Predictors of Health Deterioration Among Older New Zealanders Undergoing Dialysis: A Three-Year Accelerated Longitudinal Cohort Study

Abstract

Background: Patient involvement in dialysis decision-making is crucial, yet little is known about patient-reported outcomes over time on dialysis. Objective: To examine health-related outcomes over 24 and 36 months in an older cohort of dialysis patients. Design: The “Dialysis outcomes in those aged ≥65 years study” is a prospective longitudinal cohort study of New Zealanders with kidney failure. Setting: Three New Zealand nephrology units. Patients: Kidney failure (dialysis and predialysis) patients aged 65 or above. We have previously described outcomes after 12 months of dialysis therapy relative to baseline. Measurements: Patient-reported social and health factors using the SF-36, EQ-5D, and Kidney Symptom Score questionnaires. Methods: This article describes and compares characteristics of 120 older kidney failure patients according to whether they report “Same/better” or “Worse” health 24 and 36 months later, and identifies predictors of “worse health.” Modified Poisson regression modeling estimated relative risks (RR) of worse health. Results: Of 120 patients at 12 months, 47.5% had worse health or had died by 24 months. Of those surviving at 24 months (n = 80), 40% had “Worse health” or had died at 36 months. Variables independently associated with reduced risk of “Worse health” (24 months) were as follows: Māori ethnicity (RR = 0.44; 95% CI = 0.26-0.75), Pacific ethnicity (RR = 0.39; 95% CI = 0.33-0.46); greater social satisfaction (RR = 0.57; 95% CI = 0.46-0.7). Variables associated with an increased risk of “Worse health” were as follows: problems with usual activities (RR = 1.32; 95% CI = 1.04-1.37); pain or discomfort (RR = 1.48; 95% CI = 1.34, 1.63). At 36 months, lack of sense of community (RR = 1.41; 95% CI = 1.18-1.69), 2 or more comorbidities (RR = 1.21; 95% CI = 1.13-1.29), and problems with poor health (RR = 1.47; 95% CI = 1.41-1.54) were associated with “Worse health.” Limitations: Participant numbers restricted the number of variables able to be included in the multivariable model, and hence there may have been insufficient power to detect certain associations. Conclusions: In this study, the majority of older dialyzing patients report “Same/better health” at 24 and 36 months. Māori and Pacific people report better outcomes on dialysis. Social and/or clinical interventions aimed at improving social satisfaction, sense of community, and help with usual activities may impact favorably on the experiences for older dialysis patients. Trial registration: Australian and New Zealand clinical trials registry: ACTRN12611000024943.

Predictors of poor health-related quality of life among hemodialysis patients with anemia in Jordan

“…Patients with ESRD have multiple co-morbid conditions including diabetes and hypertension, and are more prone to renal-related complications such as imbalance in calcium and phosphate homeostasis, vitamin D deficiency, anemia, and secondary hyperparathyroidism [ 2 – 4 ], which together may significantly impact patients’ well-being and health outcomes. Additionally, maintenance dialysis by itself is an invasive procedure which subjects patients to additional pain and discomfort [ 5 ]. Anemia is prevalent in CKD, especially in patients receiving dialysis [ 6 , 7 ].…”

Health-Related Quality of Life and Disability Among Older New Zealanders With Kidney Failure: A Prospective Study

“…[10][11][12][13][14][15][16][17][18] Few studies have investigated health-related quality of life (HRQoL) among older individuals experiencing kidney failure. Previous findings from our longitudinal dialysis outcomes in older New Zealanders study (DOS65+ study) 19,20 have found that HRQoL, as measured by the EQ-5D-3L, 21 is an important determinant of subsequent overall health reported among older people treated for kidney failure. However, it appears that no studies have yet been published reporting HRQoL in relation to disability outcomes for this older age group with kidney failure-including for those on dialysis.…”

“…The main objective of this analysis was to determine if HRQoL at baseline, measured using the EQ-5D-3L, 20 predicted disability outcomes as measured by the WHO Disability Assessment Schedule (WHODAS) 2.0 29 12 months later. The EQ-5D-3L 20 asks about health status today across 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with 3 responses per dimension assessing the problem severity (ie, no, moderate, or extreme).…”

“…The main objective of this analysis was to determine if HRQoL at baseline, measured using the EQ-5D-3L, 20 predicted disability outcomes as measured by the WHO Disability Assessment Schedule (WHODAS) 2.0 29 12 months later. The EQ-5D-3L 20 asks about health status today across 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with 3 responses per dimension assessing the problem severity (ie, no, moderate, or extreme). As cognitive function is also an important aspect of older people’s health, an additional (non-EQ-5D-3L) question asked participants if they had no problems, moderate problems, or were unable to perform intellectual activities.…”