Impact of Prior Kidney Transplantation on Symptom Burden and Health-Related Quality of Life in Incident Dialysis Patients

Abstract Rationale & Objective Data on symptom burden and health-related quality of life (HRQoL) in patients with kidney graft failure returning to dialysis are limited. This study therefore assessed these parameters during the first year of dialysis in prior-transplant patients and compared this to transplant-naive incident dialysis patients. Study Design Multicenter prospective cohort study: Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO). Setting & Participants Adult patients who initiated dialysis treatment. Exposure Prior kidney transplantation or transplant-naive status. Outcomes Symptom burden (Dialysis Symptom Index) and HRQoL (Short Form-12) at dialysis initiation and three, six, and twelve months later. Analytical Approach Linear mixed models, adjusted for confounders such as age and comorbidity. Results 161 prior-transplant and 1475 transplant-naive patients were included. Symptom burden did not differ between prior-transplant and transplant-naive patients (mean differences during first year of dialysis treatment [95% CI]: number of symptoms 0.1 [-0.6;0.8], overall symptom severity score 0.8 [-1.5;3.0]). However, prior-transplant patients had lower HRQoL scores at dialysis initiation (physical -2.6 [-4.2;-0.9], mental -2.0 [-3.7;-0.3], which persisted during the first year of dialysis for physical HRQoL (mean difference in first year -2.1 [-3.3; -0.8]). Mental HRQoL was no longer different between prior-transplant and transplant-naive patients (-0.8 [-1.9;0.4]). Limitations Detailed data regarding the kidney transplantations were not available. Data on psychosocial counseling and guidance were not collected. Conclusions We observed lower HRQoL in prior-transplant compared to transplant-naive patients at dialysis initiation, which may be related to graft rejection and an immunosuppressed state. These findings suggest that patients with graft loss could benefit from additional support to address physical and mental well-being during the transition to dialysis treatment.