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

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Abstract

Background/aims

Prevalent 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.

Methods

Cross-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.

Results

PCS 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).

Conclusions

HRQOL 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.

Electronic supplementary material

The online version of this article (10.1007/s11255-018-1845-6) contains supplementary material, which is available to authorized users.

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Most cited references 32

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Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.

J M Guralnik, L Ferrucci, E Simonsick … (1995)

Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons. This prospective cohort study included men and women 71 years of age or older who were living in the community, who reported no disability in the activities of daily living, and who reported that they were able to walk one-half mile (0.8 km) and climb stairs without assistance. The subjects completed a short battery of physical-performance tests and participated in a follow-up interview four years later. The tests included an assessment of standing balance, a timed 8-ft (2.4-m) walk at a normal pace, and a timed test of five repetitions of rising from a chair and sitting down. Among the 1122 subjects who were not disabled at base line and who participated in the four-year follow-up, lower scores on the base-line performance tests were associated with a statistically significant, graduated increase in the frequency of disability in the activities of daily living and mobility-related disability at follow-up. After adjustment for age, sex, and the presence of chronic disease, those with the lowest scores on the performance tests were 4.2 to 4.9 times as likely to have disability at four years as those with the highest performance scores, and those with intermediate performance scores were 1.6 to 1.8 times as likely to have disability. Among nondisabled older persons living in the community, objective measures of lower-extremity function were highly predictive of subsequent disability. Measures of physical performance may identify older persons with a preclinical stage of disability who may benefit from interventions to prevent the development of frank disability.

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Functional status of elderly adults before and after initiation of dialysis.

Manjula Kurella Tamura, Kenneth E. Covinsky, Glenn Chertow … (2009)

It is unclear whether functional status before dialysis is maintained after the initiation of this therapy in elderly patients with end-stage renal disease (ESRD). Using a national registry of patients undergoing dialysis, which was linked to a national registry of nursing home residents, we identified all 3702 nursing home residents in the United States who were starting treatment with dialysis between June 1998 and October 2000 and for whom at least one measurement of functional status was available before the initiation of dialysis. Functional status was measured by assessing the degree of dependence in seven activities of daily living (on the Minimum Data Set-Activities of Daily Living [MDS-ADL] scale of 0 to 28 points, with higher scores indicating greater functional difficulty). The median MDS-ADL score increased from 12 during the 3 months before the initiation of dialysis to 16 during the 3 months after the initiation of dialysis. Three months after the initiation of dialysis, functional status had been maintained in 39% of nursing home residents, but by 12 months after the initiation of dialysis, 58% had died and predialysis functional status had been maintained in only 13%. In a random-effects model, the initiation of dialysis was associated with a sharp decline in functional status, indicated by an increase of 2.8 points in the MDS-ADL score (95% confidence interval [CI], 2.5 to 3.0); this decline was independent of age, sex, race, and functional-status trajectory before the initiation of dialysis. The decline in functional status associated with the initiation of dialysis remained substantial (1.7 points; 95% CI, 1.4 to 2.1), even after adjustment for the presence or absence of an accelerated functional decline during the 3-month period before the initiation of dialysis. Among nursing home residents with ESRD, the initiation of dialysis is associated with a substantial and sustained decline in functional status. 2009 Massachusetts Medical Society

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Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study.

Sanjay Rajagopalan, Friedrich Port, Fredric Finkelstein … (2005)

Health-related quality of life (QOL) is an important measure of how disease affects patients' lives. Dialysis patients have decreased QOL relative to healthy controls. Little is known about QOL in patients with chronic kidney disease (CKD) before renal replacement therapy. The Medical Outcomes Study Short Form-36 (SF-36), a standard QOL instrument, was used to evaluate 634 patients (mean glomerular filtration rate [GFR], 23.6 +/- 9.6 mL/min/1.73 m2 [0.39 +/- 0.16 mL/s/1.73 m2]) enrolled in a 4-center, prospective, observational study of CKD. SF-36 scores in these patients were compared with those in a prevalent cohort of hemodialysis (HD) patients and healthy controls (both from historical data). QOL data also were analyzed for correlations with GFR and albumin and hemoglobin levels in multivariable analyses. Patients with CKD had higher SF-36 scores than a large cohort of HD patients (P < 0.0001 for 8 scales and 2 summary scales), but lower scores than those reported for the US adult population (P < 0.0001 for 7 of 8 scales and 1 of 2 summary scales). Patients with CKD stage 4 had lower QOL scores than patients with CKD stage 5, although differences were not significant. Hemoglobin level was associated positively with higher mental and physical QOL scores (P < 0.05) in all individual and component scales except Pain. SF-36 scores were higher in this CKD cohort compared with HD patients, but lower than in healthy controls. GFR was not significantly associated with QOL. Hemoglobin level predicted both physical and mental domains of the SF-36. Longitudinal studies are needed to define at-risk periods for decreases in QOL during progression of CKD.

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Author and article information

Contributors

Natascha J. H. Broers: +31 43 387 50 07 , natascha.broers@mumc.nl

Journal

Journal ID (nlm-ta): Int Urol Nephrol

Journal ID (iso-abbrev): Int Urol Nephrol

Title: International Urology and Nephrology

Publisher: Springer Netherlands (Dordrecht )

ISSN (Print): 0301-1623

ISSN (Electronic): 1573-2584

Publication date (Electronic): 26 March 2018

Publication date PMC-release: 26 March 2018

Publication date (Print): 2018

Volume: 50

Issue: 6

Pages: 1131-1142

Affiliations

[1 ]ISNI 0000 0004 0480 1382, GRID grid.412966.e, Division of Nephrology, Department of Internal Medicine, , Maastricht University Medical Center+, ; PO Box 5800, 6202 AZ Maastricht, The Netherlands

[2 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, NUTRIM School of Nutrition and Translational Research in Metabolism, , Maastricht University, ; Maastricht, The Netherlands

[3 ]GRID grid.415062.4, Fresenius Medical Care GmbH, ; Bad Homburg, Germany

[4 ]ISNI 0000 0004 0578 1096, GRID grid.414977.8, Department of Nephrology, , Jessa Hospital, ; Hasselt, Belgium

[5 ]ISNI 0000 0004 0477 5022, GRID grid.416856.8, Department of Internal Medicine, Division of Nephrology, , Viecuri Medical Center, ; Venlo, The Netherlands

[6 ]ISNI 0000 0004 0398 8384, GRID grid.413532.2, Department of Internal Medicine, Division of Nephrology, , Catharina Hospital Eindhoven, ; Eindhoven, The Netherlands

[7 ]Department of Internal Medicine, Division of Nephrology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands

[8 ]ISNI 0000 0004 0568 7032, GRID grid.415842.e, Department of Internal Medicine, Division of Nephrology, , Laurentius Hospital Roermond, ; Roermond, The Netherlands

Article

Publisher ID: 1845

DOI: 10.1007/s11255-018-1845-6

PMC ID: 5986848

PubMed ID: 29582338

SO-VID: 50b80ec4-a465-4e34-a3a4-f79b3cce811a

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 21 November 2017

Date accepted : 12 March 2018

Custom metadata

ScienceOpen disciplines: Nephrology

Keywords: health-related quality of life,physical activity,end-stage renal disease,dialysis

Data availability:

ScienceOpen disciplines: Nephrology

Keywords: health-related quality of life, physical activity, end-stage renal disease, dialysis

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

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Electronic supplementary material

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Karger: Nephrology

Most cited references 32

Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.

Functional status of elderly adults before and after initiation of dialysis.

Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study.

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