Patients with kidney disease who changed from home dialysis to in-center care showed lower quality of life scores for physical function over time, according to a recently published study.
“Among a national cohort of chronic dialysis patients, there was a trend towards different patterns of HrQoL (health-related quality of life) that were only observed among patients who changed modality,” wrote Nwamaka D. Eneanya, MD, of the renal and electrolyte division of the Perelman School of Medicine at the University of Pennsylvania, along with colleagues from Maastricht University Medical Center in Maastricht, Netherlands, and Fresenius Medical Care North America (FMCNA), which supplied the data for the study. “Patients who switched from home to in-center modalities had significant lower physical functioning over time. Providers and patients should be mindful of HrQoL changes that may occur with dialysis modality change.”
Researchers used data from adult patients who received dialysis treatment in an FMCNA clinic or at home between Jan. 1, 2013 and June 30, 2015. Patients qualified for the study if they had their first outpatient dialysis session within 120 days of dialysis initiation at FMCNA and also completed two Kidney Disease and Quality of Life (KDQOL-36) surveys within 485 days. Patients were categorized as using a home dialysis modality (825 patients on PD) and home hemodialysis (HHD; 61 patients). Most patients were on in-center hemodialysis (n=19,129) based on their first modality recorded in the FMCNA database. A change in modality was defined by those patients who went to in-center care or home dialysis within the first 120 days of dialysis initiation, and between 365 and 485 days after dialysis initiation.
Of 5,114 patients in the study group, 4,179 remained on in-center dialysis and 814 remained on home modalities. Fifty-five patients switched from in-center to a home modality and 66 switched from a home modality to in-center dialysis.
“Patients who changed from home modalities to in-center dialysis were more often of Black race, had lower annual household income and were unmarried as compared to in-center patients who changed to home or those who remained on the same modality,” the researchers wrote. “Additionally, patients who switched from home modalities to in-center dialysis tended to have a higher number of comorbidities, lower albumin, higher systolic blood pressure and higher body mass index as compared to in-center patients who changed to home or those who remained on the same modality.”
When patients switched to a different modality, researchers tracked their quality of life scores, which did not change long term for patients who remained on in-center dialysis or home modalities.
“However, patients who switched from in-center dialysis to home modalities had a large increase in the mean [burden of kidney disease] BKD score ... In comparison, patients who switched from a home modality to in-center dialysis had decreases in the mean [physical composite summary score] PCS,” the authors wrote.
KDQOL subscale scores for in-center patients on dialysis did have lower mean HrQoL scores compared to patients on a home modality at baseline, the authors acknowledged. They added: “Patients who transition from home modalities to in-center dialysis may do so because of ultrafiltration failure, infection, or access-related problems which could ultimately contribute to progressive physical limitations after loss of residual renal function. Indeed, we noted that patients who switched from home to in-center dialysis in this study appeared to be sicker given a higher number of comorbidities and lower mean albumin compared to the other groups of patients.
“Given these stipulations, providers should clearly delineate the potential positive and negative health status changes that could potentially occur as patients switch dialysis modalities,” the authors wrote. “Engaging in shared dialysis decision-making where the specifics of each dialysis modality are reviewed can help patient reconcile their unique strengths and weaknesses with treatment objectives.” – by Mark Neumann
Disclosures: Eneanya reports no relevant disclosures. Please see the study for all other authors’ relevant financial disclosures.