Predictive model of variables associated with health-related quality of life in patients with advanced chronic kidney disease receiving hemodialysis.

PURPOSE: Chronic kidney disease (CKD) affects over 10% of the global population. Health-related quality of life (HRQoL) has been identified as a reliable indicator for assessing the effectiveness of treatment in chronic patients, and resilience as a predictor of low levels of stress and higher QoL. The aim of this research is to identify the relationship between HRQoL, resilience, perceived stress, and the different sociodemographic and clinical routine variables of advanced chronic kidney disease (ACKD). METHODS: Multicenter, cross-sectional, and correlational study with 155 ACKD patients in the Valencian Community (Spain). The measures for the study included the Kidney Disease Quality of Life 36 (KDQOL-36), the Perceived Stress Scale 10 (PSS10), and the Connors-Davidson Resilience Scale (CD-RISC). To identify the variables with predictive power over the scales and subscales of the KDQOL-36, multiple regression analyses were performed. RESULTS: Average participants' age was 67.39, 68.4% were male, 29% diabetic, and 83.2% had undergone arteriovenous vascular access placement with a Charlson Comorbidity Index of 6 (SD = 2.09). The regression models identified that age and resilience explained up to 26.8% of the variance of the KDQOL-36 total score. As for the physical component of QoL, comorbidity with other clinical conditions, resilience, and the presence of diabetes explained 32.1% of its variance. CONCLUSIONS: Resilience was identified as one of the most important predictors of HRQoL. Thus, the development of interventions aiming to improve the level of resilience may have a positive impact over the quality of life of patients with CKD.

Symptomatic refractures after vertebroplasty in patients with steroid-induced osteoporosis.

BACKGROUND AND PURPOSE: Refracture after percutaneous vertebroplasty in patients receiving oral glucocorticoid therapy has caused some patients and referring physicians to have negative perceptions concerning the efficacy of the initial vertebroplasty treatment. The purpose of this study was to analyze symptomatic refractures after vertebroplasty in patients on oral steroid therapy. We hypothesized that the higher refracture rate of patients on oral glucocorticoid therapy after percutaneous vertebroplasty is due not to an inadequacy of the procedure but rather to a naturally higher predisposition of these patients to refracture compared with patients with primary osteoporosis. METHODS: A retrospective analysis was performed on all osteoporosis patients having initial vertebroplasty from August 1999 to August 2003. The follow-up period was limited to 1 year after initial vertebroplasty session, with the last follow-up date ending in August 2004. Data were collected on 387 osteoporosis patients. RESULTS: Of the patients with primary osteoporosis, 20.6% patients refractured whereas 37.8% of the patients with steroid-induced osteoporosis had symptomatic refractures within 1 year of initial vertebroplasty. Relative risk of refracture within 1 year for the patients with steroid-induced osteoporosis was 1.84 compared with the patients with primary osteoporosis. In addition, the patients with steroid-induced osteoporosis were more likely to refracture after their second treatment session (within 1 year of initial vertebroplasty) than those with primary osteoporosis. CONCLUSION: Patients presenting on oral steroid therapy at their initial vertebroplasty are almost twice more likely to have symptomatic refractures than primary osteoporosis patients within 1 year of initial vertebroplasty.