Original Investigations: Dialysis Therapies
Health-related quality of life and associated outcomes among hemodialysis patients of different ethnicities in the United States: The Dialysis Outcomes and Practice Patterns Study (DOPPS)*,**,*

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Abstract

Background: In the United States, an association between mortality risk and ethnicity has been observed among hemodialysis patients. This study was developed to assess whether health-related quality of life (HRQOL) scores also vary among patients of different ethnic backgrounds. Associations between HRQOL and adverse dialysis outcomes (ie, death and hospitalization) also were assessed for all patients and by ethnicity. Methods: Data are from the Dialysis Outcomes and Practice Patterns Study for 6,151 hemodialysis patients treated in 148 US dialysis facilities who filled out the Kidney Disease Quality of Life Short Form. We determined scores for three components of HRQOL: Physical Component Summary (PCS), Mental Component Summary (MCS), and Kidney Disease Component Summary (KDCS). Patients were classified by ethnicity as Hispanic and five non-Hispanic categories: white, African American, Asian, Native American, and other. Multiple linear regression models were used to estimate differences in HRQOL scores among ethnic groups, using whites as the referent category. Cox regression models were used for associations between HRQOL and outcomes. Regression models were adjusted for sociodemographic variables, delivered dialysis dose (equilibrated Kt/V), body mass index, years on dialysis therapy, and several laboratory/comorbidity variables. Results: Compared with whites, African Americans showed higher HRQOL scores for all three components (MCS, PCS, and KDCS). Asians had higher adjusted PCS scores than whites, but did not differ for MCS or KDCS scores. Compared with whites, Hispanic patients had significantly higher PCS scores and lower MCS and KDCS scores. Native Americans showed significantly lower adjusted MCS scores than whites. The three major components of HRQOL were significantly associated with death and hospitalization for the entire pooled population, independent of ethnicity. Conclusion: The data indicate important differences in HRQOL among patients of different ethnic groups in the United States. Furthermore, HRQOL scores predict death and hospitalization among these patients. Am J Kidney Dis 41:605-615. © 2003 by the National Kidney Foundation, Inc.

Section snippets

Methods

Data used for analyses are from the Dialysis Outcomes and Practice Patterns Study (DOPPS), an international, prospective, observational study of hemodialysis practice patterns and associated outcomes.17, 18 The study is ongoing in the United States, Europe (France, Germany, Italy, Spain, and the United Kingdom), and Japan. Nationally representative samples of dialysis facilities have been recruited in each country. Within each participating facility, study patients were randomly selected. The

Results

Table 1 lists information on sociodemographic variables and years on dialysis therapy for all patients and by ethnicity.Non-Hispanic whites were significantly older than patients from other ethnic backgrounds. Whites also presented a greater proportion of men (P < 0.01 compared with African Americans and Native Americans) and those with a shorter time on dialysis therapy (P < 0.01 compared with African Americans and Hispanics). Higher levels of income and education were observed for whites,

Discussion

African Americans treated by hemodialysis scored higher than whites in several subscales and three major components of HRQOL (PCS, MCS, and KDCS). Asians and Hispanics also had higher scores for the PCS than whites. Conversely, lower scores in the KDCS were observed for Asians and Hispanics than whites. Lower MCS scores were observed for Native Americans and Hispanics than whites. Except for Native Americans, all other ethnic groups had higher scores in Vitality than whites. Also, a lower score

Acknowledgements

The authors thank the members of the Worldwide DOPPS Committee for contributions during the design and implementation of the DOPPS. For a full list of committee members, see Young et al.17

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    *

    Supported in part by an unrestricted grant from Kirin-Amgen; and grant no. BEX2018/00-4 from the Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Ministry of Education of Brazil (A.A.L.).

    **

    Address reprint requests to Friedrich K. Port, MD, University Renal Research and Education Association (URREA), 315 W Huron, Ste 260, Ann Arbor, MI 48103. E-mail: [email protected]

    *

    0272-6386/03/4103-0009$30.00/0

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