title: Understanding What Influences the Health-Related Quality of Life of Hemodialysis Patients: A Collaborative Study in England and Ireland.
abstract: BACKGROUND
  The international cohort of hemodialysis patients is aging and increasing in number. Nephrologists have a therapeutic relationship with their patients that may span decades. Often overlooked components of chronic disease management include symptom control and assessment of health-related quality of life (HRQoL).
  
  
  OBJECTIVE
  This study describes the symptom profile of a large cohort of patients with end-stage renal disease on hemodialysis in England and Ireland and evaluates how symptom burden and other factors influence quality-of-life scores.
  
  
  METHODS
  A prospective cross-sectional observational study of hemodialysis patients was conducted in Ireland and England during 2011 and 2012. Two validated clinical tools were used to determine HRQoL and symptom burden. Demographic and clinical data were examined, and regression analysis was used to determine associations with HRQoL scores.
  
  
  RESULTS
  A total of 893 patients on hemodialysis (mean [SD] age 64 [16] years) had a high symptom burden and poor HRQoL compared with population norms. Specifically, 64% of patients reported pain (95% confidence interval 61%-67%) and 79% reported weakness (95% confidence interval 75%-81%). A total of 43 percent of patients reported between six and 10 symptoms in the week preceding the survey. HRQoL was significantly and independently associated with poor mobility and pain and remained significant after adjusting for variations in clinical characteristics. Being listed on a transplant wait-list register was positively associated with HRQoL.
  
  
  CONCLUSIONS
  These findings illustrate the high symptom burden and poor HRQoL of the hemodialysis population. Emphasis during clinical reviews on pain assessment and on assessing mobility plus interventions, such as pain management and physiotherapy/occupational therapy, are practical ways for renal teams to help improve patients' quality of life.
authors: Department of Palliative Medicine, Marymount University Hospital & Hospice, Cork, Ireland; Department of Palliative Medicine, Cork University Hospital, Cork, Ireland. Electronic address: aoifelowney@gmail.com.
authors: Aoife C
authors: AC
authors: Lowney
authors: Department of Palliative Medicine, Beaumont Hospital, Dublin, Ireland.
authors: Helena T
authors: HT
authors: Myles
authors: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom.
authors: Katherine
authors: K
authors: Bristowe
authors: College of Medicine and Health at University College Cork, Cork, Ireland.
authors: Eanna L
authors: EL
authors: Lowney
authors: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom.
authors: Katie
authors: K
authors: Shepherd
authors: Department of Palliative Medicine, Marymount University Hospital & Hospice, Cork, Ireland.
authors: Marie
authors: M
authors: Murphy
authors: Department of Palliative Medicine, Marymount University Hospital & Hospice, Cork, Ireland; Department of Palliative Medicine, Cork University Hospital, Cork, Ireland; College of Medicine and Health at University College Cork, Cork, Ireland.
authors: Tony
authors: T
authors: O'Brien
authors: Department of Renal Medicine, Limerick University Hospital, Limerick, Ireland.
authors: Liam
authors: L
authors: Casserly
authors: Department of Palliative Medicine, St Francis Hospice, Raheny, Dublin, Ireland.
authors: Regina
authors: R
authors: McQuillan
authors: College of Medicine and Health at University College Cork, Cork, Ireland; Department of Renal Medicine, Cork University Hospital, Cork, Ireland.
authors: William D
authors: WD
authors: Plant
authors: Department of Renal Medicine, Beaumont Hospital Dublin, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
authors: Peter J
authors: PJ
authors: Conlon
authors: Department of Renal Medicine, Kings College Hospital NHS Foundation Trust, London, United Kingdom.
authors: Catherine
authors: C
authors: Vinen
authors: College of Medicine and Health at University College Cork, Cork, Ireland; Department of Renal Medicine, Cork University Hospital, Cork, Ireland; HRB Clinical Research Facility at University College Cork, Cork, Ireland.
authors: Joseph A
authors: JA
authors: Eustace
authors: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom.
authors: Fliss E M
authors: FE
authors: Murtagh
mesh_terms: D000368:Aged; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000401:mortality / Q000503:physiopathology / Q000523:psychology; D010166:Palliative Care / Q000523:psychology; D011581:Psychological Tests; D011788:Quality of Life; D012044:Regression Analysis; D006435:Renal Dialysis / Q000523:psychology*; D012720:Severity of Illness Index
keywords: End-stage renal disease; health-related quality of life; hemodialysis; palliative care; symptom burden