title: Recovery time, quality of life, and mortality in hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS).
abstract: BACKGROUND
  There is limited information about the clinical and prognostic significance of patient-reported recovery time.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  6,040 patients in the DOPPS (Dialysis Outcomes and Practice Patterns Study).
  
  
  METHODS
  Answer to question "How long does it take you to recover from a dialysis session?" categorized as follows: fewer than 2, 2-6, 7-12, or longer than 12 hours.
  
  
  METHODS
  Cross-sectional and longitudinal associations between recovery time and patient characteristics, hemodialysis treatment variables, health-related quality of life (HRQoL), and hospitalization and mortality.
  
  
  RESULTS
  32% reported recovery time shorter than 2 hours; 41%, 2-6 hours; 17%, 7-12 hours; and 10%, longer than 12 hours. Using proportional odds (ordinal) logistic regression, shorter recovery time was associated with male sex, full-time employment, and higher serum albumin level. Longer recovery time was associated with older age, dialysis vintage, body mass index, diabetes, and psychiatric disorder. Greater intradialytic weight loss, longer dialysis session length, and lower dialysate sodium concentration were associated with longer recovery time. In facilities that used uniform dialysate sodium concentrations for ≥90% of patients, the adjusted OR of longer recovery time, comparing dialysate sodium concentration<140 vs 140 mEq/L, was 1.72 (95% CI, 1.37-2.16). Recovery time was correlated positively with symptoms of kidney failure and kidney disease burden score and inversely with HRQoL mental and physical component summary scores. Using Cox regression, adjusting for potential confounders not influenced by recovery time, it was associated positively with first hospitalization and mortality (adjusted HRs for recovery time>12 vs 2-6 hours 1.22 [95% CI, 1.09-1.37] and 1.47 [95% CI, 1.19-1.83], respectively).
  
  
  CONCLUSIONS
  Answers are subjective and not supported by physiologic measurements.
  
  
  CONCLUSIONS
  Recovery time can be used to identify patients with poorer HRQoL and higher risks of hospitalization and mortality. Interventions to reduce recovery time and possibly improve clinical outcomes, such as increasing dialysate sodium concentration, need to be tested in randomized trials.
authors: Heart of England NHS Foundation Trust, Birmingham, United Kingdom. Electronic address: hughrayner@gmail.com.
authors: Hugh C
authors: HC
authors: Rayner
authors: Arbor Research Collaborative for Health, Ann Arbor, MI.
authors: Lindsay
authors: L
authors: Zepel
authors: Arbor Research Collaborative for Health, Ann Arbor, MI.
authors: Douglas S
authors: DS
authors: Fuller
authors: Arbor Research Collaborative for Health, Ann Arbor, MI; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI.
authors: Hal
authors: H
authors: Morgenstern
authors: Arbor Research Collaborative for Health, Ann Arbor, MI.
authors: Angelo
authors: A
authors: Karaboyas
authors: Baxter Healthcare Corporation, McGaw Park, IL.
authors: Bruce F
authors: BF
authors: Culleton
authors: Arbor Research Collaborative for Health, Ann Arbor, MI.
authors: Donna L
authors: DL
authors: Mapes
authors: Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Salvador, BA, Brazil.
authors: Antonio A
authors: AA
authors: Lopes
authors: University of Michigan, Ann Arbor, MI.
authors: Brenda W
authors: BW
authors: Gillespie
authors: Fujigaoka Hospital, Fujigaoka, Japan.
authors: Takeshi
authors: T
authors: Hasegawa
authors: University of Michigan, Ann Arbor, MI.
authors: Rajiv
authors: R
authors: Saran
authors: Arbor Research Collaborative for Health, Ann Arbor, MI; Vanderbilt University Medical Center, Nashville, TN.
authors: Francesca
authors: F
authors: Tentori
authors: Medical University of Vienna, Vienna, Austria.
authors: Manfred
authors: M
authors: Hecking
authors: Arbor Research Collaborative for Health, Ann Arbor, MI.
authors: Ronald L
authors: RL
authors: Pisoni
authors: Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI.
authors: Bruce M
authors: BM
authors: Robinson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000523:psychology / Q000628:therapy*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D020127:Recovery of Function; D006435:Renal Dialysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: DOPPS (Dialysis Outcomes and Practice Patterns Study); Hemodialysis; patient-reported outcomes; quality of life