Patient involvement with the tasks of in-center hemodialysis and health-related quality of life in the DOPPS.

Introduction and Aims:We measured the involvement of in-center patients in their dialysis treatment and assessed cross-sectional associations with measures of health-related quality of life in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Method(s): Data on self-care activities (listed in Table 1) were available in DOPPS phase 4 (2009-11). Descriptive analyses included 5657 patients in 8 countries with >2% of patients reporting >=1 activity. 3242 of these patients reported the physical (PCS) and mental (MCS) component summary of the KDQoL-36TM. Linear mixed models adjusted for many potential confounders, including country, estimated the effects of self-care activities on PCS and MCS. Result(s): The % of patients who performed >=1 self-care activity was 9% overall and highest in Australia/New Zealand and Sweden (16% each, Table 1). The activity most commonly performed was setting up the machine/dialyzer (7%). Facility % of patients who performed >=1 self-care activity was 0% in 39% of facilities, with median 4% (IQR: 0%, 12%) and 95th percentile 36%. Patients performing >=1 self-care activity were younger (51 vs 66 yrs), had longer vintage (6.2 vs 3.6 yrs), lower catheter use (23% vs 36%), higher albumin (3.9 vs 3.6 g/dL), higher creatinine (9.3 vs 7.5 mg/dL), longer session length, (256 vs 238 min), and fewer comorbidities than patients performing none of the 4 activities. For patients performing >=1 self-care activity: crude mean PCS (39.2 vs 34.9) and MCS (47.9 vs 45.3) were higher, and after covariate adjustment, mean PCS was 1.6 points higher (95% CI: 0.3, 2.8) and mean MCS was 2.2 points higher (95% CI: 0.7, 3.7). Conclusion(s): Greater patient involvement in the routine tasks of hemodialysis is associated with better physical and mental quality of life; however, methodological limitations limit causal inference. Marked variation in up-take of self-care is likely to represent facility preferences for empowering patients. The impact and safety of th