Nephrol Dial Transplant (2003) 18: 1330-1338
© 2003 European Renal Association-European Dialysis and Transplant Association
Early referral and planned initiation of dialysis: what impact on quality of life?
1 Medicine and Therapeutics, University of Aberdeen, 2 Health Economics Research Unit, University of Aberdeen, UK, 3 Medical University of Debrecen, Hungary, 4 Erasmus University, Rotterdam, The Netherlands, 5 Centre Hospitalier Universitaire de Nantes, France, 6 St Petersburg Medical Institute, Russia, 7 University Medical Centre, Nijmegen, The Netherlands, 8 Ninewells Hospital, Dundee, UK, 9 Hippokration General Hospital, Thessaloniki, Greece, 10 Aberdeen Royal Infirmary, UK, 11 Tallinn Pelgulinna Hospital, Estonia, 12 Department of Public Health, University of Aberdeen, UK, 13 Veria General Hospital, Greece and 14 University Medical Centre, Tirana, Albania
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
Correspondence and offprint requests to: Dr Fergus J. Caskey, Renal Research Group, Medicine and Therapeutics, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK. Email: f.caskey{at}abdn.ac.uk
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