4.6 Article

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

Journal

NEPHROLOGY DIALYSIS TRANSPLANTATION
Volume 32, Issue 3, Pages 521-527

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/ndt/gfw233

Keywords

Dialysis Outcomes Practice Patterns Study; hemo-dialysis; quality of life; survival

Funding

  1. Amgen
  2. Kyowa Hakko Kirin
  3. AbbVie, Inc.
  4. Sanofi Renal
  5. Baxter Healthcare
  6. Vifor Fresenius Medical Care Renal Pharma, Ltd.
  7. National Institute of Diabetes and Digestive and Kidney Diseases [K01DK087762]

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Background: Cross-sectional health-related quality of life (HRQOL) 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 HRQOL 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 orMCS 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 HRQOL prior to thatmeasurement; more frequent HR-QOLmeasurements 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.

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