J Yeungnam Med Sci.  2023 Jan;40(1):49-57. 10.12701/jyms.2022.00080.

The impact of quality of life measured by WHOQOL-BREF on mortality in maintenance hemodialysis patients: a single center retrospective cross-sectional study

• Kim SG
• Lee IH

• KMID: 2538785
• DOI: http://doi.org/10.12701/jyms.2022.00080

Abstract

Background
Several previous studies have reported that quality of life (QoL) in hemodialysis patients affects mortality. However, the 36-item Short Form Health Survey, which has been used mainly in previous studies, is complicated in terms of questionnaire composition and interpretation. This study aimed to identify the impact of QoL on mortality in hemodialysis patients using an easier and simpler diagnostic tool.
Methods
This retrospective study included 160 hemodialysis patients. QoL was evaluated using the World Health Organization Quality of Life Questionnaire-Brief version (WHOQOL-BREF). Psychosocial factors were evaluated using the Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Montreal Cognitive Assessment, and Pittsburgh Sleep Quality Index. We also evaluated medical factors, such as dialysis adequacy and laboratory results.
Results
The mean hemodialysis vintage was 70.7±38.0 months. The proportion of patients who were elderly was higher in the mortality group than in the surviving group, and the Charlson Comorbidity Index score was also higher in the former group. Of the four domains of the WHOQOL-BREF, the physical health and psychological scores of the mortality group were significantly lower than those of the survival group. When the score in the physical health domain or psychological domain was ≤10, the 10-year mortality rate after hemodialysis initiation increased by approximately 2.3- and 2-fold, respectively.
Conclusion
QoL may have a significant effect on mortality in patients undergoing hemodialysis. The WHOQOL-BREF is an instrument that can measure QoL relatively easily and can be used to improve the long-term prognosis of patients undergoing hemodialysis.

Keyword

Hemodialysis; Mortality; Quality of life; WHOQOL-BREF

Figure

• 

  Fig. 1. Cumulative death rate curves using Cox proportional regression hazard model according to (A) physical health domain and (B) psychological domain of World Health Organization Quality of Life Questionnaire-Brief version adjusted by male sex, age of ≥60 years, Charlson Comorbidity Index of ≥4 points, moderate-to-severe cognitive impairment by Montreal Cognitive Assessment, and serum calcium of <8.7 mg/dL. HD, hemodialysis.

Reference

References

1. Himmelfarb J, Kliger AS. End-stage renal disease measures of quality. Annu Rev Med. 2007; 58:387–99.

2. Bradbury BD, Fissell RB, Albert JM, Anthony MS, Critchlow CW, Pisoni RL, et al. Predictors of early mortality among incident US hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol. 2007; 2:89–99.

3. Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. United States Renal Data System 2011 Annual Data Report: atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis. 2012; 59(1 Suppl 1):A7.

4. Robinson BM, Zhang J, Morgenstern H, Bradbury BD, Ng LJ, McCullough KP, et al. Worldwide, mortality risk is high soon after initiation of hemodialysis. Kidney Int. 2014; 85:158–65.

5. Jin DC. Analysis of mortality risk from Korean hemodialysis registry data 2017. Kidney Res Clin Pract. 2019; 38:169–75.

6. Kimmel PL, Peterson RA. Depression in end-stage renal disease patients treated with hemodialysis: tools, correlates, outcomes, and needs. Semin Dial. 2005; 18:91–7.

7. Perl J, Unruh ML, Chan CT. Sleep disorders in end-stage renal disease: ‘markers of inadequate dialysis’? Kidney Int. 2006; 70:1687–93.

8. Mehrotra R, Kopple JD. Nutritional management of maintenance dialysis patients: why aren’t we doing better? Annu Rev Nutr. 2001; 21:343–79.

9. Toorians AW, Janssen E, Laan E, Gooren LJ, Giltay EJ, Oe PL, et al. Chronic renal failure and sexual functioning: clinical status versus objectively assessed sexual response. Nephrol Dial Transplant. 1997; 12:2654–63.

10. Perl J, Karaboyas A, Morgenstern H, Sen A, Rayner HC, Vanholder RC, et al. Association between changes in quality of life and mortality in hemodialysis patients: results from the DOPPS. Nephrol Dial Transplant. 2017; 32:521–7.

11. Mapes DL, Lopes AA, Satayathum S, McCullough KP, Goodkin DA, Locatelli F, 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; 64:339–49.

12. Lee J, Kim YC, Kwon S, Li L, Oh S, Kim DH, et al. Impact of health-related quality of life on survival after dialysis initiation: a prospective cohort study in Korea. Kidney Res Clin Pract. 2020; 39:426–40.

13. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40:373–83.

14. The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998; 28:551–8.

15. Min SK, Kim KI, Lee CI, Jung YC, Suh SY, Kim DK. Development of the Korean versions of WHO Quality of Life scale and WHOQOL-BREF. Qual Life Res. 2002; 11:593–600.

16. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67:361–70.

17. Oh SM, Min KJ, Park DB. A study on the standardization of the Hospital Anxiety and Depression Scale for Koreans: a comparison of normal, depressed and anxious groups. J Korean Neuropsychiatr Assoc. 1999; 38:289–96.

18. Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess. 1990; 55:610–7.

19. Dahlem NW, Zimet GD, Walker RR. The Multidimensional Scale of Perceived Social Support: a confirmation study. J Clin Psychol. 1991; 47:756–61.

20. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53:695–9.

21. Kang JM, Cho YS, Park S, Lee BH, Sohn BK, Choi CH, et al. Montreal cognitive assessment reflects cognitive reserve. BMC Geriatr. 2018; 18:261.

22. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28:193–213.

23. Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev. 2016; 25:52–73.

24. Daugirdas JT. Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol. 1993; 4:1205–13.

25. Depner TA, Daugirdas JT. Equations for normalized protein catabolic rate based on two-point modeling of hemodialysis urea kinetics. J Am Soc Nephrol. 1996; 7:780–5.

26. Feroze U, Noori N, Kovesdy CP, Molnar MZ, Martin DJ, Reina-Patton A, et al. Quality-of-life and mortality in hemodialysis patients: roles of race and nutritional status. Clin J Am Soc Nephrol. 2011; 6:1100–11.

27. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol. 2001; 12:2797–806.

28. Liebman S, Li NC, Lacson E. Change in quality of life and one-year mortality risk in maintenance dialysis patients. Qual Life Res. 2016; 25:2295–306.

29. Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992; 305:160–4.

30. Skevington SM, Lotfy M, O’Connell KA; WHOQOL Group. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004; 13:299–310.

31. Wang HH, Ho MC, Hung KY, Cheng HT. A single question regarding mobility in the World Health Organization quality of life questionnaire predicts 3-year mortality in patients receiving chronic hemodialysis. Sci Rep. 2017; 7:11981.