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

doi:10.1053/j.ajkd.2014.01.014

American Journal of Kidney Diseases

Volume 64, Issue 1, July 2014, Pages 86-94

https://doi.org/10.1053/j.ajkd.2014.01.014 Get rights and content

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.

Section snippets

Study Population

Data were from phase 4 (2009-2011) of the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective cohort study of a random sample of hemodialysis patients from stratified random samples of hemodialysis facilities in 12 countries: Australia, Belgium, Canada, France, Germany, Japan, Italy, New Zealand, Spain, Sweden, the United Kingdom, and the United States. The DOPPS study design and sampling scheme have been published previously.4, 5

Measurement of Recovery Time and Other Patient Characteristics

Patient demographics, comorbid conditions,

Descriptive Analysis

There were 6,860 patients who returned the questionnaire; 6,513 (95%) answered the recovery time question and 5,427 (79%) answered all relevant SF-36 subscale questions in the KDQOL-36 (allowing MCS and PCS scores to be calculated).

Table 1 lists the distribution of reported recovery times; Fig S1 (provided as online supplementary material) shows distributions by country. Sixty-eight percent of patients reported recovery time of at least 2 hours; 10% reported recovery time longer than 12 hours.

Discussion

After a hemodialysis treatment, many patients describe feeling tired and in need of rest or sleep. In this international population receiving unit-based thrice-weekly hemodialysis, 68% of patients reported taking longer than 2 hours to recover from a dialysis session, and 27%, longer than 6 hours. Reported recovery time was more likely to be longer if patients were older, were female, or had higher BMI, diabetes, or a psychiatric disorder. Patients who had symptoms of kidney failure, such as

Acknowledgements

Jennifer McCready-Maynes, an employee of Arbor Research Collaborative for Health, provided editorial assistance.

Support: The DOPPS is supported by research grants from Amgen (since 1996), Kyowa Hakko Kirin (since 1999, in Japan), Sanofi Renal (since 2009), Abbvie (since 2009), Baxter (since 2011), Vifor Fresenius Renal Pharma (since 2011), and Fresenius Medical Care (since 2012) without restrictions on publications. Dr Tentori is supported in part by National Institute of Diabetes and Digestive

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

Background

Study Design

Setting & Participants

Predictor

Outcomes & Measurements

Results

Limitations

Conclusions

Section snippets

Study Population

Measurement of Recovery Time and Other Patient Characteristics

Descriptive Analysis

Discussion

Acknowledgements

Kidney Int

Kidney Int

Am J Kidney Dis

Kidney Int Suppl

Kidney Int

Kidney Int

Kidney Int

Am J Kidney Dis

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