Effects of hemodialysis dose and membrane flux on health-related quality of life in the HEMO Study.
BACKGROUND
It has been widely supposed that high dose and high flux hemodialysis would affect the quality as well as the length of life of patients treated by maintenance hemodialysis. The HEMO Study examined changes in health-related quality of life as a secondary study outcome. Specific hypotheses were that study interventions would affect physical functioning, vitality, Short Form-36 Health Survey (SF-36) physical and mental component summary scores, symptoms and problems associated with kidney disease, and sleep quality.


METHODS
At baseline and annually, subjects responded to both the Index of Well-Being and the Kidney Disease Quality of Life-Long Form questionnaires. The interventions were assessed on the basis of their average effects over 3 years.


RESULTS
At baseline, the SF-36 physical component summary score was lower than in healthy populations, but the mental component score was nearly normal. Over 3-year follow-up, physical health continued to decline; mental health and kidney disease-targeted scores remained relatively stable. The high dose hemodialysis intervention was associated with significantly less pain (4.49 points, P < 0.001) and higher physical component scores (1.23 points P= 0.007), but these effects were small compared to the natural variability in scores. High flux membranes were not associated with statistically significant differences in health-related quality of life.


CONCLUSIONS
The HEMO Study results demonstrate the marked burden of chronic kidney failure and hemodialysis treatment on daily life. In this trial among patients undergoing maintenance three times a week hemodialysis, the SF-36 physical component summary score and pain scale showed significant but very small clinical effects favoring the higher dialysis dose. No clinically meaningful benefits or either the dose or flux interventions were observed for other indices of health-related quality of life.
Unruh
Mark
M
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. unruh@pitt.edu
Benz
Robert
R
Greene
Tom
T
Yan
Guofen
G
Beddhu
Srinivasan
S
DeVita
Maria
M
Dwyer
Johanna T
JT
Kimmel
Paul L
PL
Kusek
John W
JW
Martin
Alice
A
Rehm-McGillicuddy
Josephine
J
Teehan
Brendan P
BP
Meyer
Klemens B
KB
D000368:Aged; D004058:Diffusion; D005260:Female; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008603:Mental Health; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation; D011795:Surveys and Questionnaires; D016019:Survival Analysis
D008567:Membranes, Artificial