Skip to main content

Advertisement

Log in

Relation between level or change of hemoglobin and generic and disease-specific quality of life measures in hemodialysis

  • Original Paper
  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Objective

We sought to examine the relation between meeting or exceeding the current minimum guideline for hemoglobin (11 g/dl) in dialysis patients and generic and disease-specific QOL scores at 1 year.

Methods

In 438 incident hemodialysis patients from a national prospective cohort study, we used regression models to predict QOL score (all scaled 0–100) at 1 year using 6-month values of hemoglobin, adjusting for potential confounders.

Results

Compared to values <11 g/dl, hemoglobin ≥11 g/dl at 6 months was associated with higher scores for the general domains of physical functioning, role physical, mental health, social functioning, and bodily pain at 1 year; cognitive function, diet restriction, and dialysis access dialysis-specific domain scores were also higher for these patients. Each 1 g/dl greater hemoglobin was also statistically significantly associated with higher QOL scores for most domains. In longitudinal analyses, most of the domains showed that, with each 1 g/dl increase in hemoglobin concentration from baseline to 6 months, QOL score increased significantly over the first year.

Conclusions

Hemodialysis patients who attain higher hemoglobin concentration at 6 months, especially ≥11 g/dl, have better QOL at 1 year, with regard to important physical, mental, social, and cognitive domains.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

QOL:

Quality of life

KDOQI:

Kidney Disease Outcomes Quality Initiative

CHOICE:

Choices for Healthy Outcomes in Caring for End-Stage Renal Disease

CHEQ:

CHOICE Health Experience Questionnaire

PCS:

Physical component summary

MCS:

Mental component summary

BMI:

Body mass index

ICED:

Index of Coexistent Disease

USRDS:

United States Renal Data System

CMS:

Centers for Medicare & Medicaid Services.

References

  1. Astor, B. C., Eustace, J. A., Powe, N. R., Klag, M. J., Sadler, J. H., Fink, N. E., & Coresh, J. (2001). Timing of nephrologist referral and arteriovenous access use: the CHOICE Study. American Journal of Kidney Diseases, 38, 494–501.

    PubMed  CAS  Google Scholar 

  2. Athienites, N. V., Miskulin, D. C., Fernandez, G., Bunnapradist, S., Simon, G., Landa, M., Schmid, C. H., Greenfield, S., Levey, A. S., & Meyer, K. B. (2000). Comorbidity assessment in hemodialysis and peritoneal dialysis using the index of coexistent disease. Seminars in Dialysis, 13, 320–326.

    Article  PubMed  CAS  Google Scholar 

  3. Baiardi, F., Degli, E. E., Cocchi, R., Fabbri, A., Sturani, A., Valpiani, G., & Fusarol, M. (2002). Effects of clinical and individual variables on quality of life in chronic renal failure patients. Journal of Nephrology, 15, 61–67.

    PubMed  Google Scholar 

  4. Berns, J. S. (2005). Should the target hemoglobin for patients with chronic kidney disease treated with erythropoietic replacement therapy be changed? Seminars in Dialysis, 18, 22–29.

    Article  PubMed  Google Scholar 

  5. Besarab, A., Bolton, W. K., Browne, J. K., Egrie, J. C., Nissenson, A. R., Okamoto, D. M., Schwab, S. J., & Goodkin, D. A. (1998). The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. New England Journal of Medicine, 339, 584–590.

    Article  PubMed  CAS  Google Scholar 

  6. Breiterman-White, R. (2005). Functional ability of patients on dialysis: the critical role of anemia. Nephrology Nursing Journal 32, 79–82.

    PubMed  Google Scholar 

  7. Centers for Medicare & Medicaid Services (2005) Centers for Medicare & Medicaid Services Claims Monitoring Policy: Erythropoietin/darbepoietin alfa Usage for Beneficiaries with End Stage Renal Disease.

  8. Collins, A. J., Ma, J. Z., Xia, A., & Ebben, J. (1998). Trends in anemia treatment with erythropoietin usage and patient outcomes. American Journal of Kidney Diseases, 32, S133–S141.

    PubMed  CAS  Google Scholar 

  9. Daugirdas, J. T. (1993). Second-generation logarithmic estimates of single-pool variable volume of Kt/V: an analysis of error. Journal of the American Society of Nephrology, 4, 1204–1213.

    Google Scholar 

  10. Eschbach, J. W. (1993). Erythropoietin is not a cause of access thrombosis. Seminars in Dialysis, 6, 180–184.

    Google Scholar 

  11. Evans, R. W., Rader, B., & Manninen D. L. (1990). The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. Cooperative Multicenter EPO Clinical Trial Group. The Journal of the American Medical Association, 263, 825–830.

    Article  CAS  Google Scholar 

  12. Foley, R. N., Parfrey, P. S., Harnett, J. D., Kent, G. M., Murray, D. C., & Barre, P. E. (1996). The impact of anemia on cardiomyopathy, morbidity, and mortality in end-stage renal disease. American Journal of Kidney Diseases, 28, 53–61.

    PubMed  CAS  Google Scholar 

  13. Furuland, H., Linde, T., Ahlmen, J., Christensson, A., Strombom, U., & Danielson, B. G. (2003). A randomized controlled trial of haemoglobin normalization with epoetin alfa in pre-dialysis and dialysis patients. Nephrology, Dialysis, Transplantion, 18, 353–361.

    Article  CAS  Google Scholar 

  14. Greenfield, S., Apolone, G., McNeil, B. J., & Cleary, P. D. (1993). The importance of coexistent disease in the occurrence of postoperative complications and one-year recovery in patients undergoing total hip replacement. Comorbidity and outcomes after hip replacement. Medical Care, 31, 141–154.

    Article  PubMed  CAS  Google Scholar 

  15. Gregory, N. (2005). Quality of life in patients on dialysis: benefits of maintaining a hemoglobin of 11 to 12 g/dL. Nephrology Nursing Journal, 32, 307–310.

    PubMed  Google Scholar 

  16. Hays, R. D., Farivar, S. S., & Liu, H. (2005). Approaches and recommendations for estimating minimally important differences for health-related quality of life measures. COPD:. J ournal of Chronic Obstructive Pulmonary Disease, 2, 63–67.

    Google Scholar 

  17. Hudis, C. A., Vogel, C. L., Gralow, J. R., & Williams, D. (2005). Weekly epoetin alfa during adjuvant chemotherapy for breast cancer: effect on hemoglobin levels and quality of life. Clinical Breast Cancer, 6, 132–142.

    Article  PubMed  CAS  Google Scholar 

  18. Kalantar-Zadeh, K., Kopple, J. D., Block, G., & Humphreys, M. H. (2001). Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. Journal of the American Society of Nephrology, 12, 2797–2806.

    PubMed  CAS  Google Scholar 

  19. Lawrence, I. G., Price, D. E., Howlett, T. A., Harris, K. P., Feehally, J., & Walls, J. (1997). Erythropoietin and sexual dysfunction. Nephrology, Dialysis, Transplantion, 12, 741–747.

    Article  CAS  Google Scholar 

  20. Lim, V. S. (1987). Reproductive function in patients with renal insufficiency. American Journal of Kidney Diseases, 9:363–367.

    PubMed  CAS  Google Scholar 

  21. Lin, D. Y., & Wei, L. J. (1989). The robust inference for the Cox proportional hazards model. Journal of the American Statistical Association, 84, 1074–1078.

    Article  Google Scholar 

  22. Localio, A. R., Berlin, J. A., Ten, Have, T. R., & Kimmel, S. E. (2001). Adjustments for center in multicenter studies: an overview. Annals of International Medicine, 135, 112–123.

    CAS  Google Scholar 

  23. Ma, J. Z., Ebben, J., Xia, H., & Collins, A. J. (1999). Hematocrit level and associated mortality in hemodialysis patients. Journal of the American Society of Nephrology, 10, 610–619.

    PubMed  CAS  Google Scholar 

  24. Mapes, D. L., Lopes, A. A., Satayathum, S, McCullough, K. P., Goodkin, D. A., Locatelli, F., Fukuhara, S., Young, E. W., Kurokawa, K., Saito, A., Bommer, J., Wolfe, R. A., Held, P. J., & Port, F. K. (2003). Health-related quality of life as a predictor of mortality and hospitalization: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney International, 64, 339–349.

    Article  PubMed  Google Scholar 

  25. Miskulin, D. C., Meyer, K. B., Athienites, N. V., Martin, A. A., Terrin, N., Marsh, J. V., Fink, N. E., Coresh, J., Powe, N. R., Klag, M. J., & Levey, A. S. (2000). Comorbidity and other factors associated with modality selection in incident dialysis patients: the CHOICE Study. Choices for Healthy Outcomes in Caring for End-Stage Renal Disease. American Journal of Kidney Diseases, 39, 324–336.

    Google Scholar 

  26. Miskulin, D. C., Athienites, N. V., Yan, G., Martin, A. A., Ornt, D. B., Kusek, J. W., Meyer, K. B., & Levey, A. S. (2001). Comorbidity assessment using the Index of Coexistent Diseases in a multi-center clinical trial. Kidney International, 60, 1498–1510.

    Article  PubMed  CAS  Google Scholar 

  27. Moreno, F., Sanz-Guajardo, D., Lopez-Gomez, J. M., Jofre, R., & Valderrabano, F. (2000). Increasing the hematocrit has a beneficial effect on quality of life and is safe in selected hemodialysis patients. Spanish Cooperative Renal Patients Quality of Life Study Group of the Spanish Society of Nephrology. Journal of the American Society of Nephrology, 11, 335–342.

    PubMed  CAS  Google Scholar 

  28. Muirhead, N. (1993). Erythropoietin is a cause of access thrombosis. Seminars in Dialysis, 6, 184–188.

    Google Scholar 

  29. National Kidney Foundation (2005). Kidney Disease Outcomes Quality Initiative (KDOQI). Clinical Practice Guidelines. Available at: http://www.kidney.org/professionals/kdoqi/guidelines.cfm. 2005. New York, NY, National Kidney Foundation.

  30. Parfrey, P. S., Foley, R. N., Wittreich, B. H., Sullivan, D. J., Zagari, M. J., & Frei, D. (2005). Double- blind comparison of full and partial anemia correction in incident hemodialysis patients without symptomatic heart disease. Journal of the American Society of Nephrology, 16(7), 2180–2189.

    Article  PubMed  Google Scholar 

  31. Perlman, R. L., Finkelstein, F. O., Liu, L., Roys, E., Kiser, M., Eisele, G., Burrows-Hudson, S., Messana, J. M., Levin, N., Rajagopalan, S., Port, F. K., Wolfe, R. A., & Saran, R. (2005). Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study. American Journal of Kidney Diseases, 45, 658–666.

    Article  PubMed  Google Scholar 

  32. Powe, N. R., Klag, M. J., Sadler, J. H., Anderson, G. F., Bass, E. B., Briggs, W. A., Fink, N. E., Levey, A. S., Levin, N. W., Meyer, K. B., Rubin, H. R., & Wu, A. W. (1996). Choices for healthy outcomes in caring for end stage renal disease. Seminars in Dialysis, 9, 9–11.

    Google Scholar 

  33. Schatell, D., & Witten, B. (2004). Anemia: dialysis patients experiences. Nephrology News & Issues, 18, 49–54.

    Google Scholar 

  34. Semba, R. D., Martin, B. K., Kempen, J. H., Thorne, J. E., & Wu, A. W. (2005). The impact of anemia on energy and physical functioning in individuals with AIDS. Archives of Internal Medicine 165, 2229–2236.

    Article  PubMed  Google Scholar 

  35. Stivelman, J. C. (2000). Benefits of anaemia treatment on cognitive function. Nephrology, Dialysis, Transplantation, 15(Suppl 3), 29–35.

    PubMed  Google Scholar 

  36. Taft, C., Karlsson, J., & Sullivan, M. (2001). Do SF-36 summary component scores accurately summarize subscale scores? Quality of Life Research, 10, 395–404.

    Article  PubMed  CAS  Google Scholar 

  37. Taji, Y., Morimoto, T., Okada, K., Fukuhara, S., Fukui, T., & Kuwahara, T. (2004). Effects of intravenous ascorbic acid on erythropoiesis and quality of life in unselected hemodialysis patients. Journal of Nephrology, 17, 537–543.

    PubMed  CAS  Google Scholar 

  38. Tonelli, M., Winkelmayer, W. C., Jindal, K. K., Owen, W. F., & Manns, B. J. (2003). The cost-effectiveness of maintaining higher hemoglobin targets with erythropoietin in hemodialysis patients. Kidney International, 64, 295–304.

    Article  PubMed  CAS  Google Scholar 

  39. Valderrabano, F. (2000). Quality of life benefits of early anaemia treatment. Nephrology, Dialysis, Transplantation, 15(Suppl 3), 23–28.

    PubMed  Google Scholar 

  40. Valderrabano, F., Jofre, R., & Lopez-Gomez, J. M. (2001). Quality of life in end-stage renal disease patients. American Journal of Kidney Disease, 38, 443–464.

    CAS  Google Scholar 

  41. Vazquez, I., Valderrabano, F., Jofre, R., Fort, J., Lopez-Gomez, J. M., Moreno, F, & Sanz-Guajardo, D. (2003). Psychosocial factors and quality of life in young hemodialysis patients with low comorbidity. Journal of Nephrology, 16, 886–894.

    PubMed  Google Scholar 

  42. Ware, J. E. Jr (1993). SF-36 Health Survey: Manual & Interpretation Guide. Boston, MA: The New England Medical Center Health Institute.

    Google Scholar 

  43. Wei, L. J., Lin, D. Y., & Weissfeld, L. (1989). Regression analysis of multivariate incomplete failure time data by modeling marginal distributions. Journal of the American Statistical Association, 84, 1065–1073.

    Article  Google Scholar 

  44. Wu, A. W., Fink, N. E., Cagney, K. A., Bass, E. B., Rubin, H. R., Meyer, K. B., Sadler, J. H., & Powe, N. R. (2001). Developing a health-related quality-of-life measure for end-stage renal disease: The CHOICE Health Experience Questionnaire. American Journal of Kidney Diseases, 37, 11–21.

    PubMed  CAS  Google Scholar 

  45. Xia, H., Ebben, J., Ma, J. Z., & Collins, A. J. (1999). Hematocrit levels and hospitalization risks in hemodialysis patients. Journal of the American Society of Nephrology, 10, 1309–1316.

    PubMed  CAS  Google Scholar 

  46. Yang, S. C., Kuo, P. W., Wang, J. D., Lin, M. I., & Su, S. (2005). Quality of life and its determinants of hemodialysis patients in Taiwan measured with WHOQOL-BREF(TW). American Journal of Kidney Disorders, 46, 635–641.

    Article  Google Scholar 

Download references

Acknowledgments

We thank the patients, staff, and medical directors of the participating clinics at DCI and St. Raphael’s Hospital who contributed to the study. This study was presented in part at the 2005 American Society of Nephrology Annual Meeting in Philadelphia, Pennsylvania. Some of the data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. government. This work was supported by grant no. RO1 DK 59616 from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, grant no. R01-HS-08365 from the Agency for Health Care Research and Quality, Rockville, Maryland and grant no. R01 HL 62985 from the National Heart Lung and Blood Institute, Bethesda, MD. Dr. Powe is supported by grant K24DK02643 from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. Dr. Jaar is supported by a Clinician Scientist Award from the Johns Hopkins School of Medicine.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Laura C. Plantinga.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Plantinga, L., Fink, N., Jaar, B. et al. Relation between level or change of hemoglobin and generic and disease-specific quality of life measures in hemodialysis. Qual Life Res 16, 755–765 (2007). https://doi.org/10.1007/s11136-007-9176-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-007-9176-6

Keywords

Navigation