title: Health related quality of life in patients in dialysis after renal graft loss and effect of gender.
abstract: BACKGROUND
  An increasing number of dialysis patients have returned to dialysis after renal graft loss, and the transition in disease state could likely be associated with reduced health related quality of life (HRQOL). Furthermore, gender differences in HRQOL have been observed in dialysis and kidney transplanted patients, but whether transition in disease state affects HRQOL differently in respect to gender is not known. The aims of this study were to compare HRQOL in dialysis patients with graft loss to transplant naïve dialysis patients, and to explore possible gender differences.
  
  
  METHODS
  In a cross-sectional study, HRQOL was measured in 301 prevalent dialysis patients using the Kidney Disease and Quality of Life Short Form version 1.3. Adjusted comparisons were made between dialysis patients with previous graft loss and the transplant naïve patients. Multiple linear regression analyses were performed with HRQOL as outcome variables. Interaction analyses using product terms were performed between gender and graft loss. HRQOL was analysed separately in both genders.
  
  
  RESULTS
  Patients with renal graft loss (n = 50) did not experience lower HRQOL than transplant naïve patients after multiple adjustments. Among patients with graft loss, women (n = 23) reported lower HRQOL than men (n = 27) in the items physical function (40 vs. 80, p = 0.006), and effect of kidney disease (49 vs. 67, p = 0.017). Women with graft loss reported impaired kidney-specific HRQOL compared to transplant naïve women (n = 79) in the items effect of kidney disease (50 vs. 72, p = 0.002) and cognitive function (80 vs. 93, p = 0.006), and this observation persisted after multiple adjustments. Such differences were not apparent in the male counterparts.
  
  
  CONCLUSIONS
  Patients who resumed dialysis after renal graft loss did not have lower HRQOL than dialysis patients not previously transplanted. However, losing graft function was associated with reduced HRQOL in females, and important interactions were identified between graft loss and gender. This needs to be further explored in prospective studies.
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway. n.v.d.lippe@medisin.uio.no.
authors.forename: Nanna
authors.initials: N
authors.lastname: von der Lippe
authors.forename: Bård
authors.initials: B
authors.lastname: Waldum
authors.forename: Tone-Brit Hortemo
authors.initials: TB
authors.lastname: Østhus
authors.forename: Anna Varberg
authors.initials: AV
authors.lastname: Reisæter
authors.forename: Ingrid
authors.initials: I
authors.lastname: Os
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003071:Cognition; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000150:complications; D011788:Quality of Life; D006435:Renal Dialysis; D012737:Sex Factors; D011795:Surveys and Questionnaires; D017211:Treatment Failure