title: Not early referral but planned dialysis improves quality of life and depression in newly diagnosed end stage renal disease patients: a prospective cohort study in Korea.
abstract: BACKGROUND
  Health-related quality of life (HRQOL) has recently become an important issue. It reportedly affects morbidity and mortality in patients with end-stage renal disease (ESRD). In this study, we investigated whether early referral and planned dialysis improve the HRQOL and depression of patients with ESRD.
  
  
  METHODS
  We prospectively enrolled newly diagnosed patients with ESRD, from 31 hospitals in Korea, who completed questionnaires at 3 months after dialysis. We also got follow-up survey at 1 year after dialysis. To measure HRQOL and depression, Kidney Disease Quality of Life Short Form 36 (KDQOL-36) and Beck's Depression Inventory (BDI) were utilized.
  
  
  RESULTS
  A total of 643 patients were analyzed. Referral type did not affect either KDQOL-36 or BDI scores. However, the planned dialysis group showed significantly better scores in 4 of 5 KDQOL-36 domains than did the unplanned group at 3 months after dialysis and partly, the effect was sustained for 1 year after dialysis. The benefit of planned dialysis was significant after adjusting for age, sex, type of dialysis, marital status, educational attainment, occupation, modified Charlson comorbidity index, albumin, and hemoglobin levels. BDI scores were also lower which indicate less depressive mood in planned dialysis group than those in unplanned group both at 3 months and 1 year after dialysis.
  
  
  CONCLUSIONS
  Not early referral but planned dialysis improved both the short- and long-term HRQOL and depression of patients with ESRD. Nephrologists should try to help patients to initiate dialysis in a planned manner.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea.
authors.forename: Ji In
authors.initials: JI
authors.lastname: Park
authors.affiliation: Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea; Department of Dental Hygiene, College of Health Science, Eulji University, Seongnam, Korea.
authors.forename: Myounghee
authors.initials: M
authors.lastname: Kim
authors.affiliation: Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea; Department of Epidemiology and Biostatistics, School of Public Health, Seoul National University, Seoul, Korea.
authors.forename: Ho
authors.initials: H
authors.lastname: Kim
authors.affiliation: Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jung Nam
authors.initials: JN
authors.lastname: An
authors.affiliation: Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea; Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea.
authors.forename: Jeonghwan
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Seung Hee
authors.initials: SH
authors.lastname: Yang
authors.affiliation: Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea; Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Jang-Hee
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea; Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
authors.affiliation: Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea; Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University of Medicine, Jinju, Korea.
authors.forename: Ki-Soo
authors.initials: KS
authors.lastname: Park
authors.affiliation: Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Yun Kyu
authors.initials: YK
authors.lastname: Oh
authors.affiliation: Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Chun Soo
authors.initials: CS
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea.
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea.
authors.forename: Yon Su
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Clinical Research Center of End Stage Renal Disease in Korea, Daegu, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea; N-Bio, Seoul National University, Seoul, Korea.
authors.forename: Jung Pyo
authors.initials: JP
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012017:Referral and Consultation; D006435:Renal Dialysis / Q000523:psychology*; D056910:Republic of Korea; D011795:Surveys and Questionnaires; D013997:Time Factors