Clinical factors impacting quality of life and outcomes through the transition from pre-dialysis chronic kidney disease to early dialysis treatment

This thesis, “Clinical factors impacting quality of life and outcomes through the transition from pre-dialysis CKD to early dialysis treatment”, examines clinical factors that improve dialysis start and patient survival. The gathered data suggests that patient differences, which affect the way patients start dialysis, may be present in late stage CKD. Clinical interventions related to blood pressure, dialysis preparation, and home therapy use may benefit patients. The way patients start dialysis and dialysis changes in the first treatment year may impact quality of life perceptions. CKD clinical data analysis may help to personalize CKD care and improve the transition to dialysis start

The Association of Weekly pre-Hemodialysis Systolic Blood Pressure and Following Week Mortality

Background/Aims: Few studies examine the impact of systolic blood pressure (SBP) on mortality in the incident hemodialysis (HD) period, and throughout the first HD year. This large retrospective observational study analyzes the impact of “current” and cumulative low preSBP <110 mmHg (L), and variations in preSBP on short-term (1 week) mortality over the first HD year. Methods: Weekly mean preSBP for HD weeks 1 to 51 was categorized into L or high preSBP>=110 mmHg (H) for each patient. A generalized linear model (GLM) was used to compute the probability of death in the following week. The model includes age, gender, race and three preSBP-related parameters: (a) percent of prior weeks with L preSBP; (b) percent of prior weeks with switching between L to H; (c) “current” week’s preSBP as a binary variable. Separate models were constructed that include demographics and BP-related parameters (a), (b), and (c) separately. Results: In a model combining (a), (b), and (c) above, “current” week L preSBP is associated with increased odds ratio for following week mortality throughout the first HD year. The percent of prior week’s L and more switching between L and H are less significantly associated with short-term mortality. In models including (a), (b), and (c) separately, “current” L preSBP is associated with higher mortality. Conclusion: This study confirms an association of L preSBP with increased short-term mortality which is maintained over the first HD year. Percent of L preSBP in prior weeks, switching between L and H, and “current” week L are all associated with short-term mortality risk, but “current” week L preSBP is most significant

The Association of Weekly pre-Hemodialysis Systolic Blood Pressure and Following Week Mortality

Background/Aims: Few studies examine the impact of systolic blood pressure (SBP) on mortality in the incident hemodialysis (HD) period, and throughout the first HD year. This large retrospective observational study analyzes the impact of “current” and cumulative low preSBP <110 mmHg (L), and variations in preSBP on short-term (1 week) mortality over the first HD year. Methods: Weekly mean preSBP for HD weeks 1 to 51 was categorized into L or high preSBP>=110 mmHg (H) for each patient. A generalized linear model (GLM) was used to compute the probability of death in the following week. The model includes age, gender, race and three preSBP-related parameters: (a) percent of prior weeks with L preSBP; (b) percent of prior weeks with switching between L to H; (c) “current” week’s preSBP as a binary variable. Separate models were constructed that include demographics and BP-related parameters (a), (b), and (c) separately. Results: In a model combining (a), (b), and (c) above, “current” week L preSBP is associated with increased odds ratio for following week mortality throughout the first HD year. The percent of prior week’s L and more switching between L and H are less significantly associated with short-term mortality. In models including (a), (b), and (c) separately, “current” L preSBP is associated with higher mortality. Conclusion: This study confirms an association of L preSBP with increased short-term mortality which is maintained over the first HD year. Percent of L preSBP in prior weeks, switching between L and H, and “current” week L are all associated with short-term mortality risk, but “current” week L preSBP is most significant

Longitudinal patterns of health-related quality of life and dialysis modality: a national cohort study

Abstract Background Health-related quality of life (HrQoL) varies among dialysis patients. However, little is known about the association of dialysis modality with HrQoL over time. We describe longitudinal patterns of HrQoL among chronic dialysis patients by treatment modality. Methods National retrospective cohort study of adult patients who initiated in-center dialysis or a home modality (peritoneal or home hemodialysis) between 1/2013 and 6/2015. Patients remained on the same modality for the first 120 days of the first two years. HrQoL was assessed by the Kidney Disease and Quality of Life-36 (KDQOL) survey in the first 120 days of the first two years after dialysis initiation. Home modality patients were matched to in-center patients in a 1:5 fashion. Results In-center (n=4234) and home modality (n=880) patients had similar demographic and clinical characteristics. In-center dialysis patients had lower mean KDQOL scores across several domains compared to home modality patients. For patients who remained on the same modality, there was no change in HrQoL. However, there were trends towards clinically meaningful changes in several aspects of HrQoL for patients who switched modalities. Specifically, physical functioning decreased for patients who switched from home to in-center dialysis (p< 0.05). Conclusions Among a national cohort of chronic dialysis patients, there was a trend towards different patterns of HrQoL life that were only observed among patients who changed modality. Patients who switched from home to in-center modalities had significant lower physical functioning over time. Providers and patients should be mindful of HrQoL changes that may occur with dialysis modality change