Temporal Trends in Health-Related Quality of Life among Hemodialysis Patients in the United States

Gabbay, Ezra; Meyer, Klemens B.; Griffith, John L.; Richardson, Michelle M.; Miskulin, Dana C.

doi:10.2215/cjn.03890609

Cited by 47 publications

(47 citation statements)

References 27 publications

(24 reference statements)

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“…Depressive symptoms, common in the dialysis population, double a patient's likelihood of death (53). Importantly, QOL trends in a sample of the U.S. dialysis population remained unchanged between 1997 and 2006, despite the previously described trends toward early start during a comparable period of time (54).…”

Section: Quality-of-life Benefits Of Early Dialysismentioning

confidence: 95%

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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Section: Quality-of-life Benefits Of Early Dialysismentioning

confidence: 95%

Early Start of Dialysis

Rosansky¹,

Glassock²,

Clark³

2011

Clinical Journal of the American Society of Nephrology

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“…In the United States, the majority are treated with in-center hemodialysis (2). Patients receiving hemodialysis have a higher mortality rate and reduced quality of life compared with the general population (2,3). Although there has been some reported improvement in survival in recent years (2,4), studies have shown no improvement in quality of life (3).…”

Section: Introductionmentioning

confidence: 99%

A Thematic Synthesis of the Experiences of Adults Living with Hemodialysis

Reid

Seymour

Jones

2016

CJASN

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Background and objectives Patients on in-center dialysis spend significant amounts of time in the dialysis unit; additionally, managing ESRD affects many aspects of life outside the dialysis unit. To improve the care provided to patients requiring hemodialysis, their experiences and beliefs regarding treatment must be understood. This systematic review aimed to synthesize the experiences of patients receiving in-center hemodialysis.Design, setting, participants, & measurements We searched Embase, MEDLINE, CINAHL, PsychINFO, Google Scholar, and reference lists for primary qualitative studies published from 1995 to 2015 that explored the experiences of adult patients receiving treatment with in-center hemodialysis. A thematic synthesis was conducted.Results Seventeen studies involving 576 patients were included in the synthesis. Four analytic themes were developed. The first theme (a new dialysis-dependent self) describes the changes in identity and perceptions of self that could result from dialysis dependence. The second theme (a restricted life) describes the physical and emotional constraints that patients described as a consequence of their dependence. Some patients reported strategies that allowed them to regain a sense of optimism and influence over the future, and these contributed to the third theme (regaining control). The first three themes describe a potential for change through acceptance, adaption, and regaining a sense of control. The final theme (relationships with health professionals) describes the importance of these relationships for in-center patients and their influence on perceptions of power and support. These relationships are seen to influence the other three themes through information sharing, continuity, and personalized support.Conclusions Our synthesis has resulted in a framework that can be used to consider interventions to improve patients' experiences of in-center hemodialysis care. Focusing on interventions that are incorporated into the established relationships that patients have with their health care professionals may enable patients to progress toward a sense of control and improve satisfaction with care.

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“…Treatment time is also a clinical determinant that when associated with factors such as advanced age, female gender, low level of schooling, unemployment and low income can affect QoL (11,12). Some studies have not identified significant changes in QoL in relation to HD treatment time (13,14). However, the presence of concomitant comorbidities presented a negative correlation with the QoL domains, justifying the reduced values evidenced by these patients, which improved in some domains one year after starting HD (15).…”

Section: Introductionmentioning

confidence: 99%

Quality of life and duration of hemodialysis in patients with chronic kidney disease (CKD): a cross-sectional study

et al. 2017

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Introduction: Quality of life (QoL) of hemodialysis patients is a major evaluative marker currently measured, while treatment time is a clinical determinant associated with impaired QOL. Objective: To evaluate QOL in individuals undergoing hemodialysis (HD) considering treatment time and the presence of comorbidities. Methods: A cross-sectional study conducted in the hemodialysis unit of the Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE). We studied patients with Chronic Kidney Disease (CKD) of both genders over the age of 18 years, at any level of education and undergoing HD for at least 6 months. We evaluated the demographic/socioeconomic and clinical data, followed by application of the quality of life questionnaire (KDQOL-SF). Results: Participants were 47 patients with a mean age of 50.94 ± 13.33 years, 55.3% were male and average treatment time of 57.35 ± 61.46 months. Hypertension (59.6%) was the most frequent underlying disease. According to the responses obtained through the KDQOL-SF, the situation at work and physical limitation scored worse. Sexual function (85.83) and encouragement by the team had the best performance. There were no differences in dimensions of questionnaire and treatment time. Conclusion: The presence of comorbidities and HD duration were not found to be possible factors for changing QoL in this study. However, we suggest that future studies evaluate other factors such as laboratory, emotional and functional data to check for changes in QoL in these patients related to HD duration.

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Temporal Trends in Health-Related Quality of Life among Hemodialysis Patients in the United States

Cited by 47 publications

References 27 publications

Early Start of Dialysis

Early Start of Dialysis

A Thematic Synthesis of the Experiences of Adults Living with Hemodialysis

Quality of life and duration of hemodialysis in patients with chronic kidney disease (CKD): a cross-sectional study

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