Clinical and functional determinants including cognitive functioning and usual activities independently predicted overall quality of life in older hemodialysis patients, explaining 31% of its variance.
Cross-Sectional (n=111)
Yes
What are the determinants of overall quality of life and its relationship to health-related quality of life in older adults receiving in-center hemodialysis?
In older hemodialysis patients, overall quality of life is not correlated with standard health-related quality of life metrics like EQ-5D, but is independently predicted by cognitive functioning, usual activities, and social functioning.
Abstract Background The incidence of end-stage kidney disease (ESKD) is rising, particularly among adults aged 65 and older, who account for over half of new cases in Europe. While older adults consistently prioritize quality of life (QoL), it is rarely a primary endpoint in clinical trials and remains underemphasized in clinical decision making. Health-Related QoL (HRQoL) captures only part of the broader QoL concept, which may contribute to inconsistencies across studies. We examined determinants of overall QoL and its relationship to HRQoL using comprehensive assessments. Methods We conducted a cross-sectional study of adults ≥ 65 receiving in-center hemodialysis at four hospitals in Flanders, Belgium. Data included sociodemographic and treatment-specific information, a Comprehensive Geriatric Assessment, Groningen Frailty Indicator, Brussels Integrated Activities of Daily Living Inventory, and HRQoL measures (EQ-5D-3L, QLQ-C30, QLQ-MY20). Overall QoL was assessed with the Anamnestic Comparative Self-Assessment (ACSA). We conducted descriptive, univariate, multivariate, and cluster analyses. Results We included 111 patients (64.9% male; mean age 78.1 ± 7.4 years; median dialysis vintage 36.0 months IQR 11.0 to 65.8). Overall QoL was moderately positive (ACSA mean 1.97 ± 2.05; range − 5 to 5). The EQ-5D utility index was not correlated with the ACSA (ρ = −0.052, p = 0.591). Multivariate analysis identified ‘cognitive functioning’ (QLQ-C30), ‘usual activities’ (EQ-5D-3L), hospital admissions, ‘subjective health status’ (EQ-5D-3L), and ‘social functioning’ (QLQ-C30) as independent predictors, explaining 31% of the variance in the ACSA. Cluster analysis identified three subgroups: a relatively resilient subgroup (n = 59), a functioning-impaired subgroup (n = 36), and a psychologically frail subgroup (n = 12). Conclusions Focusing on cognition, usual activities, and social functioning may improve outcome relevance, identify vulnerable subgroups, and support more effective resource allocation for older adults with ESKD.
Moreels et al. (Mon,) conducted a cross-sectional in End-stage kidney disease (ESKD) (n=111). Clinical and functional determinants was evaluated on Overall QoL assessed with the Anamnestic Comparative Self-Assessment (ACSA). Clinical and functional determinants including cognitive functioning and usual activities independently predicted overall quality of life in older hemodialysis patients, explaining 31% of its variance.
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