Predictors of Health Deterioration Among Older Adults After 12 Months of Dialysis Therapy: A Longitudinal Cohort Study From New Zealand
Aged, 80 and over
Male
Depression
Health Status
Personal Satisfaction
Anxiety
Social Participation
16. Peace & justice
3. Good health
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Renal Dialysis
Humans
Kidney Failure, Chronic
Regression Analysis
Female
Longitudinal Studies
Patient Reported Outcome Measures
Poisson Distribution
Prospective Studies
Peritoneal Dialysis
Aged
New Zealand
DOI:
10.1053/j.ajkd.2017.06.023
Publication Date:
2017-08-18T10:06:51Z
AUTHORS (8)
ABSTRACT
Involving patients in dialysis decision making is crucial, yet little is known about patient-reported experiences and patient-reported outcomes of dialysis.A prospective longitudinal cohort study of older patients receiving long-term dialysis. Predictors of worse health status were assessed using modified Poisson regression analysis.150 New Zealanders 65 years or older with end-stage kidney disease dialyzing at 1 of 3 nephrology centers.Patient-reported social and health characteristics based on the 36-Item Short Form Health Survey, EQ-5D, and Kidney Symptom Score questionnaires and clinical information from health records.Health status after 12 months of follow-up.35% of study participants had reported worse health or had died at 12 months. Baseline variables independently associated with reduced risk for worse health status were Pacific ethnicity (relative risk [RR], 0.63; 95% CI, 0.53-0.72), greater bother on the Kidney Symptom Score (RR, 0.78; 95% CI, 0.62-0.97), and dialyzing at home with either home hemodialysis (RR, 0.55; 95% CI, 0.36-0.83) or peritoneal dialysis (RR, 0.86; 95% CI, 0.79-0.93). Baseline variables independently associated with increased risk were greater social dissatisfaction (RR, 1.66; 95% CI, 1.27-2.17), lower sense of community (RR, 1.70; 95% CI, 1.09-2.64), comorbid conditions (RR, 1.70; 95% CI, 1.09-2.64), EQ-5D anxiety/depression (RR, 1.61; 95% CI, 1.07-2.42); poor/fair overall general health (RR, 1.60; 95% CI, 1.37-1.85), and longer time on dialysis therapy (RR, 1.03; 95% CI, 1.00-1.05).Small sample size restricted study power.Most older dialyzing patients studied reported same/better health 12 months later. Home-based dialysis, regardless of whether hemodialysis or peritoneal dialysis, was associated with reduced risk for worse health, and older Pacific People reported better outcomes on dialysis therapy. Social and/or clinical interventions aimed at improving social satisfaction, sense of community, and reducing anxiety/depression may favorably affect the experiences of older patients receiving long-term dialysis.
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