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  • Among older adults with advanced chronic kidney disease, mental and physical health-related quality of life worsened in the year before they started dialysis treatment, but their quality of life stabilized after dialysis was initiated.

Newswise — Washington, DC (July 28, 2022) — In a study published in CJASN that included older adults with advanced chronic kidney disease, mental and physical health-related quality of life (HRQoL) worsened in the year before patients started dialysis, but this decline stabilized after dialysis was initiated.

Older people with kidney failure may feel that improving HRQoL is more important than solely prolonging life. Therefore, although dialysis can help older patients live longer, it’s equally or even more important to determine its effects on HRQoL.

To investigate, Esther N.M. de Rooij, MD (Leiden University Medical Center, in The Netherlands) and her colleagues analyzed data from the European Quality (EQUAL) study, an ongoing prospective multicenter study in patients aged 65 years and older with advanced chronic kidney disease. Between April 2012 and December 2021, HRQoL was assessed every 3–6 months using the 36-item Short-Form Health Survey, providing a mental component summary score and physical component summary score. Scores can range from 0–100, with higher scores indicating better HRQoL. Changes of 3 to 5 points in mental or physical HRQoL score are considered as clinically relevant.  

The analysis included 457 patients who started dialysis treatment. At dialysis initiation, the median mental HRQoL score was 53 and the median HRQoL physical score was 39. During the year preceding dialysis, the average change in mental HRQoL was -13 and the average change in physical HRQoL was -11. In the year following dialysis initiation, the average change in mental HRQoL was +2 and the average change in physical HRQoL was -2.

“Very few studies have investigated the change in quality of life before and after dialysis. We are first to do so in a large international cohort of older patients,” said Dr. de Rooij. “We hope these results can inform older patients with kidney failure who have decided to start dialysis on what to expect in changes related to their HRQoL.”

An accompanying editorial notes that the data are impressive in that the researchers were able to prospectively gather patient-reported outcomes across 6 countries, at 3–6 month intervals over a number of years, on more than 400 patients. The authors state that over the coming months and years, it will be interesting to see how clinicians across the world use these data for patient care. “One hopes the ultimate goal remains to identify those on a ‘destination dialysis path’ and place more emphasis on providing Healthcare rather than Healthtreatments,” 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 Torino, Gaetana Porto, Maciej Szymczak, Christiane Drechsler, Christoph Wanner, Friedo W. Dekker, and Ellen K. Hoogeveen.

Disclosures: The authors reported no financial disclosures related to this research.

The article, titled “Quality of Life before and after the Start of Dialysis in Older Patients,” will appear online at http://cjasn.asnjournals.org/ on July 28, 2022, doi: 10.2215/CJN.16371221.

The editorial, titled “Health Care for Older Adults with Kidney Failure,” will appear online at http://cjasn.asnjournals.org/ on July 28, 2022, doi: 10.2215/CJN.07110622.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies. 

About ASN Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has more than 20,000 members representing 132 countries. For more information, visit www.asn-online.org and follow us on Facebook, Twitter, LinkedIn, and Instagram.

 

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CITATIONS

CJASN doi: 10.2215/CJN.16371221