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Nephrol Dial Transplant. 2017 Mar 1;32(3):521-527. doi: 10.1093/ndt/gfw233.

Association between changes in quality of life and mortality in hemodialysis patients: results from the DOPPS.

Author information

1
Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
2
Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
3
Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA.
4
Department of Biostatistics and Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
5
Heart of England NHS Foundation Trust, Birmingham, UK.
6
University Hospital, Ghent, Belgium.
7
Centre Hospitalier Universitaire de Bordeaux and Université de Bordeaux, Bordeaux, France.
8
Department of Innovative Research and Education for Clinicians and Trainees, Fukushima Medical University Hospital, Fukushima, Japan.
9
Division of Nephrology, Showa University Fujigaoka Hospital, Yokohama, Japan.
10
Hospital of St Raphael, Yale University, New Haven, CT, USA.
11
Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil.
12
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
13
Vanderbilt University, Medical Center, Nashville, TN, USA.

Abstract

Background:

Cross-sectional health-related quality of life (HR-QOL) measures are associated with mortality in hemodialysis (HD) patients. The impact of changes in HR-QOL on outcomes remains unclear. We describe the association of prior changes in HR-QOL with subsequent mortality among HD patients.

Methods:

A total of 13 784 patients in the Dialysis Outcomes and Practice Patterns Study had more than one measurement of HR-QOL. The impact of changes between two measurements of the physical (PCS) and mental (MCS) component summary scores of the SF-12 on mortality was estimated with Cox regression.

Results:

Mean age was 62 years (standard deviation: 14 years); 59% were male and 32% diabetic. Median time between HR-QOL measurements was 12 months [interquartile range (IQR): 11, 14]. Median initial PCS and MCS scores were 37.5 (IQR: 29.4, 46.2) and 46.4 (IQR: 37.2, 54.9); median changes in PCS and MCS scores were -0.2 (IQR: -5.5, 4.7) and -0.1 (IQR: -6.8, 5.9), respectively. The adjusted hazard ratio (HR) for a 5-point decline in HR-QOL score was 1.09 [95% confidence interval (CI): 1.06-1.12] for PCS and 1.05 (95% CI: 1.03-1.08) for MCS. Adjusting for the second QOL score, the change was not associated with mortality: HR = 1.01 (95% CI: 0.98-1.05) for delta PCS and 1.01 (95% CI: 0.98-1.03) for delta MCS. Categorizing the first and second scores as predictors, only the second PCS or MCS score was associated with mortality.

Conclusions:

In our study, only the most recent HR-QOL score was associated with mortality. Hence, the predictive power of a measurement of HR-QOL is not affected by changes in HR-QOL prior to that measurement; more frequent HR-QOL measurements are needed to improve the prediction of outcomes in HD. Further studies are needed to determine the optimal frequency and appropriate instrument to be used for serial measurements.

KEYWORDS:

Dialysis Outcomes Practice Patterns Study; hemodialysis; quality of life; survival

PMID:
27270292
PMCID:
PMC5837512
DOI:
10.1093/ndt/gfw233
[Indexed for MEDLINE]
Free PMC Article

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