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Open Access Highly Accessed Research article

Health-related quality of life and all-cause mortality in patients with diabetes on dialysis

Tone Britt Hortemo Østhus12, Nanna von der Lippe1, Lis Ribu3, Tone Rustøen3, Torbjørn Leivestad4, Toril Dammen5 and Ingrid Os12*

Author Affiliations

1 Department of Nephrology, Oslo University Hospital, Ullevål, N-0484, Oslo, Norway

2 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

3 Faculty, Lovisenberg Diaconal, Oslo University College, Oslo, Norway

4 Department of Organ Transplantation, Oslo University Hospital, Oslo, Norway

5 Institute of Basic Medical Sciences, Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

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BMC Nephrology 2012, 13:78  doi:10.1186/1471-2369-13-78

Published: 3 August 2012

Abstract

Background

This study tests the hypotheses that health-related quality of life (HRQOL) in prevalent dialysis patients with diabetes is lower than in dialysis patients without diabetes, and is at least as poor as diabetic patients with another severe complication, i.e. foot ulcers. This study also explores the mortality risk associated with diabetes in dialysis patients.

Methods

HRQOL was assessed using the Short Form-36 Health Survey (SF-36), in a cross-sectional study of 301 prevalent dialysis patients (26% with diabetes), and compared with diabetic patients not on dialysis (n = 221), diabetic patients with foot ulcers (n = 127), and a sample of the general population (n = 5903). Mortality risk was assessed using a Kaplan-Meier plot and Cox proportional hazards analysis.

Results

Self-assessed vitality, general and mental health, and physical function were significantly lower in dialysis patients with diabetes than in those without. Vitality (p = 0.011) and general health (p <0.001) was impaired in diabetic patients receiving dialysis compared to diabetic patients with foot ulcers, but other subscales did not differ. Diabetes was a significant predictor for mortality in dialysis patients, with a hazard ratio (HR) of 1.6 (95% CI 1.0-2.5) after adjustment for age, dialysis vintage and coronary artery disease. Mental aspects of HRQOL were an independent predictor of mortality in diabetic patients receiving dialysis after adjusting for age and dialysis vintage (HR 2.2, 95% CI 1.0-5.0).

Conclusions

Physical aspects of HRQOL were perceived very low in dialysis patients with diabetes, and lower than in other dialysis patients and diabetic patients without dialysis. Mental aspects predicted mortality in dialysis patients with diabetes. Increased awareness and measures to assist physical function impairment may be particularly important in diabetes patients on dialysis.

Keywords:
Dialysis; Diabetes; Foot Ulcers; QOL; Mortality