Background. Quality of life (QoL) is an important outcome in chronic kidney disease (CKD). Patients feel that symptoms are an important determinant of QoL. However, this relation is unknown. The... Show moreBackground. Quality of life (QoL) is an important outcome in chronic kidney disease (CKD). Patients feel that symptoms are an important determinant of QoL. However, this relation is unknown. The aims of this study were to investigate the impact of the number and severity of symptoms on QoL in elderly pre-dialysis patients, assessed by both the effect of symptoms and their importance relative to kidney function, and other clinical variables on QoL.Methods. The European Quality study (EQUAL study) is an ongoing European prospective follow-up study in late Stage 4/5 CKD patients aged >= 65 years. We used patients included between March 2012 and December 2015. Patients scored their symptoms with the Dialysis Symptom Index, and QoL with the research and development-36 (RAND-36) item Health Survey (RAND-36). The RAND-36 results in a physical component summary (PCS) and a mental component summary (MCS). We used linear regression to estimate the relation between symptoms and QoL at baseline and after 6 months, and to calculate the variance in QoL explained by symptoms.Results. The baseline questionnaire was filled in by 1079 (73%) patients (median age 75 years, 66% male, 98% Caucasian), and the follow up questionnaire by 627 (42%) patients. At baseline, every additional symptom changed MCS with -0.81 [95% confidence interval (CI): -0.91 to -0.71] and PCS with -0.50 (95% CI: -0.62 to -0.39). In univariable analyses, number of symptoms explained 22% of MCS variance and 11% of PCS variance, whereas estimated glomerular filtration rate only explained 1%.Conclusions. In elderly CKD Stage 4/5 patients, symptoms have a substantial impact on QoL. This indicates symptoms should have a more prominent role in clinical decision-making. Show less
Voskamp, P.W.M.; Dekker, F.W.; Rookmaaker, M.B.; Verhaar, M.C.; Bos, W.J.W.; Diepen, M. van; Ocak, G. 2018
This thesis aimed to provide insight in quality of life (QOL) as an outcome in pre-dialysis patients by investigating appropriate ways to measure this construct and by investigating factors... Show moreThis thesis aimed to provide insight in quality of life (QOL) as an outcome in pre-dialysis patients by investigating appropriate ways to measure this construct and by investigating factors affecting QOL. The second aim was to increase the understanding of the different associations between several cardiovascular risk factors and traditional outcomes in pre-dialysis and dialysis patients. In elderly pre-dialysis patients symptoms have a substantial impact on QOL. The effect of symptoms on a relevant outcome measure indicates symptoms which in turn affect other important outcomes, should have a more prominent role in clinical decision making. An appropriate way to measure the construct QOL in pre-dialysis patients with a short questionnaire is by using the SF-12. No association between dyslipidemia and start of dialysis in pre-dialysis patients was found. In pre-dialysis patients, both dual RAS blockade and single ACEi-use were associated with a lower risk of RRT or death, as compared with no RAS blockade. There is no association between vitamin K antagonist use and rate of renal function decline or time until start of dialysis in the pre-dialysis population. Vitamin K-antagonist use compared to no vitamin K-antagonist use is associated with an increased all-cause mortality risk in dialysis patients. Show less
Voskamp, P.W.M.; Diepen, M. van; Dekker, F.W.; Hoogeveen, E.K. 2018
