Abstract
BackgroundAn increasing number of dialysis patients have returned to dialysis after renal graft loss, and the transition in disease state could likely be associated with reduced health related quality of life (HRQOL). Furthermore, gender differences in HRQOL have been observed in dialysis and kidney transplanted patients, but whether transition in disease state affects HRQOL differently in respect to gender is not known. The aims of this study were to compare HRQOL in dialysis patients with graft loss to transplant naïve dialysis patients, and to explore possible gender differences.MethodsIn a cross-sectional study, HRQOL was measured in 301 prevalent dialysis patients using the Kidney Disease and Quality of Life Short Form version 1.3. Adjusted comparisons were made between dialysis patients with previous graft loss and the transplant naïve patients. Multiple linear regression analyses were performed with HRQOL as outcome variables. Interaction analyses using product terms were performed between gender and graft loss. HRQOL was analysed separately in both genders.ResultsPatients with renal graft loss (n = 50) did not experience lower HRQOL than transplant naïve patients after multiple adjustments. Among patients with graft loss, women (n = 23) reported lower HRQOL than men (n = 27) in the items physical function (40 vs. 80, p = 0.006), and effect of kidney disease (49 vs. 67, p = 0.017). Women with graft loss reported impaired kidney-specific HRQOL compared to transplant naïve women (n = 79) in the items effect of kidney disease (50 vs. 72, p = 0.002) and cognitive function (80 vs. 93, p = 0.006), and this observation persisted after multiple adjustments. Such differences were not apparent in the male counterparts.ConclusionsPatients who resumed dialysis after renal graft loss did not have lower HRQOL than dialysis patients not previously transplanted. However, losing graft function was associated with reduced HRQOL in females, and important interactions were identified between graft loss and gender. This needs to be further explored in prospective studies.
Highlights
An increasing number of dialysis patients have returned to dialysis after renal graft loss, and the transition in disease state could likely be associated with reduced health related quality of life (HRQOL)
The aims of this study were twofold: first, to explore the hypothesis that patients resuming dialysis after functional graft loss have impaired HRQOL compared to dialysis patients not previously transplanted; second, to assess whether there are gender differences in the two groups
Half of the patients in the RG + group were on the waiting list for transplantation; this number did not differ from the RG – patients (Table 1)
Summary
An increasing number of dialysis patients have returned to dialysis after renal graft loss, and the transition in disease state could likely be associated with reduced health related quality of life (HRQOL). Gender differences in HRQOL have been observed in dialysis and kidney transplanted patients, but whether transition in disease state affects HRQOL differently in respect to gender is not known. It is imperative to improve health related quality of life (HRQOL) in dialysis patients, as this repeatedly has been shown to be low compared to the general population as well as to patients with other chronic diseases [1,2]. Renal transplantation has been claimed to provide the greatest benefit regarding HRQOL [10,14], and the transition in the disease state to dialysis, would likely be associated with reduced HRQOL. Immunosuppressive therapy is usually maintained in lowered doses in Norway after graft loss, and this may affect the HRQOL [15]
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