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Association between changes in quality of life and mortality in hemodialysis patients: results from the DOPPS.

Perl, Jeffrey and Karaboyas, Angelo and Morgenstern, Hal and Sen, Ananda and Rayner, Hugh C and Vanholder, Raymond C and Combe, Christian and Hasegawa, Takeshi and Finkelstein, Fredric O and Lopes, Antonio A and Robinson, Bruce M and Pisoni, Ronald L and Tentori, Francesca (2016) Association between changes in quality of life and mortality in hemodialysis patients: results from the DOPPS. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. ISSN 1460-2385.

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Official URL: https://academic.oup.com/ndt/search-results?page=1...

Abstract

BACKGROUND

Cross-sectional health-related quality of life (HR-QOL) measures are associated with mortality in hemodialysis (HD) patients. The impact of changes in HR-QOL on outcomes remains unclear. We describe the association of prior changes in HR-QOL with subsequent mortality among HD patients.

METHODS

A total of 13 784 patients in the Dialysis Outcomes and Practice Patterns Study had more than one measurement of HR-QOL. The impact of changes between two measurements of the physical (PCS) and mental (MCS) component summary scores of the SF-12 on mortality was estimated with Cox regression.

RESULTS

Mean age was 62 years (standard deviation: 14 years); 59% were male and 32% diabetic. Median time between HR-QOL measurements was 12 months [interquartile range (IQR): 11, 14]. Median initial PCS and MCS scores were 37.5 (IQR: 29.4, 46.2) and 46.4 (IQR: 37.2, 54.9); median changes in PCS and MCS scores were -0.2 (IQR: -5.5, 4.7) and -0.1 (IQR: -6.8, 5.9), respectively. The adjusted hazard ratio (HR) for a 5-point decline in HR-QOL score was 1.09 [95% confidence interval (CI): 1.06-1.12] for PCS and 1.05 (95% CI: 1.03-1.08) for MCS. Adjusting for the second QOL score, the change was not associated with mortality: HR = 1.01 (95% CI: 0.98-1.05) for delta PCS and 1.01 (95% CI: 0.98-1.03) for delta MCS. Categorizing the first and second scores as predictors, only the second PCS or MCS score was associated with mortality.

CONCLUSIONS

In our study, only the most recent HR-QOL score was associated with mortality. Hence, the predictive power of a measurement of HR-QOL is not affected by changes in HR-QOL prior to that measurement; more frequent HR-QOL measurements are needed to improve the prediction of outcomes in HD. Further studies are needed to determine the optimal frequency and appropriate instrument to be used for serial measurements.

Item Type: Article
Subjects: WJ Urogenital system. Urology
Divisions: Emergency Services > Renal
Related URLs:
Depositing User: Miss Adele Creak
Date Deposited: 03 Mar 2017 13:55
Last Modified: 03 Mar 2017 13:55
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1234

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