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Factors associated with health-related quality of life among hemodialysis patients in the DOPPS

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Quality of Life Research Aims and scope Submit manuscript

An Erratum to this article was published on 04 May 2007

An Erratum to this article was published on 04 May 2007

An Erratum to this article was published on 04 May 2007

Abstract

Objective

To identify modifiable factors associated with health-related quality of life (HRQOL) among chronic hemodialysis patients.

Methods

Analysis of baseline data of 9,526 hemodialysis patients from seven countries enrolled in phase I of the Dialysis Outcomes and Practice Patterns Study (DOPPS). Using the Kidney Disease Quality of Life Short Form (KDQOL-SFTM), we determined scores for 8 generic scale summaries derived from these scales, i.e., the physical component summary [PCS] and mental component summary [MCS], and 11 kidney disease-targeted scales. Regression models were used to adjust for differences in comorbidities and sociodemographic and treatment factors. The Benjamin-Hochberg procedure was used to correct P-values for multiple comparisons.

Results

Unemployment and psychiatric disease were independently and significantly associated with lower scores for all generic and several kidney disease-targeted HRQOL measures. Several other comorbidities, lower educational level, lower income, and hypoalbuminemia were also independently and significantly associated with lower scores of PCS and/or MCS and several generic and kidney disease-targeted scales. Hemodialysis by catheter was associated with significantly lower PCS scores, partially explained by the correlation with covariates.

Conclusion

Associations of poorer HRQOL with preventable or controllable factors support a greater focus on psychosocial and medical interventions to improve the well-being of hemodialysis patients.

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Abbreviations

HRQOL:

Health-related quality of life

DOPPS:

Dialysis Outcomes and Practice Patterns Study

KDQOL-SF:

Kidney Disease Quality of Life Short Form

PCS:

Physical Component Summaries

MCS:

Mental Component Summaries

ESRD:

End-stage renal disease

SF-36:

Short-Form Health Survey

SBP:

Systolic blood pressure

NPCR:

Normalized protein catabolic rate

BMI:

Body Mass Index

ADIFS:

Adjusted difference in score

eKt/V:

Equilibrated Kt/V (dialysis dose)

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Acknowledgements

The DOPPS is supported by research grants from Amgen and Kirin without restrictions on publications. Antonio Alberto Lopes was supported by a grant (BEX2018/00-4) from the Fundaşáo Coordenaşáo de Aperfeişoamento de Pessoal de Nível Superior (CAPES Foundation), Ministry of Education of Brazil.

The authors express appreciation to members of the WorldWide DOPPS Committee for contributions during the design and implementation of the DOPPS I. For a full listing of committee members, please see “The Dialysis Outcomes and Practice Patterns Study (DOPPS): An international hemodialysis study” Young et al., Kidney Int 57(Suppl 74):S74-S81 or www.dopps.org.

Author information

Authors and Affiliations

  1. Department of Medicine, Federal University of Bahia, Salvador, Brazil

    Antonio Alberto Lopes

  2. University of Michigan, Ann Arbor, MI, USA

    Antonio Alberto Lopes & Brenda W. Gillespie

  3. Arbor Research Collaborative for Health/formerly, University Renal Research and Education Association (URREA), 315 W. Huron, Suite 260, Ann Arbor, MI, 48103, USA

    Jennifer L. Bragg-Gresham, David A. Goodkin, Donna L. Mapes, Brenda W. Gillespie, Philip J. Held & Friedrich K. Port

  4. ICOS Corporation, Bothell, WA, USA

    David A. Goodkin

  5. Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan

    Shunichi Fukuhara

  6. Division of Nephrology, University of Michigan and VAMC, Ann Arbor, MI, USA

    Eric W. Young

  7. Wakayama Medical University, Wakayama, Japan

    Tadao Akizawa

  8. Lister Hospital, Stevenage, UK

    Roger N. Greenwood

  9. Università Federico II, Naples, Italy

    Vittorio E. Andreucci

  10. Tokyo Women’s Medical University, Tokyo, Japan

    Takashi Akiba

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  1. Antonio Alberto Lopes
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  2. Jennifer L. Bragg-Gresham
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  4. Shunichi Fukuhara
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  11. Takashi Akiba
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  12. Philip J. Held
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  13. Friedrich K. Port
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Corresponding author

Correspondence to Friedrich K. Port.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s11136-007-9213-5

Appendix

Appendix

KDQOL Scales and Questions KDQOL scales and questions originally from the SF-36, version 1.0

Scale

Questions or Items

Physical functioning

The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports? Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf? Lifting or carrying groceries? Climbing several flights of stairs? Climbing one flight of stairs? Bending, kneeing or stooping? Walking more than a mile? Walking several blocks? Walking one block? Bathing or dressing yourself? Possible responses: 1. Yes, limited a lot, 2. Yes, limited a little, 3. No, not limited at all

Role physical

During the past 4 weeks, have you had any of the following problems with your work or other regular activities as a result of your physical health? Cut down on the amount of time you spent on work or other activities? Accomplished less than you would like? Were limited in the kind of work or other activities? Had difficulty performing the work or other activities (for example it took extra effort)? Possible responses: Yes or No

Bodily pain

How much bodily pain have you had during the past 4 weeks? Possible responses: 1. None, 2. Very mild, 3. Mild, 4. Moderate, 5. Severe, 6. Very severe

During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? Possible responses: 1. Not at all, 2. A little bit, 3. Moderately, 4. Quite a bit, 5. Extremely

General health

In general, would you say your health is: 1. excellent, 2. very good, 3. good, 4. fair, 5. poor

How true or false is each of the following four statements for you? I seem to get sick a little easier than other people? I am as healthy as anybody I know? I expect my health to get worse? My health is excellent? Possible responses: 1. Definitely true, 2. Mostly true, 3. Don’t know, 4. Mostly false, 5. Definitely false

Vitality (energy/vitality)

How much of the time during the past 4 week did you: feel full of pep? have a lot of energy? feel worn out? feel tired? Possible responses: 1. All of the time, 2. Most of the time, 3.A good bit of the time, 4. Some of the time, 5. A little of the time, 6. None of the time

Social Functioning

During the past 4 weeks how much of the time has your physical health or emotional problems interfered with your social activities? Possible responses: 1. All of the time, 2. Most of the time, 3. A good bit of the time, 4. Some of the time, 5. A little of the time, 6. None of the time

During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups? Possible responses: 1. Not at all, 2. Slightly, 3. Moderately, 4. Quite a bit, 5. Extremely

Role emotional

During the past 4 weeks, have you had any of the following problems with your work or other regular activities as a result of any emotional problems (such as feeling depressed or anxious)? Cut down on the amount of time you spent on work or other activities; Cut down on the amount of time you spent on work or other activities; Accomplished less than you would like. Possible responses: yes or no.

Mental Health (emotional well-being)

How much of the time during the past 4 weeks have you: been a very nervous person? felt so down in the dumps that nothing could cheer you up? felt calm and peaceful? felt downhearted and blue? been a happy person? Possible responses: 1. All of the time, 2. Most of the time, 3.A good bit of the time, 4. Some of the time, 5.A little of the time, 6. None of the time

II. KDQOL scales and questions targeted to kidney disease and dialysis patients

Symptoms/Problems

During the past 4 weeks, to what extent were you bothered by each of the following? Soreness in your mouth; chest pain; cramps ; itchy skin ; dry skin ; shortness of breath ; faintness or dizziness ; lack of appetite ; washed out or drained ; numbness in hands or feet ; nausea or upset stomach ; problems with your access site. The questions for each of these twelve symptoms have five options of response: 1. Not at all bothered, 2. Somewhat bothered, 3. Moderately bothered, 4. Very much bothered, 5. Extremely bothered

Effect of kidney disease on daily life

How much does kidney disease bother you in each of the following areas? fluid restriction; dietary restriction; your ability to work around the house; your ability to travel; being dependent on doctors and other medical staff; stress or worries caused by kidney disease; your sex life; your personal appearance. The questions for each of these eight areas have five options of response: 1. Not at all bothered, 2. Somewhat bothered, 3. Moderately bothered, 4. Very much bothered, 5. Extremely bothered

Burden of kidney disease

How true or false is each of the following statements for you? My kidney disease interferes too much with my life; Too much of my time is spent dealing with my kidney disease; I feel frustrated dealing with my kidney disease; I feel like a burden on my family. These five questions have five options of response: 1. Definitely true, 2. Mostly true, 3. Don’t know, 4. Mostly false, 5. Definitely false

Work status

During the past 4 weeks, did you work at a paying job? Yes or No; Does your health keep you from working at a paying job? Yes or No

Cognitive function

How much of the time during the past 4 weeks did you: react slowly to things that were said or done? have difficulty concentrating or thinking? become confused? Possible responses: 1. None of the time, 2. A little of the time, 3. Some of the time, 4. A good bit of the time, 5. Most of the time, 6. All of the time.

Quality of social interaction

How much of the time during the past 4 weeks did you: isolate yourself from people around you ? act irritable toward those around you? get along well with other people? Possible responses: 1. None of the time, 2. A little of the time, 3. Some of the time, 4. A good bit of the time, 5. Most of the time, 6. All of the time.

Sexual function

How much of a problem was each of the following in the past 4 weeks? enjoying sex; becoming sexually aroused. The questions for these aspects of sexual function have five options of response: 1. Not a problem, 2. A little problem, 3. Somewhat of a problem, 4. Very much a problem, 5. Severe problem

Sleep

On a scale from 0 (very bad) to 10 (very good), how would you rate your sleep overall?

How often during the past 4 weeks did you...

awake during the night and have trouble falling asleep again? get the amount of sleep you need? have trouble awake during the day? The questions for these three aspects of sleep have six options of response: 1. None of the time, 2. A little of the time, 3. Some of the time, 4. A good bit of the time, 5. Most of the time, 6. All of the time.

Social support

Concerning your family and friends, how satisfied are you: with the amount of time you are able to spend with your family and friends? the support you receive from your family and friends? Possible responses: 1. Very dissatisfied, 2. Somewhat dissatisfied, 3. Somewhat satisfied, 4. Very satisfied.

Dialysis staff encouragement

How true or false is each of the following statements? Dialysis staff encourage me to as independent as possible; dialysis staff support me in coping with my kidney disease. Possible responses: 1. Definitely true, 2. Mostly true, 3. Don’t know, 4. Mostly false, 5. Definitely false

Satisfaction with Care

Think about the care you receive for kidney dialysis. In terms of your satisfaction, how would you rate the friendliness and interest shown in you as a person? Possible responses: 1. Very poor, 2. Poor, 3. Fair, 4. Good, 5. Very good, 6. Excellent, 7. The best

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Lopes, A.A., Bragg-Gresham, J.L., Goodkin, D.A. et al. Factors associated with health-related quality of life among hemodialysis patients in the DOPPS. Qual Life Res 16, 545–557 (2007). https://doi.org/10.1007/s11136-006-9143-7

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