The Associations of Hemodialysis Access Type and Access Satisfaction with Health-related Quality of Life
Natalie D. Sridharan, MD, Larry Fish, Lan Yu, Steven Weisbord, MD, Michel Makaroun, MD, Theodore Yuo, MD, MS.
University of Pittsburgh, Pittsburgh, PA, USA.
OBJECTIVES: In addition to age and comorbidities, health related quality of life (HRQOL) is known to predict mortality in hemodialysis patients. Understanding the association of vascular access type with HRQOL can help surgeons provide patient-centered dialysis-access recommendations. We sought to understand the impact of hemodialysis access-type on HRQOL. METHODS: We conducted a cross-sectional prospective study of community-dwelling prevalent hemodialysis patients in Pittsburgh, PA. We assessed patient satisfaction with their access using the Vascular Access Questionnaire (VAQ) and HRQOL with the Short Form Health Survey (SF36). We compared access satisfaction and HRQOL across access-types. We used logistic regression modeling to evaluate the association of access-type with satisfaction and multivariate analysis of variance (MANOVA) to evaluate the association of both of these variables on HRQOL. RESULTS: We surveyed 77 patients. Mean age was 61.8 ± 15.9 years. Fistula (AVF) was used by 62.3%, tunneled catheter (TDC) by 23.4%, and graft (AVG) by 14.3%. There was a significant difference in satisfaction by access-type with lowest median VAQ score (indicating highest satisfaction) in patients with AVF followed by TDC and lastly AVG (4.5 vs. 6.5 vs. 7.0, P=.013). Defining a VAQ score of less than 7 to denote satisfaction, AVF patients were more likely to be satisfied with their access, compared to TDC or AVG (77% vs 56% vs 55%, P=NS). Multivariate regression analysis yielded a model that predicted 46% of the variance of VAQ score; important predictors of dissatisfaction included less than one year on dialysis (β =3.36, p<0.001), increasing number of access-related hospital admissions in the last year (β=1.69, p<0.001), and AVG (β=1.72, P=.04) or TDC (β=1.67, P=.02) access. Mean physical and mental QOL scores (the composite scores of SF36) were not different by access-type (P=.49, P=.41). In an additive MANOVA with the two composite QOL scores as dependent variables, 25.8% of the generalized variance in HRQOL (effect size) was accounted for by access satisfaction with only an additional 3% accounted for by access-type. CONCLUSIONS: Hemodialysis patients experience highest satisfaction with fistula, and access satisfaction is significantly associated with better HRQOL. Controlling for access satisfaction, there is no significant independent association of access-type on HRQOL. Future research should investigate the relationship between access satisfaction and patient adherence to dialysis regimens and the consequent implications for patient-centered care.
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