Health-related quality of life improved among patients the year after dialysis initiation
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In the year preceding dialysis initiation, older adults with advanced chronic kidney disease experienced worse mental and physical health-related quality of life compared with the year after dialysis.
“Very few studies have investigated the change in quality of life before and after dialysis. We are first to do so in a large international cohort of older patients,” Esther N.M. de Rooij, MD, from the department of nephrology at Leiden University Medical Center in The Netherlands, said in the press release. “We hope these results can inform older patients with kidney failure who have decided to start dialysis on what to expect in changes related to their health-related quality of life.”
In the ongoing prospective, multicenter European Quality study, researchers explored the change in health-related quality of life during the years before and after dialysis initiation among 457 patients at least 65 years old with an incident eGFR equal or less than 20 mL/min per 1.73 m2. The study has been conducted in Germany, Italy, Poland, Sweden, The Netherlands and the United Kingdom.
Researchers measured health-related quality of life among patients every 3 to 6 months between April 2012 and December 2021 using the 36-item Short-Form Health Survey. The survey included mental and physician component summaries in which higher scores on a 0 to 100 scale indicated better health-related quality of life. All patients completed at least one survey.
Using linear mixed models, researchers assessed the course of quality of life the year before and after each patient started dialysis.
Analyses revealed the median mental component summary was 53 and the median physical component summary was 39. In the year before dialysis, the average change in average health-related quality of life mental score was -13 and -11 for the physical score. However, the change in the mental score was +2 the year after dialysis initiation and -2 for the physical score.
In an accompany editorial, Jorge I. Fonseca Correa, MD, from the department of nephrology and mineral metabolism at National Institute of Medical Sciences and Nutrition Salvador Zubirán in Mexico, and S. Vanita Jassal, MSc, MD, from the division of nephrology at University Health Network in Canada, wrote, “The results presented are striking and show a dramatic fall in quality of life in older individuals in the 12 months preceding dialysis start in both the physical component scale and the mental component scale domains.”
They added, “One key positive finding reported by the authors is that the decline in quality of life stabilizes after dialysis is started. Although from one perspective, this is a positive observation, our interpretation is rather more pessimistic. Despite the introduction of a costly and intensive therapy, these patients did not experience a return to their previous baseline health. In fact, the quality-of-life scores barely showed an uptick that peaked around the 3-month mark and then started to slowly decline.”
Fonseca Correa and Jassal and colleagues noted that it will be interesting to see how clinicians use these data for patient care.
References:
Study Examines Older Adults’ Quality of Life Before and After Starting Dialysis. https://www.newswise.com/articles/study-examines-older-adults-quality-of-life-before-and-after-starting-dialysis?sc=mwhr&xy=10007438/?ad2f=1&aid=775074. Published July 28, 2022. Accessed July 28, 2022.
Fonseca-Correa JI, et al. Clin J Am Soc Nephrol. 2022;doi:10.2215/CJN.07110622.
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