Abstract
Background and objectives. In older people with kidney failure, improving health-related quality of life (HRQoL) is often more important than solely prolonging life. However, little is known about the effect of dialysis initiation on HRQoL in older patients. Therefore, we investigated the evolution of HRQoL before and after starting dialysis in older kidney failure patients.
Design, setting, participants and measurements. The European Quality (EQUAL) study is an ongoing prospective multicenter study in patients aged ≥65 years with an incident eGFR ≤20 mL/min/1.73m2. Between April 2012 and December 2021, HRQoL was assessed every 3-6 months using the 36-item Short-Form Health Survey (SF-36), providing a mental component summary (MCS) and physical component summary (PCS). Scores range from 0-100, with higher scores indicating better HRQoL. With linear mixed models we explored the course of HRQoL during the year preceding and following dialysis initiation.
Results. In total, 457 incident dialysis patients were included who filled out at least one SF-36 during follow-up. At dialysis initiation, mean±SD age was 76±6 years, eGFR was 8±3 ml/min/1.73m2, 75% were men, 9% smoked, 45% had diabetes, and 46% had cardiovascular disease. Median (IQR) MCS was 53 (38-73) and PCS was 39 (27-58). During the year preceding dialysis, estimated mean change in MCS was -13 (95%CI:-17;-9) and in PCS was -11 (95%CI:-15;-7). In the year following dialysis, estimated mean change in MCS was +2 (95%CI:-7;+11) and in PCS was -2 (95%CI:-11;+7). HRQoL patterns were similar for most mental (mental health, role emotional, social functioning, vitality) and physical domains (physical functioning, bodily pain, role physical).
Conclusions. Patients experienced a clinically relevant decline of both mental and physical HRQoL before dialysis initiation, which stabilized thereafter. These results may help inform older kidney failure patients who decided to start dialysis.
Design, setting, participants and measurements. The European Quality (EQUAL) study is an ongoing prospective multicenter study in patients aged ≥65 years with an incident eGFR ≤20 mL/min/1.73m2. Between April 2012 and December 2021, HRQoL was assessed every 3-6 months using the 36-item Short-Form Health Survey (SF-36), providing a mental component summary (MCS) and physical component summary (PCS). Scores range from 0-100, with higher scores indicating better HRQoL. With linear mixed models we explored the course of HRQoL during the year preceding and following dialysis initiation.
Results. In total, 457 incident dialysis patients were included who filled out at least one SF-36 during follow-up. At dialysis initiation, mean±SD age was 76±6 years, eGFR was 8±3 ml/min/1.73m2, 75% were men, 9% smoked, 45% had diabetes, and 46% had cardiovascular disease. Median (IQR) MCS was 53 (38-73) and PCS was 39 (27-58). During the year preceding dialysis, estimated mean change in MCS was -13 (95%CI:-17;-9) and in PCS was -11 (95%CI:-15;-7). In the year following dialysis, estimated mean change in MCS was +2 (95%CI:-7;+11) and in PCS was -2 (95%CI:-11;+7). HRQoL patterns were similar for most mental (mental health, role emotional, social functioning, vitality) and physical domains (physical functioning, bodily pain, role physical).
Conclusions. Patients experienced a clinically relevant decline of both mental and physical HRQoL before dialysis initiation, which stabilized thereafter. These results may help inform older kidney failure patients who decided to start dialysis.
| Original language | English |
|---|---|
| Pages (from-to) | 1159-1167 |
| Number of pages | 9 |
| Journal | Clinical Journal of the American Society of Nephrology |
| Volume | 17 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - 31 Aug 2022 |
Bibliographical note
Funding Information:Main funding for the EQUAL study was received from the European Renal Association and contributions from the Swedish Medical Association, the Stockholm County Council ALF Medicine and Center for Innovative Research, the Italian Society of Nephrology, the Dutch Kidney Foundation, the Young Investigators Grant in Germany, and the National Institute for Health Research in the United Kingdom.
Funding Information:
F.J. Caskey reports research funding from the National Institute for Health Research and serving as treasurer, honorary secretary, and an executive committee member of the International Society of Nephrology (unpaid). F.W. Dekker reports research funding from Astellas, Chiesi, and Vifor; collaboration with the Dutch Kidney
Publisher Copyright:
© 2022 by the American Society of Nephrology.
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