Longitudinal patterns of health-related quality of life and dialysis modality: a national cohort study

Nwamaka D Eneanya, Dugan W Maddux, Marta M Reviriego-Mendoza, John W Larkin, Len A Usvyat, Frank M van der Sande, Jeroen P Kooman, Franklin W Maddux, Nwamaka D Eneanya, Dugan W Maddux, Marta M Reviriego-Mendoza, John W Larkin, Len A Usvyat, Frank M van der Sande, Jeroen P Kooman, Franklin W Maddux

Abstract

Background: Health-related quality of life (HrQoL) varies among dialysis patients. However, little is known about the association of dialysis modality with HrQoL over time. We describe longitudinal patterns of HrQoL among chronic dialysis patients by treatment modality.

Methods: National retrospective cohort study of adult patients who initiated in-center dialysis or a home modality (peritoneal or home hemodialysis) between 1/2013 and 6/2015. Patients remained on the same modality for the first 120 days of the first two years. HrQoL was assessed by the Kidney Disease and Quality of Life-36 (KDQOL) survey in the first 120 days of the first two years after dialysis initiation. Home modality patients were matched to in-center patients in a 1:5 fashion.

Results: In-center (n=4234) and home modality (n=880) patients had similar demographic and clinical characteristics. In-center dialysis patients had lower mean KDQOL scores across several domains compared to home modality patients. For patients who remained on the same modality, there was no change in HrQoL. However, there were trends towards clinically meaningful changes in several aspects of HrQoL for patients who switched modalities. Specifically, physical functioning decreased for patients who switched from home to in-center dialysis (p< 0.05).

Conclusions: Among a national cohort of chronic dialysis patients, there was a trend towards different patterns of HrQoL life that were only observed among patients who changed modality. Patients who switched from home to in-center modalities had significant lower physical functioning over time. Providers and patients should be mindful of HrQoL changes that may occur with dialysis modality change.

Keywords: Dialysis; dialysis modality; quality-of-life.

Conflict of interest statement

Ethics approval and consent to participate

A protocol detailing this retrospective analysis was reviewed by Schulman Institutional Review Board (IRB) in Cincinnati, OH and determined to be exempt from regulatory approval. This study was of minimal risk and did not require informed consent.

Consent for publication

Not applicable

Competing interests

NDE, FVDS, JPK declare no conflicts of interest. DWM, MMR, JWL, LAU, FWM are employees of Fresenius Medical Care North America. LAU, DWM, FWM have stock ownership in Fresenius Medical Care. FWM has directorships in American National Bank & Trust, Mid-Atlantic Renal Coalition, and Sound Physicians. FWM is the chairman of Pacific Care Renal Foundation 501(c)(3) nonprofit.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow diagram

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