Health related quality of life in patients in dialysis after renal graft loss and effect of gender.

BACKGROUND: An increasing number of dialysis patients have returned to dialysis after renal graft loss, and the transition in disease state could likely be associated with reduced health related quality of life (HRQOL). Furthermore, gender differences in HRQOL have been observed in dialysis and kidney transplanted patients, but whether transition in disease state affects HRQOL differently in respect to gender is not known. The aims of this study were to compare HRQOL in dialysis patients with graft loss to transplant naïve dialysis patients, and to explore possible gender differences. METHODS: In a cross-sectional study, HRQOL was measured in 301 prevalent dialysis patients using the Kidney Disease and Quality of Life Short Form version 1.3. Adjusted comparisons were made between dialysis patients with previous graft loss and the transplant naïve patients. Multiple linear regression analyses were performed with HRQOL as outcome variables. Interaction analyses using product terms were performed between gender and graft loss. HRQOL was analysed separately in both genders. RESULTS: Patients with renal graft loss (n = 50) did not experience lower HRQOL than transplant naïve patients after multiple adjustments. Among patients with graft loss, women (n = 23) reported lower HRQOL than men (n = 27) in the items physical function (40 vs. 80, p = 0.006), and effect of kidney disease (49 vs. 67, p = 0.017). Women with graft loss reported impaired kidney-specific HRQOL compared to transplant naïve women (n = 79) in the items effect of kidney disease (50 vs. 72, p = 0.002) and cognitive function (80 vs. 93, p = 0.006), and this observation persisted after multiple adjustments. Such differences were not apparent in the male counterparts. CONCLUSIONS: Patients who resumed dialysis after renal graft loss did not have lower HRQOL than dialysis patients not previously transplanted. However, losing graft function was associated with reduced HRQOL in females, and important interactions were identified between graft loss and gender. This needs to be further explored in prospective studies.

Mortality and health-related quality of life in prevalent dialysis patients: Comparison between 12-items and 36-items short-form health survey.

BACKGROUND: To assess health- related quality of life (HRQOL) with SF-12 and SF-36 and compare their abilities to predict mortality in chronic dialysis patients, after adjusting for traditional risk factors. METHODS: The Short-Form Health Survey (SF-36) with the embedded SF-12 was applied in 301 dialysis patients cross-sectionally. Physical and mental component summary (PCS-36, MCS-36, PCS-12, and MCS-12) scores were calculated. Clinical and demographic data were collected. Mortality (followed for up to 4.5 years) was analyzed with Kaplan Meier plots and Cox proportional hazards, after censoring for renal transplantation. Exclusion factors were observation time <2 months (n = 21) and missing component summary scores (n = 10 for SF-36; n = 28 for SF-12), thus 252 patient were included in the analyses. RESULTS: In 252 patients (60.2 ± 15.5 years, 65.9% males, dialysis vintage 9.0, IQR 5.0-23.0 months), mortality during follow-up was 33.7%.(85 deaths). Significant correlations were observed between PCS-36 and PCS-12 (ρ = 0.93, p < 0.001) and between MCS-36 and MCS-12 (ρ = 0.95, p < 0.001). Mortality rate was highest in patients in the lowest quartile of PCS-12 (χ² = 15.3, p = 0.002) and PCS-36 (χ² = 16.7, p = 0.001). MCS was not associated with mortality. Adjusted hazard ratios for mortality were 2.5 (95% CI 1.0-6.3, PCS-12) and 2.7 (1.1 - 6.4, PCS-36) for the lowest compared with the highest ("best perceived") quartile of PCS. CONCLUSION: Compromised HRQOL is an independent predictor of poor outcome in dialysis patients. The SF-12 provided similar predictions of mortality as SF-36, and may serve as an applicable clinical tool because it requires less time to complete.

Health-related quality of life and depression in dialysis patients: associations with current smoking.

OBJECTIVE: The study explored health-related quality of life (HRQoL) and depression in a culturally homogeneous dialysis patient population. Furthermore, the associations between HRQoL and depression with current smoking were elaborated. MATERIAL AND METHODS: In a cross-sectional study of 301 dialysis patients from 10 dialysis centres in Norway, HRQoL was evaluated with the Kidney Disease and Quality of Life Short Form, version 1.3. Physical component summary scores (PCS) and mental component summary scores (MCS) were computed. Depression was assessed using the Beck Depression Inventory (BDI), and Cognitive Depression Index (CDI) was calculated. Depression was defined as a BDI score greater than 14. RESULTS: HRQoL was poorer in dialysis patients compared with population norms. Depression was prevalent (33.2%), and differed significantly between smokers and non-smokers (52.8 vs 26.4%, p < 0.001). MCS was significantly reduced in smokers compared with non-smokers (44.1 +/- 12.2 vs 48.7 +/- 10.3, p < 0.001), but there was no difference in PCS (35.7 +/- 10.2 vs 37.1 +/- 10.4, not significant). Current smoking was independently associated with higher BDI score (p = 0.039), as well as with higher CDI score (p = 0.005) and worse score on MCS (p = 0.002), after adjustments for multiple covariates. CONCLUSIONS: HRQoL is lower in Norwegian dialysis patients than in the general population, and depression is prevalent. The study suggests that poor perceived mental aspects of HRQoL and depression are associated with current smoking in dialysis patients, but a causal relationship remains to be shown.

Anxiety and depressive disorders in dialysis patients: association to health-related quality of life and mortality.

OBJECTIVE: To examine the associations between depressive/anxiety disorders (DAs), perceived health-related quality of life (HRQOL) and mortality in dialysis patients. METHODS: Patients were assessed for depressive and DAs with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. The HRQOL was assessed with the Medical Outcome Short Form 36 (MOS SF-36), and the Beck Depression Inventory and Hospital Anxiety and Depression Scale were also applied. Sociodemographic, clinical and laboratory data were also collected. RESULTS: Patients with depressive disorders reported more impaired HRQOL on four of the eight subscales, while those with a depressive disorder comorbid with DA reported more impairment on all MOS SF-36 subscales compared to those without any psychiatric disorder. During the observation period, 50% of those with depression, 28% of those with anxiety and 33% of patients with DA disorder died. A survival analysis did not indicate that patients with depressive or DAs had a higher mortality than patients without such disorders. CONCLUSION: Dialysis patients with depressive disorders reported impaired HRQOL, whereas those with DAs did not. Patients with DA reported the most serious HRQOL impairment. No evidence was obtained to support the hypothesis that depressive and DAs contributed to compromised survival in dialysis patients. In patients with depression, DAs should also be assessed as they significantly contribute to impaired HRQOL.

Renal transplant acceptance status, health-related quality of life and depression in dialysis patients.

Health-related quality of life (HRQOL) and depression in chronic dialysis patients, accepted (n = 122) or rejected (n = 93) for renal transplantation (Tx), were compared, whereas dialysis patients with pending acceptance status (n = 86) were followed for a median time of 3.6 years to assess whether HRQOL or depression predicted the likelihood of receiving a transplant. Clinical significant depression was present in 30% of the study patients. Less depression and better HRQOL were associated with being on the waiting list for Tx after adjusting for comorbidity, age, gender and dialysis vintage. During follow-up, 55% of the dialysis patients in the group with pending acceptance were transplanted. The likelihood of receiving a renal graft was based on comorbidity and not on impaired HRQOL or depression. Follow-up studies should investigate whether improved renal health after Tx translates into further improvement of HRQOL and less depression. Whether clinical depression and impaired HRQOL will impact graft survival needs to be explored.

Screening for anxiety and depression in dialysis patients: comparison of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory.

OBJECTIVE: Although anxiety and depression are frequent comorbid disorders in dialysis patients, they remain underrecognized and often untreated. The aim of the study was to evaluate the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory (BDI) and a truncated version of the BDI, the Cognitive Depression Index (CDI), as screening tools for anxiety and depression in dialysis patients. METHODS: A total of 109 participants (69.7% males), from four dialysis centers, completed the self-report symptom scales HADS and BDI. Depression and anxiety disorders were diagnosed with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive value, overall agreement, kappa and receiver operating characteristic (ROC) curves were assessed. RESULTS: Depressive disorders were found in 22% of the patients based on the SCID-I, while anxiety disorders occurred in 17%. The optimal screening cut-off score for depression was ≥ 7 for the HADS depression subscale (HADS-D), ≥ 14 for the HADS-total, ≥ 11 for the CDI and ≥ 17 for the BDI. The optimal screening cut-off for anxiety was ≥ 6 for the HADS anxiety subscale (HADS-A) and ≥ 14 for the HADS-total. At cut-offs commonly used in clinical practice for depression screening (HADS-D: 8; BDI: 16), the BDI performed slightly better than HADS-D. CONCLUSION: The BDI, CDI and HADS demonstrated acceptable performance as screening tools for depression, as did the HADS-A for anxiety, in our sample of dialysis patients. The recommended cut-off scores for each instrument were: ≥ 17 for BDI, ≥ 11 for CDI, ≥ 7 for HADS depression subscale, ≥ 6 for HADS anxiety subscale and ≥ 14 for HADS total. The CDI did not perform better than the BDI in our study. Lower cut-off for the HADS-A than recommended in medically ill patients may be considered when screening for anxiety in dialysis patients.

Psychiatric disorders, body mass index and C-reactive protein in dialysis patients.

OBJECTIVE: The objective of the study was to identify the prevalence of depression, anxiety and somatoform disorders in dialysis patients according to dialysis modality and to compare dialysis patients with and without psychiatric comorbidity regarding clinical characteristics, health-related quality of life (HRQoL) and markers of nutrition and inflammation. METHODS: One hundred and nine patients were assessed for depression, anxiety and somatoform disorder with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The Short Form 36 was used. Sociodemographic, clinical and laboratory data were collected. RESULTS: About one third, 30.3%, had a current psychiatric disorder regardless of dialysis modality (depression, 22%; anxiety, 17%; somatoform disorders, 1%), and these reported more impairment on HRQoL dimensions. In the multivariate analysis, significant correlations between psychiatric comorbidity and C-reactive protein (CRP≥6 mmol/L) [odds ratio (OR), 3.6; 95% confidence interval (CI), 1.3-9.9; P=.015] and body mass index (BMI≤21 kg/m(2)) (OR, 4.2; 95% CI, 1.4-12.7; P=.011) were observed. CONCLUSION: Depressive and anxiety disorders were common in dialysis patients and were associated with impaired HRQoL, while prevalence of somatoform disorders was low. A strong correlation between psychiatric comorbidity, CRP and BMI indicates that special attention should be given to patients with CRP≥6 mmol/L and BMI≤21 kg/m(2).