Sarah Derrett1, Ari Samaranayaka1, John B W Schollum2, Bronwen McNoe1, Mark R Marshall3, Sheila Williams1, Emma H Wyeth4, Robert J Walker5. 1. Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. 2. Department of Medicine, University of Otago, Dunedin, New Zealand. 3. Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand; School of Medicine, University of Auckland, Auckland, New Zealand; Therapeutic Area, Baxter Healthcare (Asia) Pte Ltd, Singapore. 4. Ngai Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. 5. Department of Medicine, University of Otago, Dunedin, New Zealand. Electronic address: rob.walker@otago.ac.nz.
Abstract
BACKGROUND: Involving patients in dialysis decision making is crucial, yet little is known about patient-reported experiences and patient-reported outcomes of dialysis. STUDY DESIGN: A prospective longitudinal cohort study of older patients receiving long-term dialysis. Predictors of worse health status were assessed using modified Poisson regression analysis. SETTING & PARTICIPANTS: 150 New Zealanders 65 years or older with end-stage kidney disease dialyzing at 1 of 3 nephrology centers. PREDICTORS: Patient-reported social and health characteristics based on the 36-Item Short Form Health Survey, EQ-5D, and Kidney Symptom Score questionnaires and clinical information from health records. OUTCOMES: Health status after 12 months of follow-up. RESULTS: 35% of study participants had reported worse health or had died at 12 months. Baseline variables independently associated with reduced risk for worse health status were Pacific ethnicity (relative risk [RR], 0.63; 95% CI, 0.53-0.72), greater bother on the Kidney Symptom Score (RR, 0.78; 95% CI, 0.62-0.97), and dialyzing at home with either home hemodialysis (RR, 0.55; 95% CI, 0.36-0.83) or peritoneal dialysis (RR, 0.86; 95% CI, 0.79-0.93). Baseline variables independently associated with increased risk were greater social dissatisfaction (RR, 1.66; 95% CI, 1.27-2.17), lower sense of community (RR, 1.70; 95% CI, 1.09-2.64), comorbid conditions (RR, 1.70; 95% CI, 1.09-2.64), EQ-5D anxiety/depression (RR, 1.61; 95% CI, 1.07-2.42); poor/fair overall general health (RR, 1.60; 95% CI, 1.37-1.85), and longer time on dialysis therapy (RR, 1.03; 95% CI, 1.00-1.05). LIMITATIONS: Small sample size restricted study power. CONCLUSIONS: Most older dialyzing patients studied reported same/better health 12 months later. Home-based dialysis, regardless of whether hemodialysis or peritoneal dialysis, was associated with reduced risk for worse health, and older Pacific People reported better outcomes on dialysis therapy. Social and/or clinical interventions aimed at improving social satisfaction, sense of community, and reducing anxiety/depression may favorably affect the experiences of older patients receiving long-term dialysis.
BACKGROUND: Involving patients in dialysis decision making is crucial, yet little is known about patient-reported experiences and patient-reported outcomes of dialysis. STUDY DESIGN: A prospective longitudinal cohort study of older patients receiving long-term dialysis. Predictors of worse health status were assessed using modified Poisson regression analysis. SETTING & PARTICIPANTS: 150 New Zealanders 65 years or older with end-stage kidney disease dialyzing at 1 of 3 nephrology centers. PREDICTORS: Patient-reported social and health characteristics based on the 36-Item Short Form Health Survey, EQ-5D, and Kidney Symptom Score questionnaires and clinical information from health records. OUTCOMES: Health status after 12 months of follow-up. RESULTS: 35% of study participants had reported worse health or had died at 12 months. Baseline variables independently associated with reduced risk for worse health status were Pacific ethnicity (relative risk [RR], 0.63; 95% CI, 0.53-0.72), greater bother on the Kidney Symptom Score (RR, 0.78; 95% CI, 0.62-0.97), and dialyzing at home with either home hemodialysis (RR, 0.55; 95% CI, 0.36-0.83) or peritoneal dialysis (RR, 0.86; 95% CI, 0.79-0.93). Baseline variables independently associated with increased risk were greater social dissatisfaction (RR, 1.66; 95% CI, 1.27-2.17), lower sense of community (RR, 1.70; 95% CI, 1.09-2.64), comorbid conditions (RR, 1.70; 95% CI, 1.09-2.64), EQ-5D anxiety/depression (RR, 1.61; 95% CI, 1.07-2.42); poor/fair overall general health (RR, 1.60; 95% CI, 1.37-1.85), and longer time on dialysis therapy (RR, 1.03; 95% CI, 1.00-1.05). LIMITATIONS: Small sample size restricted study power. CONCLUSIONS: Most older dialyzing patients studied reported same/better health 12 months later. Home-based dialysis, regardless of whether hemodialysis or peritoneal dialysis, was associated with reduced risk for worse health, and older Pacific People reported better outcomes on dialysis therapy. Social and/or clinical interventions aimed at improving social satisfaction, sense of community, and reducing anxiety/depression may favorably affect the experiences of older patients receiving long-term dialysis.
Keywords:
Dialysis; elderly; end-stage kidney disease (ESKD); end-stage renal disease (ESRD); health deterioration; health disparities; home dialysis; medical decision-making; older age group; patient-centred outcomes; quality of life outcomes on dialysis; social engagement; symptom bother
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