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. 2024 Dec 20;18(2):sfae420.
doi: 10.1093/ckj/sfae420. eCollection 2025 Feb.

Quality of life trajectories for different dialysis modalities-a nationwide study

Helena Rydell  1   2   3 , Aurora Caldinelli  4 , Jenny Wrackefeldt  1   2 , Aline Kåveryd-Hult  3   5 , Bengt Lindholm  1 , Abdul Rashid Qureshi  1 , Nicholas C Chesnaye  6   7 , Marie Evans  1   2   3
Affiliations

Quality of life trajectories for different dialysis modalities-a nationwide study

Helena Rydell et al. Clin Kidney J. .

Abstract

Background: Few contemporary studies have investigated the changes in quality of life across dialysis modalities. Our aim was to compare longitudinal changes in health-related physical and mental quality of life between patients on institutional hemodialysis (IHD), peritoneal dialysis (PD) and home hemodialysis (HHD).

Methods: Patients on dialysis with registered Research and Development 36 (RAND-36) questionnaires between 2017-2021 in the Swedish Renal Registry (SRR) were eligible for inclusion. Information on dialysis, patient characteristics and medication were collected from SRR and other registries. Patients were followed up to 39 months. Changes in physical (PCS) and mental (MCS) component summary scores were analyzed in adjusted linear mixed models and joint models.

Results: We included 930 patients (IHD 714, PD 128, HHD 88) with a median follow-up of 1.8 years (interquartile range 1.0-2.1). At baseline, the mean unadjusted PCS was lower in IHD (30.7; 95% CI 29.9, 31.4) compared with HHD (35.3; 95% CI 33.0, 37.5) and PD (33.2; 95% CI 31.3, 35.1). PCS declined over time in all modalities, but faster for PD compared with IHD (-1.2; 95% CI -2.1, -0.3 per year) and HHD (-1.5, 95% CI -2.9, -0.04). MCS was similar at baseline. HHD had improving MCS trajectory compared to IHD (-1.5, 95% CI -2.8, 0.2) and PD (-2.3, 95% CI -3.9, 0.7), largely resulting from improvement in role limitations caused by mental health (6.2, 95% CI 0.9, 11.5).

Conclusion: Insights about the variation in quality-of-life trajectories for different dialysis modalities are important for patients to make informed choices.

Keywords: RAND-36; home hemodialysis; in-center hemodialysis; peritoneal dialysis; quality of life.

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Conflict of interest statement

M.E., institutional grants from Astellas pharma and Astra Zeneca, payment for lectures and advisory boards from Astellas pharma and Vifor pharma, and payment for lectures from Astra Zeneca, Fresenius Medical Care, and Baxter Healthcare. B.L., previous affiliation with Baxter Healthcare. J.W., payment for lectures from Fresenius Medical Care.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Comparison of physical component summary score (PCS; estimated marginal means) of quality of life between patients on IHD, HHD and PD. *Linear mixed adjusted model (sex, age, Charlson Comorbidity Index score, diabetes, dialysis vintage, the number of days admitted to hospital the last year before baseline, and laboratory values; albumin, hemoglobin, phosphate).
Figure 2:
Figure 2:
Comparison of mental component summary score (MCS; estimated marginal means) of quality of life between patients on IHD, HHD and PD. *Linear mixed adjusted model (sex, age, Charlson Comorbidity Index score, diabetes, dialysis vintage, the number of days admitted to hospital the last year before baseline, and laboratory values; albumin, hemoglobin, phosphate).
Figure 3:
Figure 3:
Difference between IHD versus PD or HHD over follow-up in the eight dimensions included in the RAND-36. *Linear mixed adjusted model (sex, age, Charlson Comorbidity Index score, diabetes, dialysis vintage, the number of days admitted to hospital the last year before baseline, and laboratory values; albumin, hemoglobin, phosphate).
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