TY - JOUR
T1 - Quality of Life before and after the Start of Dialysis in Older Patients
AU - de Rooij, Esther N. M.
AU - Meuleman, Yvette
AU - de Fijter, Johan W.
AU - le Cessie, Saskia
AU - Jager, Kitty J.
AU - Chesnaye, Nicholas C.
AU - Evans, Marie
AU - Pagels, Agneta A.
AU - Caskey, Fergus J.
AU - Torino, Claudia
AU - Porto, Gaetana
AU - Szymczak, Maciej
AU - Drechsler, Christiane
AU - Wanner, Christoph
AU - Dekker, Friedo W.
AU - Hoogeveen, Ellen K.
N1 - 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.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background and objectives In older people with kidney failure, improving health-related quality of life is often more important than solely prolonging life. However, little is known about the effect of dialysis initiation on health-related quality of life in older patients. Therefore, we investigated the evolution of health-related quality of life before and after starting dialysis in older patients with kidney failure. Design, setting, participants, & measurements The European Quality study is an ongoing prospective, multicenter study in patients aged ≥65 years with an incident eGFR ≤20 ml/min per 1.73 m2. Between April 2012 and December 2021, health-related quality of life was assessed every 3–6 months using the 36-item Short-Form Health Survey (SF-36), providing a mental component summary (MCS) and a physical component summary (PCS). Scores range from zero to 100, with higher scores indicating better health-related quality of life. With linear mixed models, we explored the course of health-related quality of life during the year preceding and following dialysis initiation. Results In total, 457 patients starting dialysis 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 per 1.73 m2, 75% were men, 9% smoked, 45% had diabetes, and 46% had cardiovascular disease. Median (interquartile range) MCS was 53 (38–73), and median PCS was 39 (27–58). During the year preceding dialysis, estimated mean change in MCS was-13 (95% confidence interval,-17 to-9), and in PCS, it was-11 (95% confidence interval,-15 to-7). In the year following dialysis, estimated mean change in MCS was +2 (95% confidence interval,-7 to +11), and in PCS, it was-2 (95% confidence interval,-11 to +7). Health-related quality-of-life 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 health-related quality of life before dialysis initiation, which stabilized thereafter. These results may help inform older patients with kidney failure who decided to start dialysis.
AB - Background and objectives In older people with kidney failure, improving health-related quality of life is often more important than solely prolonging life. However, little is known about the effect of dialysis initiation on health-related quality of life in older patients. Therefore, we investigated the evolution of health-related quality of life before and after starting dialysis in older patients with kidney failure. Design, setting, participants, & measurements The European Quality study is an ongoing prospective, multicenter study in patients aged ≥65 years with an incident eGFR ≤20 ml/min per 1.73 m2. Between April 2012 and December 2021, health-related quality of life was assessed every 3–6 months using the 36-item Short-Form Health Survey (SF-36), providing a mental component summary (MCS) and a physical component summary (PCS). Scores range from zero to 100, with higher scores indicating better health-related quality of life. With linear mixed models, we explored the course of health-related quality of life during the year preceding and following dialysis initiation. Results In total, 457 patients starting dialysis 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 per 1.73 m2, 75% were men, 9% smoked, 45% had diabetes, and 46% had cardiovascular disease. Median (interquartile range) MCS was 53 (38–73), and median PCS was 39 (27–58). During the year preceding dialysis, estimated mean change in MCS was-13 (95% confidence interval,-17 to-9), and in PCS, it was-11 (95% confidence interval,-15 to-7). In the year following dialysis, estimated mean change in MCS was +2 (95% confidence interval,-7 to +11), and in PCS, it was-2 (95% confidence interval,-11 to +7). Health-related quality-of-life 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 health-related quality of life before dialysis initiation, which stabilized thereafter. These results may help inform older patients with kidney failure who decided to start dialysis.
UR - http://www.scopus.com/inward/record.url?scp=85136232841&partnerID=8YFLogxK
U2 - https://doi.org/10.2215/CJN.16371221
DO - https://doi.org/10.2215/CJN.16371221
M3 - Article
C2 - 35902127
SN - 1555-9041
VL - 17
SP - 1159
EP - 1167
JO - Clinical journal of the American Society of Nephrology
JF - Clinical journal of the American Society of Nephrology
IS - 8
ER -