Health-related quality of life, depressive symptoms, anemia, and malnutrition at hemodialysis initiation

Background and Methods: We administered the Kidney Disease Quality of Life (KDQOL) short form and a three-item depression screening measure derived from the Diagnostic Interview Schedule to 422 new patients with end-stage renal disease (ESRD; incident cohort) who began maintenance hemodialysis (HD) therapy at 151 outpatient dialysis facilities across the United States. Results: At HD therapy initiation, 56% of patients had hemoglobin levels less than 10 g/dL (100 g/L), and 52% had albumin levels of 3.5 g/dL (35 g/L) or less. The 36-Item Short Form Health Survey (SF-36) scores (part of the KDQOL) for this incident cohort were significantly lower than those of a prevalent HD cohort and a severe chronic disease cohort (P < 0.01 to 0.001), and physical health scores were among the lowest ever reported. SF-36 summary scores were 2 SDs below those of an age- and sex-adjusted US general population in physical health and half an SD below those in mental health. Patients who screened positive for depression (45% of sample) scored even lower on all eight SF-36 scale scores and 9 of 12 of the KDQOL kidney disease-targeted scales (P < 0.05 to 0.01), but did not differ from nondepressed patients on demographic, clinical, or laboratory study variables. Conclusion:The extent to which the profound impairment documented in this study can be improved by more timely high-quality predialysis care requires further investigation. Nevertheless, the high prevalence of anemia, hypoalbuminemia, and depressive symptoms at dialysis therapy initiation suggests the need for more aggressive and broader spectrum pre-ESRD care.