Effect of end-stage renal disease on the quality of life of older patients

OBJECTIVES: To assess the effect of chronic renal failure (CRF) on quality of life (QOL). DESIGN: Controlled cross-sectional study. SETTING: All 13 dialysis units in the French Lorraine region and six departments of a Nancy hospital. PARTICIPANTS: One hundred sixty-nine older patients with end-stage renal disease (ESRD) who were starting first dialysis (mean age +/- standard deviation = 76.2 +/- 5.1) and 169 age- and sex-matched non-CRF controls. MEASUREMENTS: QOL was assessed using the short-form health survey 36-item (SF-36) self-administered questionnaire. Information on comorbid conditions, clinical symptoms and laboratory findings was obtained from medical records. RESULTS: Mean QOL scores ranged from 11.2 (role limitation due to physical function (RP) dimension) to 55.5 (social function) in the ESRD group, and from 22.0 (RP) to 54.3 (mental health) in the non-CRF group. Among ESRD patients, factors related to QOL scores (physical function (PF) and vitality dimensions) were the conditions under which dialysis was initiated and comorbidity. Patients whose first dialysis was unplanned had 10.4 fewer points in the PF dimension than those in whom it was planned (P = .014). CONCLUSIONS: If dialysis initiation is planned, ESRD in older patients has no more effect on QOL than others diseases. However, patients whose dialysis is unplanned have severely impaired QOL. These results represent an argument for improving the predialysis care of older renal failure patients to optimize conditions at first dialysis.