Abstract
BackgroundHealth-related quality of life (HrQoL) varies among dialysis patients. However, little is known about the association of dialysis modality with HrQoL over time. We describe longitudinal patterns of HrQoL among chronic dialysis patients by treatment modality.MethodsNational retrospective cohort study of adult patients who initiated in-center dialysis or a home modality (peritoneal or home hemodialysis) between 1/2013 and 6/2015. Patients remained on the same modality for the first 120 days of the first two years. HrQoL was assessed by the Kidney Disease and Quality of Life-36 (KDQOL) survey in the first 120 days of the first two years after dialysis initiation. Home modality patients were matched to in-center patients in a 1:5 fashion.ResultsIn-center (n=4234) and home modality (n=880) patients had similar demographic and clinical characteristics. In-center dialysis patients had lower mean KDQOL scores across several domains compared to home modality patients. For patients who remained on the same modality, there was no change in HrQoL. However, there were trends towards clinically meaningful changes in several aspects of HrQoL for patients who switched modalities. Specifically, physical functioning decreased for patients who switched from home to in-center dialysis (p< 0.05).ConclusionsAmong a national cohort of chronic dialysis patients, there was a trend towards different patterns of HrQoL life that were only observed among patients who changed modality. Patients who switched from home to in-center modalities had significant lower physical functioning over time. Providers and patients should be mindful of HrQoL changes that may occur with dialysis modality change.
Highlights
Approximately 680,000 patients in the United States are afflicted with end-stage renal disease (ESRD) and roughly 70% of these patients receive maintenance therapies in the form of hemodialysis (HD) or peritoneal dialysis (PD).[1]
Patients were categorized as using a home dialysis modality (e.g., PD [n=825] and home hemodialysis (HHD) [n=61]) or receiving in-center HD treatments (n=19,129) based on their first modality recorded in the Fresenius Medical Care North America (FMCNA) database
Patient characteristics During the study period, we identified a total of 880 patients who initiated treatment with a home modality at a chronic dialysis facility affiliated with FMCNA and who met eligibility criteria
Summary
680,000 patients in the United States are afflicted with end-stage renal disease (ESRD) and roughly 70% of these patients receive maintenance therapies in the form of hemodialysis (HD) or peritoneal dialysis (PD).[1] Compared to the general population, dialysis patients have lower health-related quality of life (HrQoL), which is strongly associated with poorer (2019) 20:7. Several studies have compared HrQoL changes over time between incident ESRD patients receiving different renal replacement therapy modalities (e.g., in-center HD, home dialysis, and renal transplantation), most have featured small sample sizes, shorter follow-up times, or have primarily focused on stable modality choices over time.[11,12,13,14,15,16,17,18] To our knowledge, there have not been any studies that have examined changes in HrQoL over time based on modality change among a large national cohort of chronic dialysis patients. Health-related quality of life (HrQoL) varies among dialysis patients. We describe longitudinal patterns of HrQoL among chronic dialysis patients by treatment modality
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