Predicting improvement in health-related quality of life in people receiving dialysis: the leopard study

Abstract

Aim To determine factors predicting health‐related quality of life (HRQoL) at baseline and over time in adults receiving dialysis.

Background Many people receiving dialysis to manage end‐stage kidney disease report poor HRQoL and burdensome symptoms. However, it is not clear whether these measures are sensitive to reciprocal, clinically meaningful changes. We investigated the relationship between changes in HRQoL and symptoms using validated patient‐reported assessment tools.

Methods Adults receiving dialysis completed the EQ5D‐5L and POS‐S questionnaires 3‐monthly to assess overall HRQoL (visual analogue score) and symptom burden (total POS‐S score), respectively. Additional data (gender, age, Charlson comorbidity score, functional performance (Australia‐modified Karnofsky Performance Scale) and treatment modality (in‐centre haemodialysis [HD], home HD or peritoneal dialysis [PD]) were extracted from hospital records and ANZDATA registry. Factors predicting HRQoL were determined using multiple linear regression. For HRQoL and symptom burden, the minimal clinically important difference (MCID) was estimated at ½*standard deviation (9.3 for HRQoL and 4.6 for symptom burden).

Results 177 people receiving either HD or PD (31% female, median age 65 [range 19–91]) were included for analysis. At baseline, while gender, comorbidity score, age, treatment modality, symptom score and functional performance explained 32% of the variation in HRQoL overall, only symptom score and functional performance contributed significantly (both p<0.001). The relationship between MCID changes from baseline to 6 months in HRQoL and symptom scores was explored in those who participated for ≥6 months (n=165). Within this sub‐group, MCID improvement in symptom scores strongly predicted MCID improvement in HRQoL (p<0.001).

Conclusions Improved symptom management of people receiving dialysis to a clinically meaningful extent, facilitated by routine clinical assessment, may have beneficial effects on overall HRQoL.