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

Keywords: Dialysis; Mental health; Mortality; Physical health; Quality of life.

Figure 1. Patient survival according to the kidney disease elements, overall health, and patient satisfaction.

(A) Symptoms/problem list. (B) Effects of kidney disease. (C) Burden of kidney disease. (D) Work status. (E) Cognitive function. (F) Quality of social interaction. (G) Sexual function. (H) Sleep. (I) Social support. (J) Dialysis staff encouragement. (K) Overall health. (L) Patient satisfaction. Among the various elements, lower scores of HRQOL including (B) effects of kidney disease (P = 0.001), (F) quality of social interaction (P = 0.010), (I) social support (P = 0.001), and (J) dialysis staff encouragement (P = 0.028) were significantly associated with poor patient survival. Q1, Q2, Q3, Q4, and Q5 means 3- to 5-quantile group as appropriate.

Figure 1. Patient survival according to the kidney disease elements, overall health, and patient satisfaction.

(A) Symptoms/problem list. (B) Effects of kidney disease. (C) Burden of kidney disease. (D) Work status. (E) Cognitive function. (F) Quality of social interaction. (G) Sexual function. (H) Sleep. (I) Social support. (J) Dialysis staff encouragement. (K) Overall health. (L) Patient satisfaction. Among the various elements, lower scores of HRQOL including (B) effects of kidney disease (P = 0.001), (F) quality of social interaction (P = 0.010), (I) social support (P = 0.001), and (J) dialysis staff encouragement (P = 0.028) were significantly associated with poor patient survival. Q1, Q2, Q3, Q4, and Q5 means 3- to 5-quantile group as appropriate.

Figure 2. Patient survival according to the physical health domain elements.

(A) Physical function. (B) Physical role limitation. (C) Pain. (D) General health. Among elements in the physical health domain, lower scores of HRQOL including (A) physical function (P < 0.001), (B) physical role limitation (P = 0.002), and (C) pain (P = 0.005) were significantly associated with poor patient survival. Q1, Q2, Q3, Q4, and Q5 means 3- to 5- quantile group as appropriate.

Figure 3. Patient survival according to the mental health domain elements.

(A) Emotional well-being. (B) Emotional-role limitation. (C) Social function. (D) Energy/fatigue. All HRQOL elements in the mental health domain including (A) emotional well-being (P = 0.281), (B) emotional-role limitation (P = 0.257), (C) social function (P = 0.109), and (D) energy/fatigue (P = 0.294) were not significantly associated with patient survival. Q1, Q2, Q3, Q4, and Q5 means 3- to 5- quantile group as appropriate.

Figure 4. Patient survival according to the physical and mental composite scores.

(A) Physical composite score. (B) Mental composite score. Lower physical composite scores (P < 0.001) were significantly associated with poor patient survival. Mental composite scores (P = 0.607) were not associated with patient mortality. Q1, Q2, Q3, Q4, and Q5 means 3- to 5- quantile group as appropriate.