Quality of Life before and after the Start of Dialysis in Older Patients

• Published in: Clinical journal of the American Society of Nephrology 2022-08, Vol.17 (8), p.1159-1167
• Main Authors: de Rooij, Esther N M, Meuleman, Yvette, de Fijter, Johan W, Le Cessie, Saskia, Jager, Kitty J, Chesnaye, Nicholas C, Evans, Marie, Pagels, Agneta A, Caskey, Fergus J, Torino, Claudia, Porto, Gaetana, Szymczak, Maciej, Drechsler, Christiane, Wanner, Christoph, Dekker, Friedo W, Hoogeveen, Ellen K
• Format: Article
• Language: English
• Subjects: Aged; Female; Humans; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - therapy; Male; Medicin och hälsovetenskap; Original; Prospective Studies; Quality of Life - psychology; Renal Dialysis - adverse effects; Renal Insufficiency; Surveys and Questionnaires
• ISSN: 1555-9041; 1555-905X; 1555-905X
• DOI: 10.2215/CJN.16371221

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. 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 m . 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. 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 m , 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). 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.