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      Course of Symptoms and Health-Related Quality of Life during Specialized Pre-Dialysis Care

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          Abstract

          Background

          Concerns are present on the limited value of renal function alone in defining the optimal moment to start dialysis. Disease-related symptoms and health-related quality of life (HRQOL) may have additional clinical value in defining this moment, but little is known about how these parameters change during pre-dialysis care. The aims of our study were to describe the course of symptoms and HRQOL during pre-dialysis care and to investigate their association with poor health outcomes.

          Methods

          In the prospective PREPARE-2 cohort, incident patients starting specialized pre-dialysis care were included when referred to one of the 25 participating Dutch outpatient clinics (2004–2011). In the present analysis, 436 patients with data available on symptoms and HRQOL were included. Clinical data, symptoms (revised illness perception questionnaire), and HRQOL (short form-36 questionnaire; physical and mental summary score) were collected every 6-month interval. A time-dependent Cox proportional hazard model was used to associate symptoms and HRQOL with the combined poor health outcome (i.e. starting dialysis, receiving a kidney transplant, and death).

          Results

          All symptoms increased, especially fatigue and loss of strength, and both the physical and mental summary score decreased over time, with the most pronounced change during the last 6–12 months of follow-up. Furthermore, each additional symptom (adjusted HR 1.04 (95% CI, 1.00–1.09)) and each 3-point lower physical and mental summary score (adjusted HR 1.04 (1.02–1.06) and 1.04 (1.02–1.06) respectively) were associated with a higher risk of reaching the combined poor health outcome within the subsequent 6 months.

          Conclusions

          The number of symptoms increased and both the physical and mental HRQOL score decreased during pre-dialysis care and these changes were associated with starting dialysis, receiving a kidney transplant, and death. These results may indicate that symptoms and HRQOL are good markers for the medical condition and disease stage of pre-dialysis patients.

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          Most cited references31

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          Missing data: our view of the state of the art.

          Joseph Schafer, John W Graham (2002)
          Statistical procedures for missing data have vastly improved, yet misconception and unsound practice still abound. The authors frame the missing-data problem, review methods, offer advice, and raise issues that remain unresolved. They clear up common misunderstandings regarding the missing at random (MAR) concept. They summarize the evidence against older procedures and, with few exceptions, discourage their use. They present, in both technical and practical language, 2 general approaches that come highly recommended: maximum likelihood (ML) and Bayesian multiple imputation (MI). Newer developments are discussed, including some for dealing with missing data that are not MAR. Although not yet in the mainstream, these procedures may eventually extend the ML and MI methods that currently represent the state of the art.
          Article 0 comments Cited 932 times – based on 0 reviews     Review now
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            A randomized, controlled trial of early versus late initiation of dialysis.

            Bruce A Cooper, Pauline Branley, Liliana Bulfone … (2010)
            In clinical practice, there is considerable variation in the timing of the initiation of maintenance dialysis for patients with stage V chronic kidney disease, with a worldwide trend toward early initiation. In this study, conducted at 32 centers in Australia and New Zealand, we examined whether the timing of the initiation of maintenance dialysis influenced survival among patients with chronic kidney disease. We randomly assigned patients 18 years of age or older with progressive chronic kidney disease and an estimated glomerular filtration rate (GFR) between 10.0 and 15.0 ml per minute per 1.73 m2 of body-surface area (calculated with the use of the Cockcroft-Gault equation) to planned initiation of dialysis when the estimated GFR was 10.0 to 14.0 ml per minute (early start) or when the estimated GFR was 5.0 to 7.0 ml per minute (late start). The primary outcome was death from any cause. Between July 2000 and November 2008, a total of 828 adults (mean age, 60.4 years; 542 men and 286 women; 355 with diabetes) underwent randomization, with a median time to the initiation of dialysis of 1.80 months (95% confidence interval [CI], 1.60 to 2.23) in the early-start group and 7.40 months (95% CI, 6.23 to 8.27) in the late-start group. A total of 75.9% of the patients in the late-start group initiated dialysis when the estimated GFR was above the target of 7.0 ml per minute, owing to the development of symptoms. During a median follow-up period of 3.59 years, 152 of 404 patients in the early-start group (37.6%) and 155 of 424 in the late-start group (36.6%) died (hazard ratio with early initiation, 1.04; 95% CI, 0.83 to 1.30; P=0.75). There was no significant difference between the groups in the frequency of adverse events (cardiovascular events, infections, or complications of dialysis). In this study, planned early initiation of dialysis in patients with stage V chronic kidney disease was not associated with an improvement in survival or clinical outcomes. (Funded by the National Health and Medical Research Council of Australia and others; Australian New Zealand Clinical Trials Registry number, 12609000266268.)
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              Symptom burden, depression, and quality of life in chronic and end-stage kidney disease.

              Tammy Unruh, Khaled Abdel-Kader, Steven Weisbord (2009)
              While many patients with end-stage renal disease (ESRD) have impaired physical and psychologic well-being, less is known about these health domains in patients with advanced chronic kidney disease (CKD). The authors sought to compare symptoms, depression, and quality of life in patients with ESRD and those with CKD. Patients with ESRD and subjects with advanced CKD were enrolled. Patients' symptoms, depression, and quality of life were assessed using the Dialysis Symptom Index (DSI), Patient Health Questionnaire-9 (PHQ-9), and Short Form 36 (SF-36), respectively, and these health domains were compared between patient groups. Ninety patients with ESRD and 87 with CKD were enrolled. There were no differences in the overall number of symptoms or in the total DSI symptom-severity score. Median scores on the PHQ-9 were similar, as was the proportion of patients with PHQ-9 scores >9. SF-36 Physical Component Summary scores were comparable, as were SF-36 Mental Component Summary scores. The burden of symptoms, prevalence of depression, and low quality of life are comparable in patients with ESRD and advanced CKD. Given the widely recognized impairments in these domains in ESRD, findings of this study underscore the substantial decrements in the physical and psychologic well-being of patients with CKD.
              Article 0 comments Cited 148 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Olaf M. Dekkers: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2014
                Publication date (Electronic): 3 April 2014
                Volume: 9
                Issue: 4
                Electronic Location Identifier: e93069
                Affiliations
                [1 ]Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
                [2 ]Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
                [3 ]Department of Internal Medicine, Nephrology, Groene Hart Hospital, Gouda, The Netherlands
                Leiden University Medical Centre, Netherlands
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: MCMdG GO JIR JWE FWD NH. Analyzed the data: MCMdG FWD NH. Wrote the paper: MCMdG GO JIR JWE FWD NH.

                Article
                Publisher ID: PONE-D-13-31265
                DOI: 10.1371/journal.pone.0093069
                PMC ID: 3974712
                PubMed ID: 24699666
                SO-VID: 60893fc3-551b-4c9a-ab08-f6c3194c78e3
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 29 July 2013
                Date accepted : 28 February 2014
                Page count
                Pages: 9
                Funding
                This study was supported by a grant from the Dutch Kidney Foundation (SB 110, www.nierstichting.nl), and unrestricted grants from Amgen ( www.amgen.nl) and Baxter ( www.baxter.nl). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Renal System
                Subject: Physiology
                Subject: Renal Physiology
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Clinical Laboratory Sciences
                Subject: Epidemiology
                Subject: Clinical Epidemiology
                Subject: Disease Informatics
                Subject: Disease Surveillance
                Subject: Health Care
                Subject: Health Care Policy
                Subject: Health Care Quality
                Subject: Health Statistics
                Subject: Quality of Life
                Subject: Medical Humanities
                Subject: Evidence-Based Medicine
                Subject: Nephrology
                Subject: Chronic Kidney Disease
                Subject: Medical Dialysis
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Cohort Studies
                Subject: Longitudinal Studies
                Subject: Observational Studies
                Subject: Prospective Studies

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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