title: Temporal trends in health-related quality of life among hemodialysis patients in the United States.
abstract: OBJECTIVE
  Health-related quality of life (HRQOL) is a measure of the well being of hemodialysis patients and an independent prognostic predictor. Our aim was to determine whether HRQOL among hemodialysis patients has changed over time.
  
  
  METHODS
  We retrospectively analyzed data collected by Dialysis Clinic, Inc. from adult patients starting hemodialysis between January 1, 1997 and May 31, 2006. The primary outcome was HRQOL assessed by Short Form 36, 6 to 18 months after and closest to the 1-year anniversary of starting hemodialysis. Secular trends were analyzed by linear regression for continuous variables and logistic regression for categorical ones. Year of starting dialysis was the predictor. A five-point difference on a 0 to 100 scale was considered clinically significant.
  
  
  RESULTS
  Short Form 36 scores were available for 11,079 patients. Role physical, general health, vitality, social functioning, and physical component summary scores were unchanged among patients over the study period. Statistically significant (P < 0.05) but clinically insignificant changes were observed in physical functioning (-0.2 points/yr), bodily pain (+0.2 points/yr), mental health (+0.15 points/yr), and mental component summary scores (+0.13 points/yr). Only role emotional showed clinically significant improvement. Trends were unchanged after adjusting for age, gender, race, diabetes, hemoglobin, phosphorous, Kt/V, and albumin.
  
  
  CONCLUSIONS
  Most HRQOL domains showed either no statistically significant change or statistically but not clinically significant change over almost a decade. These results suggest that, despite important developments in hemodialysis care since 1997, little progress was made in improving HRQOL of hemodialysis patients.
authors.affiliation: William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts 02111, USA. egabbay@tuftsmedicalcenter.org
authors.forename: Ezra
authors.initials: E
authors.lastname: Gabbay
authors.forename: Klemens B
authors.initials: KB
authors.lastname: Meyer
authors.forename: John L
authors.initials: JL
authors.lastname: Griffith
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Richardson
authors.forename: Dana C
authors.initials: DC
authors.lastname: Miskulin
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D010146:Pain / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D010147:Pain Measurement; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology