Journal Article

Early referral and planned initiation of dialysis: what impact on quality of life?

Fergus J. Caskey, Sarah Wordsworth, Thomas Ben, Frank T. de Charro, Catherine Delcroix, Vladimir Dobronravov, Henk van Hamersvelt, Iain Henderson, Elizabeth Kokolina, Izhar H. Khan, Anne Ludbrook, Merike Luman, Gordon J. Prescott, Dimitri Tsakiris, Myftar Barbullushi and Alison M. MacLeod

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 18, issue 7, pages 1330-1338
Published in print July 2003 | ISSN: 0931-0509
Published online July 2003 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfg156
Early referral and planned initiation of dialysis: what impact on quality of life?

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Background. Early patient referral correlates with improved patient survival on dialysis. We examine whether early referral and a planned first dialysis affect quality of life (QoL).

Methods. All patients commencing dialysis in nine centres in seven European countries between 1 July 1998 and 31 October 1999 were recruited. Definitions: early referral=followed by a nephrologist >1 month before first dialysis (<1 month=late referral); planned=early referral and previous serum creatinine >300 µmol/l and non‐urgent first dialysis (early referral and no creatinine >300 µmol/l or urgent first dialysis=unplanned). QoL was measured at 8 weeks using a visual analogue scale (VAS) and Short Form 36 (SF‐36).

Results. VAS was significantly higher in early referral patients [mean (SD) 58.4 (20) vs 50.4 (19), P=0.005], particularly if the first dialysis was planned [60.7 (20) vs 54.2 (20), P=0.03]. Planned patients also had higher SF‐36 mental summary scores [45.4 (12) vs 39.7 (11), P=0.003], role emotional scores [58.0 (43) vs 30.9 (38), P=0.003], and mental health scores [63.7 (24) vs 54.6 (22), P=0.01] than unplanned patients. Adjusting for centre and other confounding variables showed that having a planned first dialysis had an independent effect on QoL (VAS, and the SF‐36's mental summary score, physical functioning, role physical, general health, role emotional and mental health). Early referral had no independent effect on QoL. Socio‐economic status had an important positive effect on physical QoL.

Conclusions. While the effect of early referral to a nephrologist on QoL appeared centre dependent, a smooth transition onto dialysis was associated with significantly better early QoL, independent of other variables.

Keywords: dialysis; early referral; Europe; international; quality of life; socio‐economic

Journal Article.  6258 words.  Illustrated.

Subjects: Nephrology

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