Health-related quality of life, depressive symptoms, anemia, and malnutrition at hemodialysis initiation

• DOI: 10.1053/ajkd.2002.36879
• Publication Date: 2002-12-02T13:45:51Z
• Authors: Brian A.J. Walters; Ron D. Hays; Karen L. Spritzer; Moshe Fridman; William B. Carter
• Keywords: Adult; Male; Adolescent; 03 medical and health sciences; Catheters, Indwelling; 0302 clinical medicine; Renal Dialysis; Humans; Longitudinal Studies; Prospective Studies; Aged; 2. Zero hunger; Depression; Age Factors; Anemia; Middle Aged; Health Surveys; Nutrition Disorders; 3. Good health; Quality of Life; Kidney Failure, Chronic; Female; Hypoalbuminemia; Follow-Up Studies

We administered the Kidney Disease Quality of Life (KDQOL) short form and a three-item depression screening measure derived from the Diagnostic Interview Schedule to 422 new patients with end-stage renal disease (ESRD; incident cohort) who began maintenance hemodialysis (HD) therapy at 151 outpatient dialysis facilities across the United States.At HD therapy initiation, 56% of patients had hemoglobin levels less than 10 g/dL (100 g/L), and 52% had albumin levels of 3.5 g/dL (35 g/L) or less. The 36-Item Short Form Health Survey (SF-36) scores (part of the KDQOL) for this incident cohort were significantly lower than those of a prevalent HD cohort and a severe chronic disease cohort (P < 0.01 to 0.001), and physical health scores were among the lowest ever reported. SF-36 summary scores were 2 SDs below those of an age- and sex-adjusted US general population in physical health and half an SD below those in mental health. Patients who screened positive for depression (45% of sample) scored even lower on all eight SF-36 scale scores and 9 of 12 of the KDQOL kidney disease-targeted scales (P < 0.05 to 0.01), but did not differ from nondepressed patients on demographic, clinical, or laboratory study variables.The extent to which the profound impairment documented in this study can be improved by more timely high-quality predialysis care requires further investigation. Nevertheless, the high prevalence of anemia, hypoalbuminemia, and depressive symptoms at dialysis therapy initiation suggests the need for more aggressive and broader spectrum pre-ESRD care.