Walking ability, anxiety and depression, significantly decrease EuroQol 5-Dimension 5-Level scores in older hemodialysis patients in Japan

BACKGROUND: Hemodialysis patients in Japan are aging, but the influence of lifestyle factors on EuroQoL 5-Dimension 5-Level (EQ-5D-5 L) scores in older hemodialysis patients is unclear. This study aimed to measure health-related quality of life using the EQ-5D-5 L for older hemodialysis patients and to identify the lifestyle factors affecting EQ-5D-5 L scores in Japan. METHODS: Outpatients aged 65 years or older who had been receiving maintenance hemodialysis for more than 5 years were selected to determine their EQ-5D-5 L scores. Multiple linear regression analysis was applied to identify items affecting the EQ-5D-5 L scores. RESULTS: The response rate was 59.7% (748/1251), after excluding 9 patients who did not fulfill the participation criteria, and we analyzed data from 739 patients (462 men, 277 women) aged 72.9 ± 6.5 years (mean ± standard deviation) with a mean duration of hemodialysis of 15.1 ± 8.8 years. The mean EQ-5D-5 L score was 0.738 ± 0.207. Higher Hospital Anxiety and Depression Scale scores (regression coefficient, -0.467; P < 0.001), reduced walking ability (-0.201; P < 0.001), duration of hemodialysis (-0.175; P < 0.001), age (-0.143; P < 0.001), and subjective symptoms (-0.128; P < 0.001) showed significant negative correlations with the EQ-5D-5 L score. CONCLUSIONS: Reduced walking ability, and Anxiety and Depression, were associated with lower EQ-5D-5 L score and appeared to be important factors in decreasing health for older hemodialysis patients. These results suggest that patients' families and dialysis facility staff should be trained in early detection of depression and that patients should maintain their walking ability by exercise therapy.