Quality of Life-Repeated Measurements Are Needed In Dialysis Patients

Lada Trajceska; Daniela Mladenovska; Pavlina Dzekova-Vidimliski; Aleksandar Sikole

doi:10.3889/oamjms.2018.305

Authors

Lada Trajceska University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje
Daniela Mladenovska University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje
Pavlina Dzekova-Vidimliski University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje
Aleksandar Sikole University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje

DOI:

https://doi.org/10.3889/oamjms.2018.305

Keywords:

Hemodialysis, Mortality, Quality of life, Predictors, Deterioration

Abstract

BACKGROUND: There is a general agreement that, besides survival, the quality of life is a highly relevant outcome in the evaluation of treatment in patients with the end-stage renal disease. Moreover, it is very important to determine whether the quality of life impacts survival.

AIM: This study aims to assess whether changes or absolute scores of the quality of life (QOL) measurements better predict mortality in dialysis patients.

MATERIAL AND METHODS: In a longitudinal study comprising 162 prevalent hemodialysis patients QOL was assessed with the 36-item - Short Form Health Survey Questionnaire (SF-36) at baseline and after 12 months. Patients were followed for 60 months. Mortality risk was assessed using Cox proportional hazards analysis for patients with below and above median levels of both physical and mental QOL component scores (PCS and MCS, respectively).

RESULTS: At the beginning of the study the mean Physical Component score was 47.43 Â± 26.94 and mean Mental Component Score was slightly higher 50.57 Â± 24.39. Comparative analysis of the changes during the first year showed a marked deterioration of all quality of life scores in surviving patients. The 5-point decline for PCS was noted in 39 (24%) patients and 42 (26%) for MCS. In the follow-up period of 60 months, 69 (43%) patients died. In the Cox analysis, mortality was significantly associated with lower PCS: HR = 2.554 [95% confidence interval (CI): 1.533-4.258], (P < 0.000) and lower MCS: 2.452 (95%CI: 1.478-4.065), P < 0.001. The patients who had lower levels of PCS and MCS in the second QOL survey 1 year later, had similarly high mortality risk: 3.570 (95%CI: 1.896-6.727, P < 0.000); 2.972 (95%CI: 1.622-5.490, P < 0.000), respectively. The hazard ratios for mortality across categories for the change of PCS and MCS were not significant. In the multivariate model categorising the first and second scores as predictors and adjusted for age, only the second PCS and MCS score were associated with mortality.

CONCLUSION: Low QOL scores are associated with mortality in repeated measurements, but only the more recent overwhelmed the power of the decline.

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Author Biography

Aleksandar Sikole, University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje

Aleksandar Sikole graduated at the Medical Faculty-University "Sv. Kiril i Metodij" of Skopje, with MD degree in 1980. Specialized internal medicine in and subspecialized nephrology. Completed PhD thesis in 1994, entitled: â€œThe effect of erythropoietin therapy on the heart and bone marrow of end-stage renal disease patients on maintenance haemodialysisâ€. Since 2006 is Professor of Medicine at the Chair of Internal Medicine. He spent six months on postgraduate medical research at the Department of Nephrology of the University of Leiden , The Netherlands. In 2003 he had three months sabbatical at Laiko hospital, Athens, Greece. He was chief of hemodialysis unit at the Clinic of Nephrology and at present Director of the Clinic. Published and/or presented over 150 papers in national and international journals, books, and national and international congresses, symposia, proceedings etc. Involved in the organisation of several national and international congresses and symposia. Has conducted several clinical prospective multicentre studies in patients with chronic kidney disease. Was invited lecturer at several national and a few international meetings. Member of several medical and nephrological societies.

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