Vitality Measured as Self-reported Energy Level and Clinical Outcomes in Hemodialysis Patients: The Japanese Dialysis Outcomes and Practice Pattern Study (J-DOPPS)

Rationale & ObjectiveThe infrequent assessment of vitality in clinical practice may be partially due to an inadequate understanding of vitality and the lack of a concise method of assessing it. This study aimed to examine the association of a simple 1-item “vitality” question measuring self-reported energy level with clinical outcomes.Study DesignProspective cohort study.Setting & Participants3,667 hemodialysis patients participating in the Japanese Dialysis Outcomes and Practice Pattern Study (J-DOPPS), phases 3 to 4 (2005-2011).PredictorResponses to a single question from the 12-item Medical Outcomes Study Short Form survey, version 2.0: “How much time during the past 4 weeks did you have a lot of energy?,” recorded using a 5-level Likert scale.OutcomesAll-cause mortality and a composite of cardiovascular hospitalizations and all-cause mortality.Analytical ApproachA pooled ordered logit model was fit to examine correlates of self-reported energy level. Cox and mixed-effects negative binomial regression models were fit for mortality and the composite outcome.ResultsLower self-reported energy level was associated with tachycardia and use of benzodiazepines, hypnotics, and antidepressants. In contrast, higher energy was associated with higher single-pool Kt/V, serum albumin concentration, and body mass index. Compared to the lowest energy level, the second-highest and middle levels were associated with lower all-cause mortality (adjusted HRs [aHRs] of 0.66 [95% CI, 0.47-0.93] and 0.75 [95% CI, 0.59-0.96], respectively). Each 1-level higher self-reported energy was associated with lower mortality (aHR, 0.86; 95% CI, 0.78-0.96). Associations between self-reported energy level and multiple cardiovascular hospitalizations and mortality were similar to those between self-reported energy and mortality.LimitationsNo psychometric assessments were done for the Short Form survey.ConclusionsThe response to a single “vitality” question addressing self-reported energy level is associated with adverse clinical outcomes and correlated with potentially modifiable factors. The infrequent assessment of vitality in clinical practice may be partially due to an inadequate understanding of vitality and the lack of a concise method of assessing it. This study aimed to examine the association of a simple 1-item “vitality” question measuring self-reported energy level with clinical outcomes. Prospective cohort study. 3,667 hemodialysis patients participating in the Japanese Dialysis Outcomes and Practice Pattern Study (J-DOPPS), phases 3 to 4 (2005-2011). Responses to a single question from the 12-item Medical Outcomes Study Short Form survey, version 2.0: “How much time during the past 4 weeks did you have a lot of energy?,” recorded using a 5-level Likert scale. All-cause mortality and a composite of cardiovascular hospitalizations and all-cause mortality. A pooled ordered logit model was fit to examine correlates of self-reported energy level. Cox and mixed-effects negative binomial regression models were fit for mortality and the composite outcome. Lower self-reported energy level was associated with tachycardia and use of benzodiazepines, hypnotics, and antidepressants. In contrast, higher energy was associated with higher single-pool Kt/V, serum albumin concentration, and body mass index. Compared to the lowest energy level, the second-highest and middle levels were associated with lower all-cause mortality (adjusted HRs [aHRs] of 0.66 [95% CI, 0.47-0.93] and 0.75 [95% CI, 0.59-0.96], respectively). Each 1-level higher self-reported energy was associated with lower mortality (aHR, 0.86; 95% CI, 0.78-0.96). Associations between self-reported energy level and multiple cardiovascular hospitalizations and mortality were similar to those between self-reported energy and mortality. No psychometric assessments were done for the Short Form survey. The response to a single “vitality” question addressing self-reported energy level is associated with adverse clinical outcomes and correlated with potentially modifiable factors.