The association between health-related quality of life and mortality among hemodialysis patients.

INTRODUCTION: Mortality rates for patients undergoing maintenance hemodialysis remain high. Published data regarding association between health-related quality of life (HRQOL) and mortality among hemodialysis patients are inconsistent. Very few data are published on the change in HRQOL over time as a predictor of mortality. The aim of this study was to assess whether HRQOL and change of it over time could be considered an independent predictor of mortality in hemodialysis patients. MATERIAL AND METHODS: This prospective observational study enrolled 183 patients undergoing maintenance hemodialysis. HRQOL was measured annually 2004-2008 using a generic Short Form 36 questionnaire. Physical component summary (PSC) and mental component summary (MSC) scores were calculated. The change of the patient's HRQOL over time was calculated as a difference between SF-36 scores of the first and the last HRQOL measurements. RESULTS: The median follow-up was 48 months (range, 1-72 months). Cutoff values for HRQOL predicting mortality for PSC score was ≥35 and for MSC score was ≥45. In the model adjusted for age, sex, dialysis months, creatinine, albumin and hemoglobin levels, mortality risk decreased by 0.96 (95% CI, 0.95-0.99) for 1-point increase in the baseline PSC score and decreased by 0.97 (95% CI, 0.95-0.98) for 1-point increase in the baseline MSC score. A 1-point decline in the PSC score (relative risk, 1.11; 95% CI, 1.008-1.221) and MSC score (relative risk, 1.07; 95% CI, 1.002-1.149) over the period of follow-up were associated with a significant additional increase in mortality. CONCLUSIONS: Both baseline HRQOL and decline of HRQOL are independent predictors of mortality in hemodialysis patients.

[Quality of life and depression in renal transplant patients]. / Pacientu, kuriems persodintas inkstas, depresijos sunkumas ir gyvenimo kokybe.

UNLABELLED: The objective of this study was to examine the factors affecting quality of life in renal transplant patients and to evaluate the association between depression and quality of life. MATERIAL AND METHODS: A study was carried out in 61 renal transplant patients. Health-related quality of life was evaluated using the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire. Depression was measured using the Beck's Depression Inventory (BDI). RESULTS: Twenty percent of the subjects had a BDI score higher than 15. The BDI score correlated inversely with these quality-of-life domains: physical functioning (r=-0.691, P<0.001), limitations in physical activities because of physical problems (r=-0.428, P=0.001), bodily pain (r=-0.662, P<0.001), and limitations in usual role activities because of emotional problems (r=-0.319, P<0.001). The BDI score also correlated with age (r=0.44, P<0.001) and serum creatinine level (r=0.453, P<0.001). Subjects with BDI score higher than 15 were significantly older (51.40+/-11.35 years vs. 42.64+/-10.89 years, P<0.05), they had higher serum creatinine levels (215.7+/-82.63 micromol/L vs. 153.2+/-50.6 micromol/L, P<0.05), lower bodily pain score (39.7+/-21.44 vs. 72.32+/-19.0, P<0.001), and lower score in limitations in usual role activities because of emotional problem (36.6+/-33.23 vs. 67.36+/-37.83, P<0.05). CONCLUSIONS: Depression was associated with a lower quality of life in four domains. Patients with depression were older and had a worse graft function.

[Sleep disorders and quality of life in patients on hemodialysis]. / Dialize gydomu pacientu miego sutrikimai ir gyvenimo kokybe

UNLABELLED: The objective of this study was to determine the rate of sleep disorders in patients on hemodialysis and to evaluate the association between quality of sleep and quality of life in these patients. METHODS: A total of 81 hemodialysis patients were enrolled in the study. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI): higher scores indicate worse sleep quality. Health-related quality of life was evaluated using the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire. RESULTS: In the present study 54 dialysis patients (66.7%) were "poor sleepers" (PSQI>5). The SF-36 mental component summary (PCS) and physical component summary (MCS) correlated with the global PSQI score (PCS, r=-0.463, p<0.001; MCS, r=-0.426, p<0.001), age (PCS, r=-0.330, p=0.003; MCS, r=-0.381, p<0.001), hemoglobin (PCS, r=0.289, p=0.009; MCS, r=0.301, p=0.006), comorbidity (PCS, r=-0.286, p=0.01; MCS, r=-0.283, p=0.011). Dialysis patients with global PSQI< or =5 ("good sleepers") had higher SF-36 PCS and MCS scores (PCS, 51.15+/-17.2 vs. 34.72+/-16.58, p<0.001; MCS, 59.52+/-17.43 vs. 41.92+/-18.34, p<0.001) and higher hemoglobin levels (102.74+/-12.34 g/l vs. 95.67+/-10.57 g/l, p=0.009) compared with "poor sleepers" (PSQI>5). CONCLUSIONS: In the present study two-thirds of dialysis patients (66.7%) were "poor sleepers". Lower hemoglobin levels correlated with worse quality of sleep and quality of life. We hypothesize that correction of anemia may improve quality of life in patients on hemodialysis. Poor sleep is associated with lower quality of life in hemodialysis patients.

[The differential diagnosis of progressively worsening dyspnea]. / Progresuojancio dusulio diferencine diagnostika.

The clinical case of differential diagnosis of progressively worsening dyspnea reflects the complicated clinical situations when the patient diagnosis should be based on the differential diagnosis of the various organ systems disturbances in the patients with uncommon diseases. We present the clinical case of the idiopathic fibrosing alveolitis. This serious interstitial lung disease, although relatively rare, is becoming increasingly common. We would like to accentuate the essence of accurate interpretation of common clinical and laboratory investigations to be able to establish the diagnosis of the rare disease. New recommendations for the diagnosis and the treatment of this disorder are presented.