRQOL, self-reported mental health has been linked with higher mortality in dialysis patients in several studies (4)(5)(6)10,11).…”

Section: Introductionmentioning

confidence: 99%

The Association of Mental Health over Time with Cardiac Outcomes in HEMO Study Patients

Kang

Pike

Ramer

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Poor mental health over time is significantly associated with cardiovascular morbidity and mortality in the general population, which is the leading cause of death in dialysis patients. Most studies of dialysis patients, however, have investigated the relationship between baseline mental health measurements and all-cause mortality and not mental health measured longitudinally throughout a study and cause-specific mortality. Design, setting, participants, & measurements This study examined the association of changes in mental health over time with all-cause and cause-specific deaths and cardiac hospitalizations in the Hemodialysis study patients. Mental health was assessed at baseline and annually during the study with short form 36 mental health index scores. Poorer mental health was defined by a mental health index score≤60. Results Patients with poorer mental health at baseline were more likely to have less than a high school education and be unmarried, have significantly higher index of coexistent disease scores, and report taking β-blockers and sleep medications. Low mental health scores over time were independently associated with a decrease in survival time from all-cause mortality by −0.06 (−0.10, −0.03; P<0.001), and they also significantly hastened time to first cardiac hospitalization by −0.08 (−0.13, −0.02; P=0.01) and composite of first cardiac hospitalization or cardiac death by −0.04 (−0.07, −0.02; P<0.001). Conclusions This study found an independent association between poor mental health over time and all-cause mortality, cardiac hospitalization, and the composite of cardiac death or cardiac hospitalization in hemodialysis patients. The results underscore the importance of attention to mental health related to cardiac complications and even death in dialysis patients.

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Health-related quality of life predicts outcomes but is not affected by peritoneal clearance: The ADEMEX trial

Abstract: We found no evidence of a long-term benefit in HRQOL of CAPD patients by increasing peritoneal small-solute clearances when HRQOL parameters were adjusted for patient dropout. Measures of HRQOL have a significant predictive value for patient survival and hospitalizations.

Cited by 100 publications

References 49 publications

Health-Related Quality of Life Predicts Major Amputation and Death, but Not Healing, in People With Diabetes Presenting With Foot Ulcers: The Eurodiale Study

Health-Related Quality of Life Predicts Major Amputation and Death, but Not Healing, in People With Diabetes Presenting With Foot Ulcers: The Eurodiale Study

Early Start of Dialysis

The Association of Mental Health over Time with Cardiac Outcomes in HEMO Study Patients

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