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American Journal of Kidney Diseases

Recovery Time, Quality of Life, and Mortality in Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

Published:February 19, 2014DOI:https://doi.org/10.1053/j.ajkd.2014.01.014

      Background

      There is limited information about the clinical and prognostic significance of patient-reported recovery time.

      Study Design

      Prospective cohort study.

      Setting & Participants

      6,040 patients in the DOPPS (Dialysis Outcomes and Practice Patterns Study).

      Predictor

      Answer to question “How long does it take you to recover from a dialysis session?” categorized as follows: fewer than 2, 2-6, 7-12, or longer than 12 hours.

      Outcomes & Measurements

      Cross-sectional and longitudinal associations between recovery time and patient characteristics, hemodialysis treatment variables, health-related quality of life (HRQoL), and hospitalization and mortality.

      Results

      32% reported recovery time shorter than 2 hours; 41%, 2-6 hours; 17%, 7-12 hours; and 10%, longer than 12 hours. Using proportional odds (ordinal) logistic regression, shorter recovery time was associated with male sex, full-time employment, and higher serum albumin level. Longer recovery time was associated with older age, dialysis vintage, body mass index, diabetes, and psychiatric disorder. Greater intradialytic weight loss, longer dialysis session length, and lower dialysate sodium concentration were associated with longer recovery time. In facilities that used uniform dialysate sodium concentrations for ≥90% of patients, the adjusted OR of longer recovery time, comparing dialysate sodium concentration < 140 vs 140 mEq/L, was 1.72 (95% CI, 1.37-2.16). Recovery time was correlated positively with symptoms of kidney failure and kidney disease burden score and inversely with HRQoL mental and physical component summary scores. Using Cox regression, adjusting for potential confounders not influenced by recovery time, it was associated positively with first hospitalization and mortality (adjusted HRs for recovery time > 12 vs 2-6 hours 1.22 [95% CI, 1.09-1.37] and 1.47 [95% CI, 1.19-1.83], respectively).

      Limitations

      Answers are subjective and not supported by physiologic measurements.

      Conclusions

      Recovery time can be used to identify patients with poorer HRQoL and higher risks of hospitalization and mortality. Interventions to reduce recovery time and possibly improve clinical outcomes, such as increasing dialysate sodium concentration, need to be tested in randomized trials.

      Index Words

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      References

        • Fukuhara S.
        • Lopes A.A.
        • Bragg-Gresham J.L.
        • et al.
        • Worldwide Dialysis Outcomes and Practice Patterns Study
        Health-related quality of life among dialysis patients on three continents: the Dialysis Outcomes and Practice Patterns Study.
        Kidney Int. 2003; 64: 1903-1910
        • Mapes D.L.
        • Lopes A.A.
        • Satayathum S.
        • et al.
        Health-related quality of life as a predictor of mortality and hospitalization: the Dialysis Outcomes and Practice Patterns Study (DOPPS).
        Kidney Int. 2003; 64: 339-349
        • Lindsay R.M.
        • Heidenheim P.A.
        • Nesrallah G.
        • Garg A.X.
        • Suri R.
        Minutes to recovery after a hemodialysis session: a simple health-related quality of life question that is reliable, valid, and sensitive to change.
        Clin J Am Soc Nephrol. 2006; 1: 952-959
        • Pisoni R.L.
        • Gillespie B.W.
        • Dickinson D.M.
        • Chen K.
        • Kutner M.H.
        • Wolfe R.A.
        The Dialysis Outcomes and Practice Patterns Study (DOPPS): design, data elements, and methodology.
        Am J Kidney Dis. 2004; 44: 7-15
        • Young E.W.
        • Goodkin D.A.
        • Mapes D.L.
        • et al.
        The Dialysis Outcomes and Practice Patterns Study (DOPPS): an international hemodialysis study.
        Kidney Int Suppl. 2000; 57: S74-S81
        • Robinson B.M.
        • Port F.K.
        Caring for dialysis patients: international insights from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Identifying best practices and outcomes in the DOPPS.
        Semin Dial. 2010; 23: 4-6
        • Ware J.E.
        • Kosinski M.
        • Keller S.D.
        SF-36 Physical and Mental Health Summary Scales: A User's Manual.
        New England Medical Center-The Health Institute, Boston, MA1994
        • Topolski T.D.
        • LoGerfo J.
        • Patrick D.L.
        • Williams B.
        • Walwick J.
        • Patrick M.B.
        The Rapid Assessment of Physical Activity (RAPA) among older adults [abstract].
        Prev Chronic Dis. 2006; 3: A118
      1. SAS/STAT User's Guide Version 8. SAS Institute, Cary, NC2000
        • Pisoni R.L.
        • Wikstrom B.
        • Elder S.J.
        • et al.
        Pruritus in hemodialysis patients: international results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).
        Nephrol Dial Transplant. 2006; 21: 3495-3505
        • Elder S.J.
        • Pisoni R.L.
        • Akizawa T.
        • et al.
        Sleep quality predicts quality of life and mortality risk in hemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).
        Nephrol Dial Transplant. 2008; 23: 998-1004
        • Lopes A.A.
        • Albert J.M.
        • Young E.W.
        • et al.
        Screening for depression in hemodialysis patients: associations with diagnosis, treatment, and outcomes in the DOPPS.
        Kidney Int. 2004; 66: 2047-2053
        • Lopes A.A.
        • Bragg J.
        • Young E.
        • et al.
        Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe.
        Kidney Int. 2002; 62: 199-207
        • Hecking M.
        • Karaboyas A.
        • Saran R.
        • et al.
        Dialysate sodium concentration and the association with interdialytic weight gain, hospitalization, and mortality.
        Clin J Am Soc Nephrol. 2012; 7: 92-100
        • Port F.K.
        • Johnson W.J.
        • Klass D.W.
        Prevention of dialysis disequilibrium syndrome by use of high sodium concentration in the dialysate.
        Kidney Int. 1973; 3: 327-333
        • Jaber B.L.
        • Lee Y.
        • Collins A.J.
        • et al.
        Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study.
        Am J Kidney Dis. 2010; 56: 531-539
        • Brown E.A.
        • Johansson L.
        • Farrington K.
        • et al.
        Broadening Options for Long-term Dialysis for the Elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients.
        Nephrol Dial Transplant. 2010; 25: 3755-3763