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Medline ® Abstract for Reference 67

of 'Kidney and patient outcomes after acute kidney injury in adults'

67
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Health-related quality of life as a predictor of mortality among survivors of AKI.
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Joyce VR, Smith MW, Johansen KL, Unruh ML, Siroka AM, O'Connor TZ, Palevsky PM, Veteran Affairs/National Institutes of Health Acute Renal Failure Trial Network
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Clin J Am Soc Nephrol. 2012;7(7):1063. Epub 2012 May 17.
 
BACKGROUND AND OBJECTIVES: This study examined the relationship between health-related quality of life and subsequent mortality among AKI survivors treated with renal replacement therapy.
DESIGN, SETTING, PARTICIPANTS,&MEASUREMENTS: Multivariable Cox regression models were used to assess the associations between Health Utilities Index Mark 3 (HUI3) and ambulation, emotion, cognition, and pain scores at 60 days and all-cause mortality at 1 year in 60-day AKI survivors (n=439 with evaluable HUI3 assessments) from a randomized multicenter study comparing less- with more-intensive renal replacement therapies.
RESULTS: The median 60-day HUI3 index score was 0.32. Patients with evaluable HUI3 data who died between 60 days and 1 year (n=99) were more likely to have lower 60-day median HUI3 scores, higher comorbidity scores, and longer initial hospital stays, and they were more likely to be dialysis-dependent. A 0.1 higher HUI3 index score was associated with a 17% decrease (hazard ratio, 0.83; 95% confidence interval 0.77-0.89) in all-cause mortality after controlling for clinical risk factors. Similar associations were observed for HUI3 ambulation, emotion, cognition, and pain attribute scores.
CONCLUSIONS: Health-related quality of life measured by HUI3 is an independent predictor of mortality among survivors of AKI after adjusting for clinical risk variables. Poor ambulation and other health-related quality of life attributes are also associated with increased risk of death. Health-related quality of life may provide clinicians with additional information to help identify patients at high risk of mortality after AKI that required renal replacement therapy.
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Health Economics Resource Center, Veteran Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA. vilija.joyce@va.gov
PMID