Abstract
BackgroundAlthough previous research has demonstrated that referral to pre-dialysis clinics is associated with favourable objective outcomes, the benefit of a pre-dialysis clinic from the perspective of patient-perceived subjective outcomes, such as quality of life (QOL), is less well defined.MethodsA retrospective incident cohort study was conducted to determine if pre-dialysis clinic attendance was a predictor of better QOL scores measured within the first six months of hemodialysis (HD) initiation. Inclusion criteria were HD initiation from January 1 1998 to January 1 2000, diagnosis of chronic renal failure, and completion of the QOL questionnaire within six months of HD initiation. Patients receiving HD for less than four weeks were excluded. An incident cohort of 120 dialysis patients was identified, including 74 patients who attended at least one pre-dialysis clinic and 46 patients who did not. QOL was measured using the SF 36-Item Health Survey. Independent variables included age, sex, diabetes, pre-dialysis clinic attendance and length of attendance, history of ischemic heart disease, stroke, peripheral vascular disease, heart failure, malignancy, and chronic lung disease, residual creatinine clearance at dialysis initiation, and kt/v, albumin and hemoglobin at the time of QOL assessment. Bivariate and multivariate linear regression analyses were used to identify predictors of QOL scores.ResultsMultivariate analysis suggested that pre-dialysis clinic attendance was an independent predictor of higher QOL scores in four of eight health domains (physical function, p < 0.01; emotional role limitation, p = 0.01; social function, p = 0.01; and general health, p = 0.03), even after statistical adjustment for age, sex, residual renal function, kt/v, albumin, and co-morbid disease. Pre-dialysis clinic attendance was also an independent predictor of the physical component summary score (p = 0.03).ConclusionsWe conclude that pre-dialysis clinic attendance favourably influences patient-perceived quality of life within six months of dialysis initiation.
Highlights
Previous research has demonstrated that referral to pre-dialysis clinics is associated with favourable objective outcomes, the benefit of a pre-dialysis clinic from the perspective of patient-perceived subjective outcomes, such as quality of life (QOL), is less well defined
Residual creatinine clearance at dialysis initiation was significantly higher among the group of patients attending the pre-dialysis clinic (p = 0.05)
Discussion previous research has suggested that pre-dialysis clinic attendance is associated with better objective outcomes compared to standard care, research examining the benefits of pre-dialysis care with respect to patient-oriented outcomes such as QOL is limited
Summary
Previous research has demonstrated that referral to pre-dialysis clinics is associated with favourable objective outcomes, the benefit of a pre-dialysis clinic from the perspective of patient-perceived subjective outcomes, such as quality of life (QOL), is less well defined. The National Institutes of Health have recommended that patients with chronic progressive renal insufficiency be referred to a multidisciplinary pre-dialysis team in order to minimize patient morbidity and ensure a smooth transition to dialysis therapy. Patients with renal failure are referred by primary care physicians to a nephrologist for initial assessment. The care of patients diagnosed with chronic and progressive renal failure who do not require imminent dialysis initiation is subsequently transferred by the nephrologist to the pre-dialysis clinic. Direct referral to the pre-dialysis clinic by a primary care physician is not permitted. The pre-dialysis clinic is scheduled weekly and staffed by nurse clinicians, dieticians, social workers, pharmacists, and nephrologists. The nephrologists at the hospital operate a group practice and staff the pre-dialysis clinic according to a rotating schedule
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