Abstract: FR-OR056

Improvement in Health-Related Quality of Life in the FREEDOM Study of Frequent Home Hemodialysis

Session Information

  • Home Hemodialysis
    November 03, 2017 | Location: Room 295, Morial Convention Center
    Abstract Time: 06:06 PM - 06:18 PM

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Finkelstein, Fredric O., Yale University, New Haven, Connecticut, United States
  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Jaber, Bertrand L., St. Elizabeth's Medical Center, Boston, Massachusetts, United States
Background

Poor health-related quality of life (HRQOL) is common in dialysis patients. Increasing treatment frequency improved physical HRQOL in the Frequent Hemodialysis Network trials. The FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study was a 12-month prospective cohort study of short daily home hemodialysis (SDHHD). Interim analysis of the FREEDOM Study indicated that SDHHD led to improvements in HRQOL. We sought to confirm these findings in a final analysis.

Methods

We analyzed HRQOL in intention-to-treat (ITT), conditional ITT (cITT), and as-treated (AT) cohorts. The ITT, cITT, and AT cohorts comprised all patients who initiated SDHHD, those who completed 2 months of follow-up, and those who completed 12 months of follow-up, respectively. HRQOL was measured with the Short Form-36 health survey at baseline, 4 months (if the patient remained on SDHHD), and 12 months (if the patient remained on SDHHD). Patients were censored at death or kidney transplantation. We used adjusted mixed models to analyze changes in HRQOL domains, the physical-composite summary (PCS), and the mental-composite summary (MCS).

Results

The ITT, cITT, and AT cohorts included 487, 408, and 247 patients, respectively. In the ITT cohort, mean PCS increased from 34.8 at baseline to 37.1 at 12 months, while mean MCS increased from 45.8 to 48.0. In the AT cohort, mean PCS increased from 35.5 to 38.6, while mean MCS increased from 48.4 to 50.4. Modeled changes in HRQOL domains between baseline, 4 months, and 12 months are displayed in the table. Changes were uniformly positive.

Conclusion

In a 12-month prospective cohort study, SDHHD was associated with widespread improvements across domains of both physical and mental HRQOL.

HRQOL domainITT cohortcITT cohortAT cohort
 4 months12 months4 months12 months4 months12 months
PCS+1.9*+2.0*+2.2*+2.2*+3.1*+3.0*
MCS+1.9*+1.8*+2.2*+2.1*+2.2*+2.0*
Physical functioning+1.4*+1.4*+1.5*+1.6*+1.9*+1.8*
Role-physical+2.9*+3.0*+3.2*+3.4*+3.9*+4.2*
Bodily pain+1.0*+1.2*+1.2*+1.4*+1.7*+1.6*
General health+1.8*+1.5*+2.1*+1.8*+2.6*+2.1*
Vitality+3.4*+2.9*+4.0*+3.3*+4.9*+3.9*
Social functioning+2.3*+2.6*+2.7*+3.1*+3.6*+4.0*
Role-emotional+1.0*+1.0+1.0*+1.2+0.3+0.3
Mental health+1.5*+1.7*+1.7*+2.0*+1.7*+1.9*

*P < 0.05, with adjustments for demographics and comorbidity