Fresenius Medical Care, Nephrocare, Madrid, Spain.
Data Science Division - Clinical Advanced Analytics, Global Medical Office - Fresenius Medical Care, Vaiano Cremasco, Italy.
BMC Nephrol. 2024 Oct 31;25(1):388. doi: 10.1186/s12882-024-03835-0.
RATIONALE & OBJECTIVE: End-stage kidney disease (ESKD) negatively affects patients' physical, emotional, and social functioning. Furthermore, adjustment to dialysis require substantial lifestyle changes that may further impact on patients physical and emotional well-being. However, the relationship between Health-Related Quality of life impairment with future adverse outcomes in dialysis is not well characterized. Our study aims to investigate the relationship between Health-Related Quality of Life (HRQoL) and patients' survival and hospitalization rates within a large European dialysis network.
A historical cohort study was conducted to evaluate association of HRQoL with hospitalization and mortality rates over a 12-month follow-up period. Patients responded to a self-administered survey as part of a Continuous Quality Improvement Program implemented in clinics affiliated with the Spanish FMC-Nephrocare organization. Health-Related Quality of Life (HRQoL) was measured with the KDQOL-36. Potential confounders included socio-demographic characteristics, comorbidities, biochemical parameters, dialysis treatment. We used Cox's Proportional Hazard regression to assess the hazard of death and Logistic Regression to assess the likelihood of hospital admissions during 12-month follow-up period.
A total of 2280 (51.5%) completed the self-administrated survey, and 1838 patients met the inclusion/exclusion criteria of the study. Higher HRQoL scores were associated with significantly lower mortality and hospitalization risk. Risk estimates were robust to adjustment for potential confounders.
Several dimensions of HRQoL are associated with patient-centered outcomes (i.e., mortality and hospitalizations at 1 year). Patient-Reported Outcomes contribute unique pieces of information characterizing patients' health. Residual confounding cannot be fully ruled out; moreover, the high attrition rate could result in selection bias, which may limit the generalizability of the findings to a broader population.
终末期肾病（ESKD）会对患者的身体、情感和社会功能产生负面影响。此外，适应透析需要生活方式的重大改变，这可能会进一步影响患者的身体和情感健康。然而，健康相关生活质量受损与透析患者未来不良结局之间的关系尚未得到充分描述。我们的研究旨在调查在一个大型欧洲透析网络中，健康相关生活质量（HRQoL）与患者生存率和住院率之间的关系。
进行了一项历史队列研究，以评估 HRQoL 与 12 个月随访期间住院率和死亡率之间的关联。患者作为西班牙 FMC-Nephrocare 组织附属诊所实施的持续质量改进计划的一部分，通过自我管理调查进行了回答。健康相关生活质量（HRQoL）通过 KDQOL-36 进行测量。潜在的混杂因素包括社会人口统计学特征、合并症、生化参数、透析治疗。我们使用 Cox 比例风险回归评估死亡风险，使用 Logistic 回归评估 12 个月随访期间住院的可能性。
共有 2280 名（51.5%）完成了自我管理调查，1838 名患者符合研究的纳入/排除标准。较高的 HRQoL 评分与死亡率和住院风险显著降低相关。风险估计在调整潜在混杂因素后仍然稳健。
HRQoL 的几个维度与以患者为中心的结局（即 1 年内的死亡率和住院率）相关。患者报告的结果提供了描述患者健康的独特信息。残留混杂因素不能完全排除；此外，高流失率可能导致选择偏倚，从而限制研究结果在更广泛人群中的推广。
