One-Year Linear Trajectories of Symptoms, Physical Functioning, Cognitive Functioning, Emotional Well-being, and Spiritual Well-being Among Patients Receiving Dialysis

Abstract

Background: This study evaluated 1-year linear trajectories of patient-reported dimensions of quality of life among patients receiving dialysis.

Study design: Longitudinal observational study.

Setting & participants: 227 patients recruited from 12 dialysis centers.

Factors: Sociodemographic and clinical characteristics.

Measurements/outcomes: Participants completed an hour-long interview monthly for 12 months. Each interview included patient-reported outcome measures of overall symptoms (Edmonton Symptom Assessment System), physical functioning (Activities of Daily Living/Instrumental Activities of Daily Living), cognitive functioning (Patient's Assessment of Own Functioning Inventory), emotional well-being (Center for Epidemiologic Studies Depression Scale, State Anxiety Inventory, and Positive and Negative Affect Schedule), and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale). For each dimension, linear and generalized linear mixed-effects models were used. Linear trajectories of the 5 dimensions were jointly modeled as a multivariate outcome over time.

Results: Although dimension scores fluctuated greatly from month to month, overall symptoms, cognitive functioning, emotional well-being, and spiritual well-being improved over time. Older compared with younger participants reported higher scores across all dimensions (all P<0.05). Higher comorbidity scores were associated with worse scores in most dimensions (all P<0.01). Nonwhite participants reported better spiritual well-being compared with their white counterparts (P<0.01). Clustering analysis of dimension scores revealed 2 distinctive clusters. Cluster 1 was characterized by better scores than those of cluster 2 in nearly all dimensions at baseline and by gradual improvement over time.

Limitations: Study was conducted in a single region of the United States and included mostly patients with high levels of function across the dimensions of quality of life studied.

Conclusions: Multidimensional patient-reported quality of life varies widely from month to month regardless of whether overall trajectories improve or worsen over time. Additional research is needed to identify the best approaches to incorporate patient-reported outcome measures into dialysis care.

Keywords: Quality of life (QoL); cognitive functioning; comorbid conditions; dialysis; emotional well-being; end-stage renal disease (ESRD); illness burden; patient-reported outcome measures (PROMs); physical functioning; questionnaire; spiritual well-being; symptom burden; trajectory.