Associations of coping strategies with quality of life, depression and mortality among hemodialysis patients in the dialysis outcomes and practice patterns study (DOPPS).

INTRODUCTION AND AIMS: Little is known about how different strategies used by hemodialysis (HD) patients to cope with their disease might affect their health status. Our objective was to estimate the effects of 4 coping strategies on quality of life (QoL) and mortality. We hypothesized that active engagement coping would lead to better patient outcomes than would avoidance or disengagement. METHOD(S): Coping strategies were reported by 2,339 HD patients from the US, UK, Australia/New Zealand, Canada, Germany and Sweden in DOPPS 4 (2009-11), using the Coping Strategies Inventory-Short Form (CSI-SF) previously validated for HD patients in these countries. The CSI-SF contains 4 subscales: problem-focused engagement & disengagement (PFE & PFD); and emotion-focused engagement & disengagement (EFE & EFD). Cox or linear regression were used to estimate the associations of each coping strategy (by quartile) with all-cause mortality during follow-up and 6 cross-sectional patient-reported outcomes (3 KDQoL kidney-disease measures with higher scores reflecting less impact on patients' lives (Effects, Burdens, Symptoms); 2 SF-12 scores (MCS, PCS) reflecting better functional status; and a CES-D score reflecting more depression symptoms), adjusting for age, sex, vintage, BMI, catheter use, 13 comorbidities, and country. RESULT(S): PFE was positively associated with less kidney-disease burden and effect scores and better mental and physical function scores, and it was inversely associated with depression symptoms. EFE was not associated with any QoL outcomes (Figure 1). In contrast, disengagement strategies (PFD & EFD) were inversely associated with the kidney-disease and functional-status scores, and they were positively associated with depression symptoms. Compared to patients in the lowest PFE quartile (Q1), the hazard ratio for mortality (95% CI) was 0.73 (0.55, 0.98) for patients in Q2, 0.67 (0.49,0.93) for patients in Q3, and 0.74 (0.53, 1.03) for patients in Q4. Little ass