Abstract: FR-PO925

Association of Kidney Disease Quality of Life (KDQOL-36) Subscale Scores with Mortality and Hospitalization in Older Dialysis Patients

Session Information

  • Geriatric Nephrology
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Geriatric Nephrology

  • 901 Geriatric Nephrology

Authors

  • Hall, Rasheeda K., Duke University, Durham, North Carolina, United States
  • Luciano, Alison, Duke University, Durham, North Carolina, United States
  • Pieper, Carl F, Duke University, Durham, North Carolina, United States
  • Colon-emeric, Cathleen, Duke University, Durham, North Carolina, United States
Background

The Kidney Disease Quality of Life (KDQOL-36) instrument is routinely administered to dialysis patients. Subscale scores may be useful for prognostication but their association with clinical outcomes has not been reported in older adults.

Methods

We conducted a longitudinal study of 3500 adults aged ≥ 75 years receiving dialysis through a large dialysis organization in 2012 and 2013. We used Cox and Fine and Gray models to evaluate the association of KDQOL-36 subscales (1- Burden of kidney disease, 2- Effects of kidney disease, 3- Symptoms of kidney disease, 4- SF-12 physical component score (PCS), and 5- SF-12 mental component score (MCS)) with risks of death and hospitalization, respectively. All models were adjusted for sociodemographic variables, hemodialysis access type, laboratory values, and Charlson index. We compared models with and without the KDQOL-36 subscales using likelihood ratio (LR) statistics.

Results

Among members of this cohort, 3,267 patients completed the KDQOL-36. From the date of KDQOL-36 completion, 929 (25.6%) patients died and 2,005 (61.4%) had at least one hospitalization over a median follow-up of 511 and 204 days, respectively. In unadjusted analyses, cohort members with KDQOL-36 scores in the lowest quintile (relative to the highest quintile) for all subscales had a higher probability of death. Cohort members with a SF-12 PCS in the lowest quintile had an increased adjusted risk of death [hazard ratio (HR), 1.53, 95% confidence interval (CI) 1.18-1.99] and hospitalization (HR, 1.33, 95% CI 1.12-1.58) compared with those with scores in the highest quintile. Cohort members with SF-12 MCS scores in the lowest quintile had an increased adjusted risk of hospitalization (HR, 1.41, 95% CI 1.19-1.68) compared with those in the highest quintile and those with Effects of kidney disease subscale scores in the lowest quintile had a lower risk of hospitalization (HR, 0.78, 95% CI 0.63-0.95). The magnitude of these associations was similar in competing risk models. Inclusion of KDQOL-36 subscales improved model fit both for death (LR 41.04; p-value = 0.004) and hospitalization (LR 68.14; p-value < 0.001).

Conclusion

Routinely administered KDQOL-36 subscales may improve risk stratification of older adults receiving dialysis for death and future hospitalizations.

Funding

  • Other NIH Support