Kimmel PL, Peterson R, Weihs K, Simmens S, Kovac J, Veis J,
Cruz I
Compliance with dialysis prescription, social support, quality
of life, and decreased depression are associated with enhanced
survival in inner city hemodialysis patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1451 1996
Held has shown that missing dialysis increases the risk of death out of
proportion to the calculated reduction in Kt/V. Skipping dialysis points
to other patterns of poor compliance that reduce survival. It would be
desirable to find predictors of and treatable conditions contributing to
poor compliance.
The authors report the relationship between survival and multiple
covariates (depression, social support, Karnofsky, HRQOL, Kt/V, PCR, time
compliance, attendance compliance, and the severity of comorbidites).
Pyschosocial factors were as important as medical factors in predicting the
relative risk of death. For all patients, shortening treatment, lessened
social support, low marital satisfaction and a low reported quality of life
were associated with an increased relative risk of death. For incident
patients depression and skipping treatments were also associated with a
higher relative risk of dying.
Comment: This is the latest in a series of important studies from
Kimmel and his
associates on the impact of functional health status in ESRD patients.
Functional health status assessment is an increasingly important tool in
outcomes assessment. It represents the patient's voice. What remains to
be seen, now, is whether once idenditified, if there are interventions that
can be effective to treat depression, improve health realted quality of
life, and to improve survival and compliance.
(Peter B. DeOreo MD, Case Western Reserve University, Cleveland)
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Am Soc Nephrol
CRF: Problem Areas :
Outcomes (Morbidity, Mortality)
CRF by organ system :
Psychiatric