Recovery time, quality of life, and mortality in hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Abstract

Background: There is limited information about the clinical and prognostic significance of patient-reported recovery time.

Study design: Prospective cohort study.

Setting & participants: 6,040 patients in the DOPPS (Dialysis Outcomes and Practice Patterns Study).

Predictor: Answer to question "How long does it take you to recover from a dialysis session?" categorized as follows: fewer than 2, 2-6, 7-12, or longer than 12 hours.

Outcomes & measurements: Cross-sectional and longitudinal associations between recovery time and patient characteristics, hemodialysis treatment variables, health-related quality of life (HRQoL), and hospitalization and mortality.

Results: 32% reported recovery time shorter than 2 hours; 41%, 2-6 hours; 17%, 7-12 hours; and 10%, longer than 12 hours. Using proportional odds (ordinal) logistic regression, shorter recovery time was associated with male sex, full-time employment, and higher serum albumin level. Longer recovery time was associated with older age, dialysis vintage, body mass index, diabetes, and psychiatric disorder. Greater intradialytic weight loss, longer dialysis session length, and lower dialysate sodium concentration were associated with longer recovery time. In facilities that used uniform dialysate sodium concentrations for ≥90% of patients, the adjusted OR of longer recovery time, comparing dialysate sodium concentration<140 vs 140 mEq/L, was 1.72 (95% CI, 1.37-2.16). Recovery time was correlated positively with symptoms of kidney failure and kidney disease burden score and inversely with HRQoL mental and physical component summary scores. Using Cox regression, adjusting for potential confounders not influenced by recovery time, it was associated positively with first hospitalization and mortality (adjusted HRs for recovery time>12 vs 2-6 hours 1.22 [95% CI, 1.09-1.37] and 1.47 [95% CI, 1.19-1.83], respectively).

Limitations: Answers are subjective and not supported by physiologic measurements.

Conclusions: Recovery time can be used to identify patients with poorer HRQoL and higher risks of hospitalization and mortality. Interventions to reduce recovery time and possibly improve clinical outcomes, such as increasing dialysate sodium concentration, need to be tested in randomized trials.

Keywords: DOPPS (Dialysis Outcomes and Practice Patterns Study); Hemodialysis; patient-reported outcomes; quality of life.

Figure 1

Odds Ratios (with 95% CI) of longer reported recovery time in three categories of dialysate sodium concentration (DNa) among facilities in which ≥ 90% of patients used the same DNa (‘non-individualized’ facilities). N=3,181 patients. “Demographic adjustments” includes country, race (US-black only), ears on dialysis, age, BMI, sex, and 14 summary comorbidities. “Health status and treatment adjustments” includes demographic adjustments plus full-time employment, dialysis session length, intradialytic weight loss, catheter use, serum albumin, hemoglobin, use of hemodiafiltration, blood flow rate, single pool K/tV, and Δ(pre-post) systolic blood pressure.