Study examines older adults’ quality of life before and after starting dialysis

In a study published in CJASN that included older adults with advanced chronic kidney disease, mental and physical health-related quality of life (HRQoL) worsened in the year before patients started dialysis, but this decline stabilized after dialysis was initiated.

Older people with kidney failure may feel that improving HRQoL is more important than solely prolonging life. Therefore, although dialysis can help older patients live longer, it’s equally or even more important to determine its effects on HRQoL.

To investigate, Esther N.M. de Rooij, MD (Leiden University Medical Center, in The Netherlands) and her colleagues analyzed data from the European Quality (EQUAL) study, an ongoing prospective multicenter study in patients aged 65 years and older with advanced chronic kidney disease. Between April 2012 and December 2021, HRQoL was assessed every 3–6 months using the 36-item Short-Form Health Survey, providing a mental component summary score and physical component summary score. Scores can range from 0–100, with higher scores indicating better HRQoL. Changes of 3 to 5 points in mental or physical HRQoL score are considered as clinically relevant.

The analysis included 457 patients who started dialysis treatment. At dialysis initiation, the median mental HRQoL score was 53 and the median HRQoL physical score was 39. During the year preceding dialysis, the average change in mental HRQoL was -13 and the average change in physical HRQoL was -11. In the year following dialysis initiation, the average change in mental HRQoL was +2 and the average change in physical HRQoL was -2.

“Very few studies have investigated the change in quality of life before and after dialysis. We are first to do so in a large international cohort of older patients,” said Dr. de Rooij. “We hope these results can inform older patients with kidney failure who have decided to start dialysis on what to expect in changes related to their HRQoL.”

An accompanying editorial notes that the data are impressive in that the researchers were able to prospectively gather patient-reported outcomes across 6 countries, at 3–6 month intervals over a number of years, on more than 400 patients. The authors state that over the coming months and years, it will be interesting to see how clinicians across the world use these data for patient care. “One hopes the ultimate goal remains to identify those on a ‘destination dialysis path’ and place more emphasis on providing Healthcare rather than Healthtreatments,” they wrote.

Additional study authors include Yvette Meuleman, Johan W. de Fijter, Saskia Le Cessie, Kitty J. Jager, Nicholas C. Chesnaye, Marie Evans, Agneta A. Pagels, Fergus J. Caskey, Claudia Torino, Gaetana Porto, Maciej Szymczak, Christiane Drechsler, Christoph Wanner, Friedo W. Dekker, and Ellen K. Hoogeveen.