#2306 Determinants of quality of life at twelve months in a multinational population on dialysis

Abstract Background and Aims Quality of life (QoL) is increasingly recognized as an important patient-centered outcome when assessing hemodialysis’ (HD) impact on people undergoing such treatment. Despite the evidence gathered so far, the evolution of QoL through time on dialysis and factors potentially involved on those changes remain to be clarified. Our primary objective was to evaluate the predictors of QoL at twelve months in a sample of patients with chronic kidney disease in maintenance HD, using the Quality of Life Short Form Health Survey (KDQOL SF-36). Additionally, we intended to (i) characterize the people with CKD in maintenance HD, (ii) identify the variables associated with KDQOL SF-36 score at baseline, and (iii) evaluate if the KDQOL SF-36’s PCS and the MCS progress similarly at 12 months. Method We performed a retrospective cohort study using data from an international HD provider database. All patients 18 years or older that voluntarily responded to the Kidney Disease Quality of Life 36-item short form health survey (KDQOL SF-36) in 2021 and 2022 were included. The test was preferably self-administered, but patients could be assisted by a health professional during dialysis session when needed. At baseline, demographic, clinical, physical and analytical data from these patients were collected. The physical (PCS) and mental (MCS) component summary scores of 2021 and 2022 were analyzed and related to the different covariates using multiple linear regression and the results presented as coefficients and 95% confidence intervals. Results A total of 19,756 persons (53% of the eligible individuals) answered to both KDQOL SF-36 questionnaires in 2021 and 2022 and were included in the study. We have documented low baseline QoL in our sample particularly in physical domains, with a slight, but significant, increase after twelve months. PCS was significantly and consistently lower than MCS, a finding observable in all age groups, in both genders, regardless of dialysis vintage, the presence of diabetes and comorbidity index. Significant differences in PCS and MCS scores were observed in the different regions of the sample studied. Living in Iberia or Eurasia was associated with higher PCS, whereas being an inhabitant in Western Europe was associated with a significant decrease in MCS. Both at baseline and after 12 months, male gender, albumin levels higher than 35 g/L and be included in the waiting list for kidney transplantation (KT) were independently associated with higher values of PCS and MCS scores. Blood flow on dialysis, haemoglobin levels above 10 g/dL and normal weight/overweight were also independently associated with higher PCS levels. Presence of diabetes was independently associated with lower PCS and MCS scores at baseline and after twelve months, while using a central venous catheter for dialysis and longer time on dialysis were predictors of lower scores only at second assessment timepoint. Older age and higher Charlson comorbidity index were also predictors of low PCS at both timepoints. Conclusion Despite the slight, but significant, increase in QoL after twelve months, in our sample we have documented low baseline QoL, particularly in physical domains. A more significant impact on the PCS, when compared to the MCS, was observed, independently of the demographic and clinical characteristics of the sample. Male individuals, with higher albumin levels and included in the waiting list for KT presented higher physical and mental domain scores of QoL. On the other hand, having diabetes, a central venous catheter and being longer time on dialysis were the main predictors for lower PCS and MCS in our sample indicating that these group of people should receive targeted interventions to promote both QoL components. Our findings provide evidence on the main factors related to a low QoL in HD and support the need for timely implementation of multidimensional interventions aiming at the promotion of QoL in persons treated with chronic HD.