Study examines quality of life in older adults before and after starting dialysis

Posted in In a study of CJASN including older adults with advanced chronic kidney disease, mental and physical health-related quality of life (HRQoL) was Patients who had worsened in the previous year started dialysis, but this decline stabilized after starting dialysis.

Older adults with renal failure may feel that improving HRQoL is more important than simply prolonging life. Therefore, while dialysis can help older patients live longer, it is equally or even more important to determine its impact on HRQoL.

For the investigation, Esther NM de Rooij, MD (Leiden University Medical Center, The Netherlands) and her colleagues analyzed data from the European Quality (EQUAL) study, an ongoing prospective multicenter study of patients 65 years and older with advanced chronic kidney disease. Between April 2012 and December 2021, HRQoL was assessed every 3-6 months using a 36-item short health survey, providing a total score for mental and physical composition. Scores range from 0-100, with higher scores indicating better HRQoL. Changes in mental or physical HRQoL scores of 3 to 5 were considered clinically relevant.

The analysis included 457 patients who started dialysis treatment. At the start of dialysis, the median psychological HRQoL score was 53 and the median HRQoL physical score was 39. In the year prior to dialysis, the mean change in mental HRQoL was -13 and the mean change in physical HRQoL was -11. The mean change in mental HRQoL was +2 and the mean change in physical HRQoL was -2 in the year following initiation of dialysis.

“Few studies have investigated changes in quality of life before and after dialysis. We are the first in a large international population of older patients cohort to do so,” said Dr de Rooij. “We hope these results will inform older kidney failure patients who decide to start dialysis about expected changes in changes associated with their HRQoL.”

The accompanying editorial notes that these data are impressive as the researchers were able to prospectively collect patient-reported outcomes from more than 400 patients in 6 countries at 3-6 month intervals. The authors say it will be interesting to see how clinicians around the world use this data for patient care in the coming months and years. “It is hoped that the ultimate goal remains to identify those on the ‘destination dialysis path’ and to place greater emphasis on providing health care rather than wellness treatment,” they wrote. )

Additional study authors include Yvette Meuleman, Johan W. de Fijter, Saskia Le Cessie, Kitty J. Jager, Nicholas C. Chesnaye, Marie Evans, Agneta A. Pagels, Fergus J . Caskey, Claudia Turin, Gaetana Porto, Maciej Szymczak, Christiane Drechsler, Christoph Wanner, Friedo W. Dekker and Ellen K. Hoogeveen.