Why Assess Health-Related Quality of Life
Dialysis is both live-saving and life-altering. It changes patients’ patterns of eating, sleeping, medication use, and daily tasks at home, in the community, or in the workplace for the 50% of incident patients each year who are working-age. The degree of lifestyle change needed—adherence to diet and medications and the symptom burden in particular—depends on the choice of treatment modality, and affects patients’ day-to-day health related quality of life. Per the U.S. Centers for Disease Control and Prevention, health-related quality of life is the impact of a chronic disease and its treatment on patients’ perceptions of their own physical and mental function.
Among people on dialysis, HRQOL scores are both a critical outcome and a predictor of morbidity and mortality. A prospective study of 1,000 patients on standard in-center hemodialysis (HD) first linked low HRQOL scores, hospitalizations, and death more than a decade ago. Patients with SF-36 scores below the center’s median were twice as likely to be hospitalized as those above it. In this study, each 5- point increase in physical component summary (PCS) score—a measure of patients’ perceptions of their physical health—was associated with a 10% improvement in the chance of survival, and a 6% reduction in hospital days.
An analysis of nearly 14,000 Fresenius patients on standard in-center HD also found that HRQOL scores predicted hospitalizations and mortality. PCS scores below 43 and mental component summary (MCS) scores—a measure of patients’ perceptions of their mental health—below 51 correlated with a higher risk of death. Each 1-point increase in PCS was associated with a 2% reduction in the relative risk of both death and hospitalization. Each 1-point increase in MCS was associated with a 2% reduction in the relative risk of death and a 1% reduction in the relative risk of hospitalization.
The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective observational study in Europe, Canada, the U.S., New Zealand, and Japan, of lab values, demographics, co-morbidities, dialysis parameters, and HRQOL data. Among 10,030 patients, low HRQOL scores were associated with a higher risk of death and hospitalization, independently of demographic factors and co-morbidities. As PCS and MCS scores fell, the risks of death and hospitalization rose significantly. Patients with PCS scores in the lowest quintile had a 56% higher risk of hospital stays and a 93% higher risk of death than those in the highest quintile. Researchers concluded that low PCS, MCS scores were as powerful an independent predictor of hospitalization and death as serum albumin.
HRQOL is a unique dimension of chronic disease care—one whose data source is patient perceptions captured via a valid, reliable tool.
- ^ http://www.cdc.gov/hrqol
- ^ DeOreo PB. Hemodialysis patient-assess functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance. Am J Kidney Dis 1997, 30:204-212
- ^ Lowrie EG, Curtin RB, LePain N, Schatell D. Medical Outcomes Study Short Form-36: A consistent and powerful predictor of morbidity and mortality in dialysis patients. Am J Kidney Dis 2003, 41:1286-1291
- ^ Mapes DL, Lopes AA, Satayathum S et al. Health-related quality of life as a predictor of mortality and hospitalization: The Dialysis Outcomes and Practice Patterns Study (DOPPS). Kid Int 2003, 64:339-349