Key result
The year of starting hemodialysis between 1997 and 2006 showed statistically but not clinically significant changes in most HRQOL domains (e.g., physical functioning -0.2 points/yr, P<0.05).
Why the study?
Has health-related quality of life among hemodialysis patients changed over time between 1997 and 2006?
Cohort (n=11,079)
Has health-related quality of life among hemodialysis patients changed over time between 1997 and 2006?
p-value: p=<0.05
Despite developments in hemodialysis care since 1997, little progress was made in improving the health-related quality of life of hemodialysis patients.
No clinically meaningful HRQOL gains in incident HD patients over 1997-2006; leaves open whether subsequent care models improve patient-reported outcomes.
BACKGROUND AND OBJECTIVES: Health-related quality of life (HRQOL) is a measure of the well being of hemodialysis patients and an independent prognostic predictor. Our aim was to determine whether HRQOL among hemodialysis patients has changed over time. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We retrospectively analyzed data collected by Dialysis Clinic, Inc. from adult patients starting hemodialysis between January 1, 1997 and May 31, 2006. The primary outcome was HRQOL assessed by Short Form 36, 6 to 18 months after and closest to the 1-year anniversary of starting hemodialysis. Secular trends were analyzed by linear regression for continuous variables and logistic regression for categorical ones. Year of starting dialysis was the predictor. A five-point difference on a 0 to 100 scale was considered clinically significant. RESULTS: Short Form 36 scores were available for 11,079 patients. Role physical, general health, vitality, social functioning, and physical component summary scores were unchanged among patients over the study period. Statistically significant (P < 0.05) but clinically insignificant changes were observed in physical functioning (-0.2 points/yr), bodily pain (+0.2 points/yr), mental health (+0.15 points/yr), and mental component summary scores (+0.13 points/yr). Only role emotional showed clinically significant improvement. Trends were unchanged after adjusting for age, gender, race, diabetes, hemoglobin, phosphorous, Kt/V, and albumin. CONCLUSIONS: Most HRQOL domains showed either no statistically significant change or statistically but not clinically significant change over almost a decade. These results suggest that, despite important developments in hemodialysis care since 1997, little progress was made in improving HRQOL of hemodialysis patients.
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Gabbay et al. (2009) conducted a cohort in Hemodialysis (n=11,079). Year of starting hemodialysis vs. Earlier years of starting hemodialysis was evaluated on Health-related quality of life (HRQOL) assessed by Short Form 36 (p=<0.05). The year of starting hemodialysis between 1997 and 2006 showed statistically but not clinically significant changes in most HRQOL domains (e.g., physical functioning -0.2 points/yr, P<0.05).
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