FC 112HEALTH-RELATED QUALITY OF LIFE (HRQOL) AND SYMPTOM BURDEN BEFORE AND AFTER START OF DIALYSIS IN OLDER PATIENTS
Authors: De Rooij Esther , Meuleman Yvette , De Fijter Johan W , Jager Kitty J , Chesnaye Nicholas , Evans Marie , Caskey Fergus , Torino Claudia , Szymczak Maciej , Drechsler Christiane , Wanner Christoph , Dekker Friedo W , Hoogeveen Ellen 
Published: May 2021

Abstract

Background and Aims
The number of older (≥65y) people with ESKD starting chronic dialysis increased substantially the past decade because of ageing of the population due to improved health care. In addition, older age is no longer a contraindication for dialysis. Finally, older individuals are more often ineligible for kidney transplantation. Many older people with stage 5 CKD non-dialysis have a low health-related quality of life (HRQOL) and high symptom burden. In this group, improving HRQOL and lowering symptom burden may be deemed more important than solely the prolongation of life. Little is known about the effect of dialysis treatment on HRQOL and symptom burden. Therefore, we investigated the evolution of HRQOL and symptoms before and after the start of dialysis in older ESKD patients.

Method
The European Quality (EQUAL) study is an ongoing European prospective multi-center follow-up study in late stage 4/5 CKD patients aged ≥65 years. For the present analyses, we included all patients who started dialysis. HRQOL was assessed every 3-6 months using the RAND-36 questionnaire, resulting in a physical component summary (PCS) and a mental component summary (MCS) score. Component scores ranged from 0-100 with higher scores indicating a better HRQOL. Kidney disease-related symptom burden was assessed every 3-6 months using the dialysis symptom index (DSI). The sum score for symptom number ranged from 0 to 30 and for symptom severity from 0 to 150, with higher scores indicating a higher symptom burden. We used linear mixed models (LMM) to explore the evolution of mental and physical HRQOL, symptom number and symptom severity during the year preceding and following dialysis initiation.

Results
In total, 571 older dialysis patients were included. At baseline (dialysis initiation), mean (SD) age was 76 (6) years, 74% were men, 47% had diabetes, 9% were current smokers, 34% had cardiovascular disease and the mean (SD) residual kidney function was 8.6 (4.4) ml/min/1.73m2. Mean (SD) MSC was 55 (23), PSC was 43 (21), and the number of symptoms was 15 (7) with a symptom severity of 88 (18). Overall, LMM showed that in the year preceding dialysis MCS decreased by 15.7 (95% CI: 11.9 to 19.5), PCS decreased by 12.0 (8.2 to 15.7), symptom number increased by 3.5 (2.5 to 4.6) and symptom severity increased by 5.3 (1.8 to 8.8). In the year following dialysis, MCS increased by 1.9 (-2.7 to 6.5), PCS decreased by 2.1 (-6.9 to 2.8), symptom number decreased by 0.9 (-0.3 to 2.1) and symptom severity decreased by 7.6 (2.8 to 12.4).

Conclusion
Both mental and physical HRQOL, as well as symptom number and severity, worsened considerably during the year preceding dialysis, but stabilized after dialysis initiation. These results could aid nephrologists in informing older ESKD patients who consider starting dialysis and improve the shared decision making process.