Quality of life in predialysis end-stage renal disease patients at the initiation of dialysis therapy

Objective:To assess health-related quality of life (QL) in a group of Dutch predialysis end-stage renal disease (ESRD) patients prior to the initiatio n of dialysis, and to compare QL between patients with different intended i nitial dialysis treatments. Design: In a prospective cohort study, demographic, clinical, and QL data w ere obtained from Dutch adult patients who were consecutively enrolled from 27 different centers 0 - 4 weeks prior to the beginning of their chronic d ialysis treatment. Patients: Of the 301 patients who completed the QL questionnaires (of a pos sible 337 enrolled patients), 152 intended to start with hemodialysis (pre- HD) and 149 patients with peritoneal dialysis (pre-PD). Main Outcome Measure: Perceived QL of pre-HD and pre-PD patients. Quality o f life was assessed with two generic health assessment instruments: the SF- 36 and the EuroQol. Results: After correction for group differences, pre-HD patients scored con sistently, but not significantly, lower for all separate dimensions of the SF-36 and the overall health score of the EuroQol compared to pre-PD patien ts. However, analyzing the dimensions of the SF-36 together, adjusted for c ase-mix, pre-HD patients scored significantly lower than pre-PD patients. M ean difference was 6.5 points (p = 0.04). Conclusion: Multivariate adjustment for known case-mix differences at the s tart of dialysis therapy was not sufficient to adjust for all patient selec tion effects on QL. Consequently, published QL comparisons between HD and P D in nonrandomized cohort studies should be interpreted with caution. Asses sment of QL just before start of dialysis therapy and subsequent adjustment for baseline values may be the only valid alternative for randomized studi es.