title: Association of social support with outcomes in incident dialysis patients.
abstract: OBJECTIVE
  The association of social support with outcomes in ESRD, overall and by peritoneal dialysis (PD) versus hemodialysis (HD), remains understudied.
  
  
  METHODS
  In an incident cohort of 949 dialysis patients from 77 US clinics, we examined functional social support scores (scaled 0 to 100 and categorized by tertile) both overall and in emotional, tangible, affectionate, and social interaction subdomains. Outcomes included 1-year patient satisfaction and quality of life (QOL), dialysis modality switching, and hospitalizations and mortality (through December 2004). Associations were examined using overall and modality-stratified multivariable logistic, Poisson, and Cox proportional hazards models.
  
  
  RESULTS
  We found that mean social support scores in this population were higher in PD versus HD patients (overall 80.5 versus 76.1; P < 0.01). After adjustment, highest versus lowest overall support predicted greater 1-year satisfaction and QOL in all patients (odds ratio 2.47 [95% confidence interval (CI) 1.18 to 5.15] and 2.06 [95% CI 1.31 to 3.22] for recommendation of center and higher mental component summary score, respectively). In addition, patients were less likely to be hospitalized (incidence rate ratio 0.86; 95% CI 0.77 to 0.98). Results were similar with subdomain scores. Modality switching and mortality did not differ by social support in these patients, and associations of social support with outcomes did not generally differ by dialysis modality.
  
  
  CONCLUSIONS
  Social support is important for both HD and PD patients in terms of greater satisfaction and QOL and fewer hospitalizations. Intervention studies to possibly improve these outcomes are warranted.
authors.affiliation: Department of Medicine, San Francisco General Hospital and University of California, San Francisco, California 94110, USA. plantingal@medsfgh.ucsf.edu
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Fink
authors.forename: Rachel
authors.initials: R
authors.lastname: Harrington-Levey
authors.forename: Frederic O
authors.initials: FO
authors.lastname: Finkelstein
authors.forename: Nasser
authors.initials: N
authors.lastname: Hebah
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
mesh_terms: D000554:Ambulatory Care Facilities; D016009:Chi-Square Distribution; D004644:Emotions; D006760:Hospitalization; D006801:Humans; D007398:Interpersonal Relations; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D016015:Logistic Models; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D010530:Peritoneal Dialysis / Q000523:psychology*; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology*; D012944:Social Support; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States