Health-related quality of life and all-cause mortality in patients with diabetes on dialysis

Abstract

BackgroundThis study tests the hypotheses that health-related quality of life (HRQOL) in prevalent dialysis patients with diabetes is lower than in dialysis patients without diabetes, and is at least as poor as diabetic patients with another severe complication, i.e. foot ulcers. This study also explores the mortality risk associated with diabetes in dialysis patients.MethodsHRQOL was assessed using the Short Form-36 Health Survey (SF-36), in a cross-sectional study of 301 prevalent dialysis patients (26% with diabetes), and compared with diabetic patients not on dialysis (n = 221), diabetic patients with foot ulcers (n = 127), and a sample of the general population (n = 5903). Mortality risk was assessed using a Kaplan-Meier plot and Cox proportional hazards analysis.ResultsSelf-assessed vitality, general and mental health, and physical function were significantly lower in dialysis patients with diabetes than in those without. Vitality (p = 0.011) and general health (p <0.001) was impaired in diabetic patients receiving dialysis compared to diabetic patients with foot ulcers, but other subscales did not differ. Diabetes was a significant predictor for mortality in dialysis patients, with a hazard ratio (HR) of 1.6 (95% CI 1.0-2.5) after adjustment for age, dialysis vintage and coronary artery disease. Mental aspects of HRQOL were an independent predictor of mortality in diabetic patients receiving dialysis after adjusting for age and dialysis vintage (HR 2.2, 95% CI 1.0-5.0).ConclusionsPhysical aspects of HRQOL were perceived very low in dialysis patients with diabetes, and lower than in other dialysis patients and diabetic patients without dialysis. Mental aspects predicted mortality in dialysis patients with diabetes. Increased awareness and measures to assist physical function impairment may be particularly important in diabetes patients on dialysis.

Diabetic retinopathy in type 1 diabetes patients in Western Norway

“…Health-related quality of life (HRQoL) in diabetes patients has been well documented both worldwide and in the Nordic countries (W€ andell 2005;Zhang et al 2007). Previous research regarding HRQoL in Norwegian diabetes patients has mainly focused on patients with specific treatment modalities or diabetes complications like foot ulcers, kidney failure, or autonomic neuropathy (Ribu et al 2007;Østhus et al 2012;Frøisland et al 2013;Søfteland et al 2014), while data on the impact of DR are missing. In the present study, we found a significant association between DR and decreased HRQoL in all the physical domains.…”

Predictors of Health-Related Quality of Life in Patients with Co-Morbid Diabetes and Chronic Kidney Disease

“…Given that CKD is a common complication of diabetes, the number of patients with diabetes requiring dialysis is also likely to increase. Contributing factors include an ageing population, increase in prevalence of obesity and improved survival rates after cardiovascular events [4]. …”

“…Patients with diabetes and CKD have significantly impaired HRQoL [6–9] which may worsen as the disease progresses [5]. Lower HRQoL scores are strongly associated with higher risk of death and hospitalisation [2, 4, 10–12] and poorer glycaemic control in patients with diabetes [13]. Assessment of HRQoL allows for identification of factors that may be targeted to improve patient well-being.…”

New directions for diabetes prevention and management in behavioral medicine

“…Diabetes is also associated with an increase in risk of cognitive impairment (Everson-Rose & Ryan, 2015). These complications exert significant impact on health care utilization aspects of health related quality of life such as vitality, general health and functional impairment as well as mortality (Osthus et al, 2012) and health care expenditures (Ward et al, 2014). …”