title: Health-related quality of life and all-cause mortality in patients with diabetes on dialysis.
abstract: BACKGROUND
  This study tests the hypotheses that health-related quality of life (HRQOL) in prevalent dialysis patients with diabetes is lower than in dialysis patients without diabetes, and is at least as poor as diabetic patients with another severe complication, i.e. foot ulcers. This study also explores the mortality risk associated with diabetes in dialysis patients.
  
  
  METHODS
  HRQOL was assessed using the Short Form-36 Health Survey (SF-36), in a cross-sectional study of 301 prevalent dialysis patients (26% with diabetes), and compared with diabetic patients not on dialysis (n = 221), diabetic patients with foot ulcers (n = 127), and a sample of the general population (n = 5903). Mortality risk was assessed using a Kaplan-Meier plot and Cox proportional hazards analysis.
  
  
  RESULTS
  Self-assessed vitality, general and mental health, and physical function were significantly lower in dialysis patients with diabetes than in those without. Vitality (p = 0.011) and general health (p <0.001) was impaired in diabetic patients receiving dialysis compared to diabetic patients with foot ulcers, but other subscales did not differ. Diabetes was a significant predictor for mortality in dialysis patients, with a hazard ratio (HR) of 1.6 (95% CI 1.0-2.5) after adjustment for age, dialysis vintage and coronary artery disease. Mental aspects of HRQOL were an independent predictor of mortality in diabetic patients receiving dialysis after adjusting for age and dialysis vintage (HR 2.2, 95% CI 1.0-5.0).
  
  
  CONCLUSIONS
  Physical aspects of HRQOL were perceived very low in dialysis patients with diabetes, and lower than in other dialysis patients and diabetic patients without dialysis. Mental aspects predicted mortality in dialysis patients with diabetes. Increased awareness and measures to assist physical function impairment may be particularly important in diabetes patients on dialysis.
authors.affiliation: Department of Nephrology, Oslo University Hospital, Ullevål, N-0484, Oslo, Norway.
authors.forename: Tone Britt Hortemo
authors.initials: TB
authors.lastname: Osthus
authors.forename: Nanna
authors.initials: N
authors.lastname: von der Lippe
authors.forename: Lis
authors.initials: L
authors.lastname: Ribu
authors.forename: Tone
authors.initials: T
authors.lastname: Rustøen
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Leivestad
authors.forename: Toril
authors.initials: T
authors.lastname: Dammen
authors.forename: Ingrid
authors.initials: I
authors.lastname: Os
mesh_terms: D003928:Diabetic Nephropathies / Q000401:mortality* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011788:Quality of Life; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome