title: Health-related quality of life, depressive symptoms, anemia, and malnutrition at hemodialysis initiation.
abstract: METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Scientific Affairs and Clinical Research, Gambro Healthcare, Ft Lauderdale, FL 33312, USA. brian.walters@us.gambro.com
authors.forename: Brian A J
authors.initials: BA
authors.lastname: Walters
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.forename: Karen L
authors.initials: KL
authors.lastname: Spritzer
authors.forename: Moshe
authors.initials: M
authors.lastname: Fridman
authors.forename: William B
authors.initials: WB
authors.lastname: Carter
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000453:epidemiology*; D002408:Catheters, Indwelling; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000453:epidemiology*; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods*; D012737:Sex Factors