Health-related quality of life in end-stage renal disease patients: the effects of starting dialysis in the first year after the transition period

Frank M Van Der Sande,Nanda M P Diederen,Marc M H Hermans,Joris J J M Wirtz,Constantijn J A M Konings,Remy J H Martens,Bernard Canaud,Frank Stifft,Natascha J H Broers,Tom Dejagere,Karel M L Leunissen,Tom Cornelis,Jeroen P Kooman

doi:10.1007/s11255-018-1845-6

Abstract

Background/aimsPrevalent dialysis patients have low scores of health-related quality of life (HRQOL) which are associated with increased risk of hospitalization and mortality. Also in CKD-5 non-dialysis patients, HRQOL scores seem to be lower as compared with the general population. This study firstly aimed to compare HRQOL between CKD-5 non-dialysis and prevalent dialysis patients in a cross-sectional analysis and to assess longitudinal changes over 1 year after the dialysis initiation. Secondly, the correlation between HRQOL and physical activity (PA) was explored.MethodsCross-sectional 44 CKD-5 non-dialysis, 29 prevalent dialysis, and 20 healthy controls were included. HRQOL was measured by Short Form-36 questionnaires to measure physical and mental domains of health expressed by the physical component summary (PCS) and mental component summary (MCS) scores. PA was measured by a SenseWear™ pro3. Longitudinally, HRQOL was assessed in 38 CKD-5 non-dialysis patients (who were also part of the cross-sectional analysis), before dialysis initiation until 1 year after dialysis initiation.ResultsPCS scores were significantly lower both in CKD-5 non-dialysis patients and in prevalent dialysis patients as compared with healthy controls (p < 0.001). MCS scores were significantly lower in both CKD-5 non-dialysis patients (p = 0.003), and in dialysis patients (p = 0.022), as compared with healthy controls. HRQOL scores did not change significantly from the CKD-5 non-dialysis phase into the first year after dialysis initiation. PA was significantly related to PCS in both CKD-5 non-dialysis patients (r = 0.580; p < 0.001), and dialysis patients (r = 0.476; p = 0.009).ConclusionsHRQOL is already low in the CKD-5 non-dialysis phase. In the first year after dialysis initiation, HRQOL did not change significantly. Given the correlation between PCS score and PA, physical activity programs may be potential tools to improve HRQOL in both CKD-5 non-dialysis as well as in prevalent dialysis patients.

Highlights

Materials and methodsNumerous studies already showed lower health-related quality of life (HRQOL) scores in dialysis patients as compared with the general population [1,2,3]
This study firstly showed a reduction in the physical domains of the Short Form-36 (SF-36) HRQOL scores in both CKD-5 non-dialysis and prevalent dialysis patients, compared with age-matched healthy controls, without significant differences between both patient groups
physical activity (PA) parameters were significantly associated with physical component summary (PCS) scores and components of the PCS scale of the social functioning (SF)-36, which was most pronounced for the physical functioning (PF) component

Summary

Introduction

Numerous studies already showed lower health-related quality of life (HRQOL) scores in dialysis patients as compared with the general population [1,2,3]. A previous study of our group showed the prognostic value of changes in HRQOL over time in maintenance hemodialysis (HD) patients, but did not include the stage 5 chronic kidney disease (CKD-5) non-dialysis phase [4]. Few prospective studies have focused on the effects of starting dialysis treatment on HRQOL [9, 10], despite the fact that in patients with endstage renal disease (ESRD) the transition from the CKD-5 non-dialysis phase to the start of dialysis is a major life event [11,12,13]. Previous studies showed a reduction in HRQOL in patients with CKD-5 in the non-dialysis phase as compared with the general population [10, 14, 15], but a comparative study between CKD-5 non-dialysis and prevalent dialysis patients, or a longitudinal study following the start of dialysis before dialysis initiation, has not yet been performed

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