Health-Related Quality of Life at Hemodialysis Initiation May Be Associated with One-Year Hospitalization and Death

Background: Health-related quality of life (HRQoL), one of patient-reported outcomes, is not only an indicator that should be evaluated in providing appropriate medical management and care, but has been also known to be a possible prognostic factor. We investigated the association between HRQoL at hemodialysis (HD) initiation and prognosis up to 1 year later. Methods: HRQoL was assessed using the SF-12 Japanese version 2.0 (SF-12v2) in patients starting HD between September 2021 and May 2024 at our hospital. Summary scores of SF-12v2, physical component score (PCS) and mental component score (MCS), were calculated. The primary outcome was the composite of hospitalization and death, and the secondary outcome was the composite of CVD and death. The relationship between PCS or MCS at HD initiation and 1-year outcomes was evaluated. Results: This study included 110 patients (81 were male) with a mean age of 67.1 years at HD initiation. Median value of PCS was 40.4, which was lower than the national norm. Results of ROC analysis showed that PCS could predict the occurrence of primary and secondary outcomes within 1 year (AUC [95% CI] were 0.66 [0.55–0.77] and 0.68 [0.55–0.81], respectively), suggesting the cut-off value of PCS as 36.4. When the two groups divided based on PCS value (36.4) were compared using Kaplan-Meier analysis, the lower PCS group (N=43) had a significantly higher incidence of primary and secondary outcomes within one year after HD initiation than the higher PCS group (N=67). (log-rank, p＝0.004 and 0.033, respectively). Cox proportional hazards model suggested that PCS lower than 36.4 may be an independent risk factor for hospitalization and death (HR [95%] = 2.63[1.29–5.36]). There was a positive correlation between PCS and diastolic blood pressure, serum albumin, serum creatinine, and serum phosphorus (correlation coefficients of 0.38, 0.23, 0.29, and 0.25, respectively). There was no correlation between MCS and outcomes. Conclusion: In incident HD patients, PCS, indicating physical health aspects of HRQoL, might be a predictor of 1-year hospitalization and death.