SUN-099 IS HEALTH-RELATED QUALITY OF LIFE AND WELLBEING IN OLDER PEOPLE HIGHER FOR THOSE MANAGED WITH COMPREHENSIVE CONSERVATIVE CARE THAN THOSE MANAGED ON DIALYSIS?

Abstract

Decisions regarding treatment of older people with end-stage kidney disease (ESKD) need to be supported by information about the impact of dialysis on health-related quality of life (HRQoL) and wellbeing. Few data exist from patients aged 75 years of age or older. Prospective cross-sectional study of HR-QoL in older ESKD patients treated at three renal units in the UK and Australia. Patients managed with dialysis or with an estimated glomerular filtration (eGFR)≤10ml/min/1.73m2 and managed with comprehensive conservative, non-dialytic care. HRQoL and wellbeing were assessed using Short-Form six dimensions (SF-6D, 0-1 scale); KDQOL-36 (0-100 scale) and Investigating Choice Experiments Capability Measure–Older people (ICECAP-O, 0-1 scale). Linear regression assessed associations between treatment, HRQoL and wellbeing. Pearson’s correlation coefficient assessed convergent validity between instruments. Of 129 patients, the median age of 81 years [IQR 78–85], 65% males; 83 (64%) were managed with dialysis and 46 (36%) with conservative care. When adjusted for treatment type and sociodemographic variables, those managed on dialysis reported lower mean SF-6D utility (-0.05, 95 % CI -0.12 to 0.01); lower KDQOL Physical component summary score (-3.17, 95 % CI -7.61 to 1.27); lower Mental component summary score (-2.41, 95 % CI -7.66 to 2.84); lower quality of life due to burden (-28.59, 95 % CI -41.77 to -15.42); symptoms (-5.93, 95 % CI -14.61 to 2.73), and effects of kidney disease (-16.49, 95 % CI -25.98 to -6.99); and lower overall ICECAP-O wellbeing (-0.07, 95 % CI -0.16 to 0.02) than those managed conservatively. Correlation between ICECAP-O wellbeing and SF-6D utility scores was strong overall, 0.65 (p < 0.001), but weak to moderate at the domain level. TableAdjusted Difference in SF-6D utilities, KDQOL-36 scores, and ICECAP-O capability index for dialysis compared with conservative care (fully adjusted)Differences†95% Lower CI95% Upper CIp-valueSF-6D utilities-0.05-0.120.010.12KDQOL-PCS-3.17-7.611.270.16KDQOL-MCS-2.41-7.662.840.37KDQOL-Burden of Disease-28.59-41.77-15.42<0.001*KDQOL-Symptoms of Disease-5.93-14.612.730.18KDQOL-Effects of Disease-16.49-25.98-6.99<0.001*ICECAP-O Capability index-0.07-0.160.020.12 Open table in a new tab Table footnote: † Difference in scores adjusted for age, gender, country, education, and health insurance status. * p < 0.001, statistical significance. CI - Confidence interval. KDQOL-36 - Kidney disease quality of life with 36 items. PCS - Physical Component Summary. MCS -Mental Component Summary. Older people on the dialysis report significantly higher burden and effects of kidney disease than those on conservative care. Lower HRQoL and wellbeing may be associated with dialysis treatment and should inform shared decision making about treatment options.