Abstract
BackgroundHealth-related quality of life (HRQoL) is an important component of patient-centered outcomes and a useful parameter for monitoring quality of care. We assessed HRQoL, its determinants, and associations with mortality in patients with end-stage renal disease (ESRD).MethodsShort Form-36 was used to assess HRQoL, its domain components, and physical (PCS) and mental (MCS) composite summary scores in altogether 400 (338 incident and 62 prevalent) dialysis patients with median age 64 years, 37% women, 24% diabetes mellitus (DM), 49% cardiovascular disease (CVD), and median estimated glomerular filtration rate (eGFR) of 5.3 (3.0–9.4) ml/min/1.732. Results were analyzed separately for 338 incident patients starting on hemodialysis (HD; 68%) or peritoneal dialysis (PD; 32%), and 62 prevalent PD patients. Mortality risk was analyzed during up to 60 months (median 28 months).ResultsLinear multivariate regression analysis showed that in incident dialysis patients, 1-SD higher PCS associated negatively with 1-SD higher age, DM and CVD, and positively with 1-SD higher hemoglobin and sodium (adjusted r2 = 0.17). In 62 prevalent PD patients, 1-SD higher PCS was negatively associated with 1-SD higher age. MCS was not associated to any of the investigated factors. Multivariate Cox regression analysis showed that in incident dialysis patients, 1-SD increase of PCS associated with lower all-cause mortality, hazard ratio 0.65 (95% confidence interval 0.52–0.81), after adjustments for age, sex, DM, CVD, plasma albumin, C-reactive protein and eGFR whereas 1-SD lower MCS did not associate with mortality. In PD patients, neither PCS nor MCS associated with mortality.ConclusionsMCS did not associate with any of the investigated clinical factors, whereas lower PCS associated with higher age, CVD, DM, and lower hemoglobin and sodium levels. MCS was not associated with mortality, whereas lower PCS associated with increased mortality risk. These results suggest that HRQoL - in addition to its role as patient-centered outcome - matters also for hard clinical outcomes in ESRD patients. Our knowledge about factors influencing MCS in ESRD patients is limited and should motivate further studies.
Highlights
Health-related quality of life (HRQoL) is an important component of patient-centered outcomes and a useful parameter for monitoring quality of care
Univariate correlations between physical composite summary (PCS), mental composite summary (MCS) and clinical characteristics and investigated biomarkers In 338 incident dialysis patients, PCS and MCS correlated with serum albumin and hemoglobin, respectively, and negatively with C-reactive protein (CRP) (PCS: rho = − 0.22, p < 0.001; MCS: rho = − 0.15, p < 0.01, respectively)
PCS associated with comorbidities (CVD and diabetes mellitus (DM)), body mass index (BMI), and sodium, while MCS correlated with serum calcium and male gender
Summary
Health-related quality of life (HRQoL) is an important component of patient-centered outcomes and a useful parameter for monitoring quality of care. We assessed HRQoL, its determinants, and associations with mortality in patients with end-stage renal disease (ESRD). Health-related quality of life (HRQoL) is an important aspect of patient-centered clinical outcomes [4, 5], and assessment of HRQoL is increasingly used as outcome measure when monitoring the quality and effectiveness of renal care including maintenance dialysis treatment [6,7,8]. HRQoL usually deteriorates during the course of CKD progression [9, 10] and is often markedly reduced in ESRD patients due to restrictions affecting life style and food intake, multiple medications, effects of dialysis therapy, disease-related complications [11], common comorbidities [12, 13], the uremic milieu [14, 15] and premature aging [1, 2]. Few larger studies evaluated the mortality predictive role of HRQoL in ESRD patients
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