Kidney Res Clin Pract.  2020 Dec;39(4):426-440. 10.23876/j.krcp.20.065.

Impact of health-related quality of life on survival after dialysis initiation: a prospective cohort study in Korea

Affiliations
  • 1Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
  • 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
  • 3Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
  • 4Department of Intensive Care Unit, Yanbian University Hospital, Yanji, Jilin, China
  • 5Medical Research Collaborating Center, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
  • 6Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
  • 7Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
  • 8Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea

Abstract

Background
The effect of each health-related quality of life (HRQOL) component on hemodialysis prognosis has not been well studied. We aimed to investigate the clinical factors associated with HRQOL and the effect of HRQOL after dialysis initiation on long-term survival in an Asian population.
Methods
A total of 568 hemodialysis patients were included from a nationwide prospective cohort study. HRQOL was evaluated using the Kidney Disease Quality of Life (KDQOL) Short FormTM 1.3 at 3 months after dialysis initiation. The effect of each KDQOL item score on mortality was analyzed. Multivariable Cox analysis was performed after adjusting for age, sex, modified Charlson comorbidity index, and causes of primary kidney disease.
Results
Old age, diabetes mellitus, high comorbidities, and low serum albumin levels were associated with poor physical health status. Decreased urine output was associated with both poor physical and mental health status. The scores of 3 indices in the kidney disease domain (effect of kidney disease, social support, and dialysis staff encouragement) showed significant associations with mortality, as did the 3 indices (physical function, physical role limitation, and body pain) in the physical health domain. Neither the 4 indices in the mental health domain nor the mental composite score showed a significant association with mortality. However, a high physical composite score was associated with decreased overall patient mortality (P = 0.003). The effect of physical composite score on survival was prominent among young or middle-aged groups.
Conclusion
Poor physical health status 3 months after hemodialysis start correlates significantly with overall mortality.

Keyword

Dialysis; Mental health; Mortality; Physical health; Quality of life
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