Health-related quality of life among older adults drops in the year preceding dialysis initiation, then stabilizes, a new study finds.
In the European Quality study, investigators asked 457 patients in 6 countries starting hemodialysis or peritoneal dialysis to complete short form 36 (SF-36) during the dialysis transition. Participants were aged 65 years or older with a recent decline in estimated glomerular filtration to or below 20 mL/min/1.73 m2. Each patient completed an average of 3.3 questionnaires.
In the year before dialysis initiation, the mental component summary (MCS) score declined a mean 13 points and the physical component summary (PCS) score declined a mean 11 points among respondents, Esther de Rooij, a PhD student at Leiden University Medical Center in The Netherlands, and colleagues reported in the Clinical Journal of the American Society of Nephrology. Results were consistent across patient age, sex (75% of the cohort were male), and health profile (approximately half had diabetes and/or cardiovascular disease). In various chronic conditions, clinically important differences in SF-36 range from 3 to 5 points, the investigators pointed out, so the declines preceding dialysis are “substantial.”
In the year before dialysis initiation, patients experienced declines in each domain of MCS, with scores for mental health, role limitations due to emotional problems, social functioning, and vitality falling significantly by 9, 17, 14, and 12 points, respectively. With respect to PCS, scores for physical functioning, bodily pain, and role functioning declined significantly by 11, 9, and 18 points, respectively. General health had a nonsignificant decline of 2 points.
In the year following dialysis initiation, MCS score increased by a mean 2 points, whereas the PCS score decreased by a mean 2 points, de Rooij and colleagues reported. All mental health domains improved, except for emotional role functioning. All physical health domains decreased slightly, except for physical role functioning, which increased by 4 points.
According to the investigators, the steep decline in health-related quality of life in the months leading up to dialysis initiation may reflect the buildup in uremic solutes and symptoms, the process of vascular access creation, and an increase in health care visits. In the year following dialysis, improvement in health-related quality of life may partly reflect a shift in patient response as they adjust to their new reality.
“These results could help with informing older patients with kidney failure who decide to start dialysis on what to expect in the change of HRQoL,” de Rooij’s team wrote. They noted that for some patients improving health-related quality of life after dialysis initiation is more important than prolonging life.
In a discussion of study limitations, the authors noted that 18% and 35% of questionnaires from follow-up visits in the year before and after dialysis initiation, respectively, were missing.
In an accompanying editorial, Jorge Fonseca-Correa, MD, of Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico, and S. Vanita Jassal, MD, of the University of Toronto in Canada, applauded the study while pointing out its limitations, and observed, “Despite the introduction of a costly and intensive therapy [ie dialysis], these patients did not experience a return to their previous baseline health.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
de Rooij ENM, Meuleman Y, de Fijter JW, et al. Quality of life before and after the start of dialysis in older patients. Clin J Am Soc Nephrol. Published online July 28, 2022. doi:10.2215/CJN.16371221
Fonseca-Correa JI, Jassal SV. Health care for older adults with kidney failure. Clin J Am Soc Nephrol. Published online July 28, 2022. doi:10.2215/CJN.07110622