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Chronic Disease

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How well dialysis patients view their current health at the start of hemodialysis is related to subsequent outcomes and utilization

Patients with end-stage renal disease (ESRD) undergo 3- to 4-hour hemodialysis sessions 3 days a week in order to filter out toxins that their kidneys are no longer able to filter. ESRD patients suffer from symptoms ranging from fatigue and muscle cramps to poor sleep quality and itching. They are also expected to follow a strict diet and limit fluid intake, and they take many medications every day. Better understanding of how dialysis patients view their current health at the start of dialysis may serve to provide insights for subsequent health care utilization and health outcomes, according to a new study.

The researchers measured the current health perceptions of 567 dialysis patients treated at 74 clinics using the time trade-off scale. The highest scores (1.0) were associated with 12 percent fewer hospitalizations than the lowest scores (less than 0.50), a finding that was consistent across gender and race. Higher scores were also associated with less worsening of coexisting diseases, especially among women. However, risk of death was not different across persons with high, intermediate, and lower preference scores for current health state.

Strong affiliation with current health status might lead to better self-management of aspects of disease under the patients' control and, hence, better subsequent clinical outcomes. For example, more patients with higher health preference scores attained 6-month clinical performance targets of dialysis dose (significant only among whites) and native vein vascular access (significant only among women) than those with lower scores.

Higher scores were also associated with subsequent improvement in both self-reported mental and physical health. The study was supported in part by the Agency for Healthcare Research and Quality (HS08365).

See "Preferences for current health and their association with outcomes in patients with kidney disease," by Laura C. Plantinga, Sc.M., Nancy E. Fink, M.P.H., Eric B. Bass, M.D., and others, in the March 2007 Medical Care 45(3), pp. 230-237.

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