Health-related quality of life as a predictor of mortality among survivors of AKI

Abstract

Background and objectives: This study examined the relationship between health-related quality of life and subsequent mortality among AKI survivors treated with renal replacement therapy.

Design, setting, participants, & measurements: Multivariable Cox regression models were used to assess the associations between Health Utilities Index Mark 3 (HUI3) and ambulation, emotion, cognition, and pain scores at 60 days and all-cause mortality at 1 year in 60-day AKI survivors (n=439 with evaluable HUI3 assessments) from a randomized multicenter study comparing less- with more-intensive renal replacement therapies.

Results: The median 60-day HUI3 index score was 0.32. Patients with evaluable HUI3 data who died between 60 days and 1 year (n=99) were more likely to have lower 60-day median HUI3 scores, higher comorbidity scores, and longer initial hospital stays, and they were more likely to be dialysis-dependent. A 0.1 higher HUI3 index score was associated with a 17% decrease (hazard ratio, 0.83; 95% confidence interval 0.77-0.89) in all-cause mortality after controlling for clinical risk factors. Similar associations were observed for HUI3 ambulation, emotion, cognition, and pain attribute scores.

Conclusions: Health-related quality of life measured by HUI3 is an independent predictor of mortality among survivors of AKI after adjusting for clinical risk variables. Poor ambulation and other health-related quality of life attributes are also associated with increased risk of death. Health-related quality of life may provide clinicians with additional information to help identify patients at high risk of mortality after AKI that required renal replacement therapy.

Trial registration: ClinicalTrials.gov NCT00076219.

Figures

Figure 1.

Kaplan–Meier survival plots showing that patients in the high Health Utilities Index (HUI3) score or subscale score tertile had significantly better survival than those in the middle and low tertiles. (A) Kaplan–Meier plot of overall survival by HUI3 index score. (B) Kaplan–Meier plot of overall survival by HUI3 ambulation subscale score. (C) Kaplan–Meier plot of overall survival by HUI3 emotion subscale score. (D) Kaplan–Meier plot of overall survival by HUI3 cognition subscale score. (E) Kaplan–Meier plot of overall survival by HUI3 pain subscale score.

Figure 1.

Kaplan–Meier survival plots showing that patients in the high Health Utilities Index (HUI3) score or subscale score tertile had significantly better survival than those in the middle and low tertiles. (A) Kaplan–Meier plot of overall survival by HUI3 index score. (B) Kaplan–Meier plot of overall survival by HUI3 ambulation subscale score. (C) Kaplan–Meier plot of overall survival by HUI3 emotion subscale score. (D) Kaplan–Meier plot of overall survival by HUI3 cognition subscale score. (E) Kaplan–Meier plot of overall survival by HUI3 pain subscale score.