Quality of life and dialysis decisions in critically ill patients with acute renal failure.

Abstract

To determine whether health-related quality of life (HRQL) in survivors of acute renal failure (ARF) occurring in intensive care is predictable from data available at the time of acute illness. Prospective pilot study in academic intensive care units. Patients requiring renal replacement therapy for ARF while in intensive care over a 6-month enrollment period were included. The primary outcome measure was HRQL among survivors 6 months following hospital discharge, as assessed by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and its association with Acute Physiology and Chronic Health Evaluation (APACHE) III score. We also asked survivors whether, in retrospect, they would choose to have dialysis again and what factors influenced this decision. Ninety-two percent (12/13) of participants surviving 6 months completed the follow-up interview. The mean mental and physical components of the SF-36 were comparable to and slightly lower than the age-matched general population, respectively. There was no correlation between APACHE III score at the time of dialysis initiation and SF-36 score at 6 months. Almost all patients, regardless of their HRQL, stated they would choose dialysis again. HRQL may not be predictable from data available at the time of dialysis initiation in this population. In retrospect, surviving patients agree with the decision to accept dialysis, even when their HRQL is poor.