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Quality of life may be a more valuable prognostic factor than depression in older hemodialysis patients



Depression and impairment of quality of life (QoL) reduce the survival of individual on hemodialysis (HD). However, few studies evaluated the impact of these conditions on the survival of older patients undergoing HD.


A retrospective cohort study was performed including patients aged ≥ 60 years on HD in Recife, Brazil, assessed in 2013 and monitored until 2017. Depression was evaluated with the Mini-International Neuropsychiatric Interview and QoL with the Control, Autonomy, Self-realization, and Pleasure Questionnaire (CASP-16). Survival differences according to the depression and QoL status were measured by Kaplan–Meier analysis and Cox regression. Death Certificates were analyzed to assess the cause of death.


A total of 171 patients were included (mean age 68.7 ± 6.9 years). The mean follow-up time was 3 years (maximum 4.5 years) and there were 98 deaths (57.3% of the sample). In a multivariate model that included depression and QoL, only QoL impairment was associated with a higher risk of death (HR 1.62, p = 0.035). Among CASP domains, only “Control” was associated with survival (HR 0.90, p = 0.014). Depression was unrelated to the cause of death, but there was a trend for death by endocrine diseases if QoL was impaired (p = 0.057).


QoL impairment is a key predictor of prognosis in older patients on HD and may be more important than depression. It is important that teams dealing with this population include in protocols an assessment of QoL, in order to offer a range of care according to the needs of these patients.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Study conception and design: SBVA, KCLP, FM, LAD, and VAD; data collection: SBVA and FML; data analysis and interpretation: SBVA and URM; statistical analysis: SBVA and URM. Writing—review and editing: SBVA, KCLP, LAD, and VAD. All authors contributed significant intellectual content during the preparation and revision of this manuscript and take full responsibility for the overall work, ensuring proper investigation and clarification of issues regarding the accuracy or integrity of any part of this work.

Correspondence to Saulo Barbosa Vasconcelos de Alencar.

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de Alencar, S.B.V., Dias, L.A., Dias, V.A. et al. Quality of life may be a more valuable prognostic factor than depression in older hemodialysis patients. Qual Life Res (2020).

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  • Quality of life
  • Depression
  • Population aging
  • Hemodialysis