Effects of hemodialysis dose and membrane flux on health-related quality of life in the HEMO Study

Unruh, Mark; Benz, Robert L.; Greene, Tom; Gao, Yan; Beddhu, Srinivasan; Devita, Maria; Dwyer, Johanna T.; Kimmel, Paul L.; Kusek, John W.; Martin, Alice; Rehm-Mcgillicuddy, Josephine; Teehan, Brendan P.; Meyer, Klemens B.

doi:10.1111/j.1523-1755.2004.00738.x

Cited by 163 publications

(151 citation statements)

References 49 publications

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“…The ES across all other scales was Յ0.2, indicating that Kt/V had a small relationship with HRQOL. Two studies measured the relationship between Kt/V and both PCS and MCS, and the relationship with Kt/V and these domains was small (ES Յ0.1 for both) (46,47). Two studies presented data using the diseasetargeted Kidney Disease Quality of Life (KDQOL) instrument, a questionnaire that includes the SF-36 as a generic core surrounded by disease-specific scales (46,48).…”

Section: Results Stratified By Traditional Biomarkersmentioning

confidence: 99%

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Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease

Spiegel

Melmed

Robbins

et al. 2008

Clinical Journal of the American Society of Nephrology

118

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Background and objectives: Health-related quality of life (HRQOL) predicts mortality in ESRD, yet adoption of HRQOL monitoring is not widespread, and regulatory authorities remain predominantly concerned with monitoring traditional biologic parameters. To assist with future efforts to adopt HRQOL monitoring while acknowledging the importance of biomarkers, this study sought to establish which domains of HRQOL are most affected by ESRD and to measure the strength of evidence linking common biomarkers to HRQOL in ESRD.Design, setting, participants, & measurements: A systematic review was performed to identify studies that measured HRQOL in ESRD. Data were abstracted according to a conceptual model regarding the measurement of HRQOL differences, and HRQOL data were converted to weighted mean effect sizes and correlation coefficients.Results: The impact of ESRD was largest in the Short Form 36 domains of physical functioning (e.g., role-physical, vitality) and smallest in mental functioning (e.g., mental health, role-emotional). Dialysis adequacy, as measured by Kt/V, was a poor correlate for Short Form 36 scores. Similarly, mineral metabolism (e.g., calcium ؋ phosphorous, parathyroid hormone) and inflammatory (e.g., C-reactive protein, TNF) biomarkers had small effect sizes and correlations with HRQOL. In contrast, hematocrit demonstrated small to moderate relationships with mental and physical HRQOL, and nutritional biomarkers (e.g., albumin, creatinine, body mass index) demonstrated moderate to large relationships.Conclusions: HRQOL in ESRD is most affected in the physical domains, and nutritional biomarkers are most closely associated with these domains. In contrast, Kt/V, mineral metabolism indices, and inflammatory markers are poor HRQOL correlates.

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Section: Results Stratified By Traditional Biomarkersmentioning

confidence: 99%

“…Two studies presented data using the diseasetargeted Kidney Disease Quality of Life (KDQOL) instrument, a questionnaire that includes the SF-36 as a generic core surrounded by disease-specific scales (46,48). The ES was Յ0.2 for all disease-targeted HRQOL scales (46,48).…”

Section: Results Stratified By Traditional Biomarkersmentioning

confidence: 99%

Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease

Spiegel

Melmed

Robbins

et al. 2008

Clinical Journal of the American Society of Nephrology

118

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“…A large randomized trial comparing higher dialysis dose (expressed as equilibrated Kt/V urea ) with the standard recommended dose showed that higher dialysis dose within the current thrice-weekly paradigm resulted in minimal improvements in health status. 12 Recent studies have shown that high serum phosphorus and parathyroid hormone levels are associated with increased mortality and cause-specific hospitalization among hemodialysis patients. 13,14 Thus, it is plausible that disordered mineral metabolism could be associated with reduced health-related quality of life and could be modifiable.…”

Section: Introductionmentioning

confidence: 99%

Chronic Kidney Disease Mineral Bone Disorder and Health-Related Quality of Life Among Incident End-Stage Renal-Disease Patients

Johansen

Chertow

2007

Journal of Renal Nutrition

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Objective-To determine the extent to which chronic kidney disease mineral bone disorder (CKD-MBD) is associated with HRQOL among incident dialysis patients. Design-Cross-sectional analysis Setting-United States Renal Data System Dialysis Morbidity and Mortality Study (DMMS), Wave 2Patients-2590 adult participants in DMMS Wave 2 for whom quality of life and laboratory data were available Methods-We stratified patients according to their serum concentrations of phosphorus, calcium, and parathyroid hormone (PTH) and compared HRQOL as a function of these indicators in analyses adjusted for demographic, clinical, and other laboratory variables. Results-Both high and low serum phosphorus concentrations were associated with lower PCS (−1.25 to −1.48 points compared to the reference category), as was low PTH (−1.49 points). Low serum phosphorus was associated with more severe symptoms of kidney disease (−3.88 points) but there were no associations between high phosphorus or either extreme of PTH and the Symptom score. Serum calcium concentration and the calcium × phosphorus product were unassociated with PCS or Symptom scores. There were no associations among phosphorus, calcium, or PTH and MCS. Analyses simultaneously controlling for serum phosphorus, calcium, and PTH showed similar results. Main Outcome Measures-PhysicalConclusions-High and low serum phosphorus and low PTH are associated with slightly poorer self-reported physical functioning. Clinical trials will be necessary to determine whether and to what extent improvement in health status may occur with correction of selected disorders of mineral metabolism.

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“…[42] HEMO study data has shown that higher dialysis doses do not improve survival. [43] However, recent data from DOPPS has shown that high-efficiency HDF reduces mortality risk by 0.65, [44] which may be an effect of cytokine reduction.…”

Section: Discussionmentioning

confidence: 99%