Change in quality of life and one-year mortality risk in maintenance dialysis patients
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Quality of life (QOL) is an important metric of high-quality dialysis care. QOL is commonly measured by the Short Form 36 Questionnaire (SF-36), which provides two summary scores: a mental component score (MCS) and a physical component score (PCS). Poor QOL is associated with mortality in dialysis patients. Small studies show that changes in QOL also predicts mortality. We investigated whether changes in QOL over time are associated with mortality in a large cohort of maintenance hemodialysis patients.
This retrospective study was conducted in 1017 outpatient dialysis facilities. Over 10,000 hemodialysis patients completed two SF-36 surveys. We compared 1-year morality rates in those whose MCS or PCS increased or decreased ±5 vs. those whose did not.
For those who completed two surveys, mean score for PCS was unchanged, whereas MCS increased slightly (48.6 vs. 48.9, p = 0.05). Individual patients, however, showed marked variation. On the second survey, more than half of patients demonstrated a ± 5 point change in the PCS and/or MCS. After multivariate adjustment, a ≥ 5 decrease in MCS was associated with an increase in mortality (HR = 1.33, 95 % CI 1.18, 1.50).
Clinicians should be aware that many patients experience a significant change in both the MCS and PCS on dialysis. A MCS decrease of ≥5 was associated with increased mortality. More study is needed to determine whether this is a causal relationship. Physicians should evaluate root causes and seek to mitigate declines in QOL whenever possible.
KeywordsQuality of life Dialysis Survival Outcomes research Psychosocial issues
Part of this work was presented in abstract form at the National Kidney Foundation’s Spring Clinical Meetings, 2012, Washington DC. We acknowledge the (non-financial) support of Frenova Renal Research, a Fresenius Medical Care North America company.
There was no support/funding for this study.
Compliance with ethical standards
Conflict of interest
Nien-Chen Li is an employee of FMCNA. Dr. Lacson was a full-time employee of FMCNA when the analyses were completed, but he has since moved to the Tufts University School of Medicine. Dr. Liebman has no conflicts of interest.
The survey results and clinical data were obtained as part of routine clinical care, for which all incoming hemodialysis patients provide consent.
Human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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