title: Health-related quality of life as a predictor of mortality and hospitalization: the Dialysis Outcomes and Practice Patterns Study (DOPPS).
abstract: BACKGROUND
  We investigated whether indicators of health-related quality of life (HRQOL) may predict the risk of death and hospitalization among hemodialysis patients treated in seven countries, taking into account serum albumin concentration and several other risk factors for death and hospitalization. We also compared HRQOL measures with serum albumin regarding their power to predict outcomes.
  
  
  METHODS
  We analyzed data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), an international, prospective, observational study of randomly selected hemodialysis patients in the United States (148 facilities), five European countries (101 facilities), and Japan (65 facilities). The total sample size was composed of 17,236 patients. Using the Kidney Disease Quality of Life Short Form (KDQOL-SFTM), we determined scores for three components of HRQOL: (1) physical component summary (PCS), (2) mental component summary (MCS), and (3) kidney disease component summary (KDCS). Complete responses on HRQOL measures were obtained from 10,030 patients. Cox models were used to assess associations between HRQOL and the risk of death and hospitalization, adjusted for multiple sociodemographic variables, comorbidities, and laboratory factors.
  
  
  RESULTS
  For patients in the lowest quintile of PCS, the adjusted risk (RR) of death was 93% higher (RR = 1.93, P < 0.001) and the risk of hospitalization was 56% higher (RR = 1.56, P < 0.001) than it was for patients in the highest quintile level. The adjusted relative risk values of mortality per 10-point lower HRQOL score were 1.13 for MCS, 1.25 for PCS, and 1.11 for KDCS. The corresponding adjusted values for RR for first hospitalization were 1.06 for MCS, 1.15 for PCS, and 1.07 for KDCS. Each RR differed significantly from 1 (P < 0.001). For 1 g/dL lower serum albumin concentration, the RR of death adjusted for PCS, MCS, and KDCS and the other covariates was 1.17 (P < 0.01). Albumin was not significantly associated with hospitalization (RR = 1.03, P> 0.5).
  
  
  CONCLUSIONS
  Lower scores for the three major components of HRQOL were strongly associated with higher risk of death and hospitalization in hemodialysis patients, independent of a series of demographic and comorbid factors. A 10-point lower PCS score was associated with higher elevation in the adjusted mortality risk, as was a 1 g/dL lower serum albumin level. More research is needed to assess whether interventions to improve quality of life lower these risks among hemodialysis patients.
authors.affiliation: Amgen, Inc., Thousand Oaks, California, USA.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Mapes
authors.forename: Antonio Alberto
authors.initials: AA
authors.lastname: Lopes
authors.forename: Sudtida
authors.initials: S
authors.lastname: Satayathum
authors.forename: Keith P
authors.initials: KP
authors.lastname: McCullough
authors.forename: David A
authors.initials: DA
authors.lastname: Goodkin
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Eric W
authors.initials: EW
authors.lastname: Young
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kurokawa
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.forename: Jürgen
authors.initials: J
authors.lastname: Bommer
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolfe
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Held
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
mesh_terms: D000368:Aged; D005060:Europe; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D011364:Professional Practice; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000401:mortality*; D012306:Risk; D012709:Serum Albumin / Q000032:analysis; D016896:Treatment Outcome; D014481:United States
chemical_list: D012709:Serum Albumin