Quality of Life in Dialysis Patients: A Retrospective Cohort Study

Abstract

Background/Aim: Physical component summary (PCS) and mental component summary (MCS) scores are associated with hospitalization and mortality in patients with end-stage renal disease. Most studies in these patients are cross-sectional in nature. This study aimed to assess the dynamics of health-related quality of life (HRQOL) over time, as well as determinants of changes in HRQOL. Also, the relation between changes in HRQOL with respect to both hospitalization and mortality was assessed. Methods: A cross-sectional analysis was performed in 77,848 hemodialysis (HD) patients whereas changes in HRQOL were assessed in 8,339 patients over a 1-year time period. HRQOL measurements were assessed with Kidney Disease Quality of Life-36 questionnaires. Also, relevant biomarkers (albumin, creatinine, hemoglobin, sodium) and equilibrated normalized protein catabolic rate (enPCR) were measured. Results: HRQOL were found to be decreased in HD patients. Nutritional indices like creatinine (r = 0.23; p < 0.0001) and serum albumin (r = 0.21; p < 0.0001) positively correlated with PCS scores. An increase in levels of albumin, creatinine, hemoglobin, enPCR and serum sodium over time are significantly (p < 0.0001) associated with positive changes in PCS scores. Changes in PCS scores were found to be predictive for hospitalization and mortality. The correlates of predictors for MCS scores were less strong compared to that of PCS scores. The strongest positive predictors of MCS scores were age (r = 0.08; p < 0.0001), albumin (r = 0.05; p < 0.0001) and sodium (r = 0.05; p < 0.0001). Conclusions: Nutritional factors are strongly associated with changes in HRQOL, especially with regard to PCS scores (change over time in HRQOL was an independent predictor of hospitalization and mortality). Increased scores of HRQOL over time are positively associated with survival.

Depression, anxiety and health‐related quality of life amongst patients who are starting dialysis treatment

“…Low albumin levels were associated with lower scores on physical function, energy‐fatigue, pain and social function. These results are consistent with those obtained in other studies and literature reviews, in which lower haemoglobin levels were associated with lower scores on both the mental and physical HRQL components (Valderrábano ; Ross et al ; Avramovic & Stefanovic ) and nutritional markers, such as creatinine, serum albumin, appetite, body mass index and energy intake, were strong predictors of HRQL (Allen et al ; Dwyer et al ; Spiegel et al ; Broers et al ).…”

Quality of life development during initial hemodialysis therapy and association with loss of residual renal function

“…17 Merkus et al included 85 Dutch patients and found a slight decrease in most scales; although some reached statistical significance, the changes were very small and the clinical relevance seemed limited. 21 22 In summary, HRQOL in HD patients appears quite stable over time and our findings are generally in agreement with previous studies.…”

“…Results are shown for five scales including MCS and PCS and are very similar to ours in terms of the absolute scores. Thus, over a 12‐month period changes were generally small with only two scales showing significant results, but with small absolute changes and thus questionable clinical relevance …”

Poor sleep and reduced quality of life were associated with symptom distress in patients receiving maintenance hemodialysis

“…Quality of life is an important measurement of clinical outcomes for patients on hemodialysis [5–7]; specifically, reduced PCS and MCS scores in MHD patients was associated with increased risks in hospitalization and mortality, and increase in PCS and MCS scores predicted better survival [5, 6]. The dialysis clinics in other countries, such as United States, had already included an annual measurement of health-related quality of life in most dialysis patients with the belief that quality of life monitoring has great potential to improve patient outcomes, yielding benefits that exceed burdens for patients and clinics.…”

“…However, compromised quality of life is common in patients on chronic hemodialysis [3–8]. Notably, reduced life quality was strongly associated with higher risk of death and hospitalization in hemodialysis patients [3, 5–7]. Complex factors contribute to a lower quality of life in hemodialysis patients [6–9].…”