Abstract: TH-PO257
Dynamic Patient-Reported Outcome Measures Evaluate Durability of Expanded Hemodialysis on Health-Related Quality of Life (HR-QoL) and Symptom Variability
Session Information
- Hemodialysis, Hemodiafiltration, and Frequent Dialysis
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Penny, Jarrin D., London Health Sciences Centre, London, Ontario, Canada
- McIntyre, Christopher W., London Health Sciences Centre, London, Ontario, Canada
Background
Current hemodialysis (HD) utilizing high-flux dialyzers, is handicapped by clearance limitations contributing to poor health-related quality-of-life (HR-QoL) and symptom-burden. Recent international guideline-setting efforts have prioritized identification and management of symptoms and subjective experience. This study aimed to utilize dynamic patient-reported-outcome-measurement tool (PROM), London Evaluation of Illness (LEVIL), to iteratively interrogate patient-experience and benefits of the use of expanded hemodialysis (HDx) on HR-QoL and symptom burden, including durability-of-effects, variability of symptoms and impact of HDx withdrawal.
Methods
Multi-centre interventional study in 47 patients established on conventional thrice weekly centre-based HD in Ontario, Canada. Study was 15-months with five phases 1) one-month observation (high-flux-HD), 2) three-months HDx 3) two-month wash-out (high-flux-HD), 4) six-months HDx, 5) three-month wash-out (high-flux-HD). HR-QoL and symptom-burden were evaluated using LEVIL throughout study.
Results
HDx-therapy improved HR-QoL p 0.0006 (19% ) and a variety of symptoms including general wellbeing p 0.005 (23%), energy p 0.004 (33%), sleep-quality p 0.001 (33%), pruritus 0.003 (30%), pain p 0.01 (19%), restless leg syndrome p 0.0006 (15%), mood p 0.02 (12%), appetite p 0.03 (9%), breathlessness p 0.001 (9%), and HD-recovery p 0.004 (26%). Response was more pronounced in those with poorer HR-QoL and higher symptom-burden. Improvements were durable over time with less symptom-variability. Improvements diminished with return to high-flux-HD. Drivers of poor HR-QoL were general-wellbeing, energy, sleep-quality, pruritus, and bodily pain.
Conclusion
Dynamic PROM effectively evaluates HR-QoL and impact of therapy. HDx improved subjective outcomes that are durable and associated with less variation in important symptomx than patients experience with conventional high-flux-HD.