Can changes in quality of life predict mortality in hemodialysis patients?

Patients on hemodialysis suffer from disproportionately high rates of depression; poor sleep, nutrition, and sexual function; and reduced ability to perform their jobs. Measures of Health-Related Quality of Life (HR-QOL) have consistently demonstrated much lower quality of life among hemodialysis patients compared to the general population and to those with other chronic medical conditions. Earlier studies have shown an independent association between reduced HR-QOL and mortality.

In a study published in Nephrology Dialysis Transplantation, investigators hypothesized that a decline in HR-QOL would be associated with increased risk of death. This study involved a sample of over 13,000 hemodialysis patients from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Data were obtained from patients around the world who had completed at least two sequential annual patient questionnaires, which included the Kidney Disease Quality of Life (KDQOL-36) survey.

Researchers found that patients with low HR-QOL scores in the second patient questionnaire had similarly high risk of death regardless of their HR-QOL score in the first patient questionnaire. In other words, the trajectory towards a lower score from the previous year – whether the patient had consistently low scores or a sharp decline in HR-QOL – was not predictive of mortality. Only the HR-QOL score of the second, more recent patient questionnaire predicted mortality.

These findings are particularly salient given that investigators also found that routine HR-QOL measurements are not performed among the majority of facilities in the study. More frequent and routine assessments of HR-QOL may be necessary to identify high-risk patients.

Lead author Dr. Jeffrey Perl noted, “This study is important because it reminds us that in order for quality of life assessments to be maximally useful, they need to be frequently measured.”

However, independent of its strong association with death, perhaps the most compelling reason to frequently measure HR-QOL is the inherent value of HR-QOL itself as a pivotal outcome measure in patient care. Efforts are needed to focus on strategies to improve HR-QOL among hemodialysis patients.

CITATION:

Perl J, Karaboyas A, Morgenstern H, Sen A, Rayner H, Vanholder R, Combe C, Hasegawa T, Finkelstein F, Lopes A, Robinson BM, Pisoni RL, Tentori F. Association between Changes in Quality of Life and Mortality in Hemodialysis Patients: Results from the DOPPS. Nephrol Dial Transplant. 2016 Jun 7. pii: gfw233. [Epub ahead of print]

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June 17, 2016 

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