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Abstract: FR-PO411

Independent Predictors of One-Year Quality of Life Trend in a Large Population of Hemodialysis Patients: Importance of Vascular Access Management

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Santos Araujo, Carla Alexandra R., Diaverum AB, Malmo, Sweden
  • Silva, Eliana, Diaverum AB, Malmo, Sweden
  • Silva, Israel Pereira, Diaverum AB, Malmo, Sweden
  • Haarhaus, Mathias, Diaverum AB, Malmo, Sweden
  • Lucas, Carlos, Diaverum AB, Malmo, Sweden
  • Pearce, Suzanne H., Diaverum AB, Malmo, Sweden
  • Macario, Fernando Jose Gordinho Rocha Maio, Diaverum AB, Malmo, Sweden
Background

Health-related quality of life (QoL) is recognized as a relevant patient-centered outcome in hemodialysis (HD). Studies evaluating the trend of QoL with time in large populations are scarce. We aimed to evaluate the changes in QoL over a one-year period in a multinational HD population.

Methods

This was a multicenter prospective observational study using a quality database from a large HD organization. All adult patients that voluntarily responded to KDQOL-36 in 2021 and 2022 were included. Mental (MCS) and Physical Composite Scales (PCS) were analyzed and divided in two groups: Group I, increase in MCS and PCS by more than 5 points; Group II, decrease in both scores. At the time of the first survey, demographic (age, gender) and clinical data (diabetes, comorbidity index - CI, vascular access) were collected. Death was registered until 6 months after the second survey. T-test and z-test were performed for group comparisons. Multivariate logistic regression, Kaplan Meyer and Cox regression for survival analysis were also used.

Results

20 006 HD patients with valid responses to both KDQOL-36 were included. Increase on both scores was observed in 2381 patients (11.9% of surveys) and decrease in 2051 (10.3%). Group I patients were significantly younger, less diabetic, had a lower CI, higher percentage of fistulas and lower time on dialysis. A significantly higher number of deaths at 6 months were observed in Group II (6.5% vs. 4.2%, p<0.005). In multivariate analysis, age and the presence of a fistula were independently associated with global QoL improvement, whereas female gender and diabetes were independent predictors of QoL decrease. Six-month mortality was associated with worsening of QoL. Males and diabetic patients in Group I and older and diabetic patients in Group II presented significant higher hazard ratios of death.

Conclusion

In our HD population, one-year trend of QoL scores were associated with several demographic and clinical variables, allowing us to define and target specific interventions on a group at risk for rapid QoL decrease. The presence of a fistula was a predictor of QoL improvement, confirming the importance of vascular access management in the global outcomes of HD patients.