Original Investigation
Dialysis
Association Between a Self-Rated Health Question and Mortality in Young and Old Dialysis Patients: A Cohort Study

https://doi.org/10.1053/j.ajkd.2008.04.001Get rights and content

Background

Self-rated health (SRH) has been shown to predict mortality in large community-based studies; however, large clinical-based studies of this topic are rare. We assessed whether an SRH item predicts mortality in a large sample of incident dialysis patients beyond sociodemographic, disease, and clinical measures and possible age interaction.

Setting & Participants

1,443 predominantly white patients from 38 dialysis centers in The Netherlands participating in the Netherlands Cooperative Study on the Adequacy of Dialysis-2 between 1997 and 2004.

Predictor

SRH score completed at 3 months after the start of dialysis therapy (baseline).

Outcomes & Measurements

Cox proportional hazards model estimated the association between SRH and all-cause mortality. Interaction of SRH with age (<65 and ≥65 years) was examined in an additive model.

Results

Mean age of patients was 59.6 ± 14.8 years, with 61% men and 69% married/living together. Mean follow-up was 2.7 ± 1.8 years. Deaths per SRH group in the multivariate analyses sample: excellent/very good (9 of 63 patients; 14.3%), good (148 of 473 patients; 31.3%), fair (194 of 508 patients; 38.2%), and poor (45 of 71 patients; 63.4%). Patients with poor, fair, or good health ratings had a greater mortality risk than those with excellent/very good health ratings (adjusted hazard ratio [HRadj], 3.56; 95% confidence interval [CI], 1.71 to 7.42; HRadj, 2.09; 95% CI, 1.06 to 4.12; HRadj, 1.87; 95% CI, 0.95 to 3.70, respectively) independent of a range of risk factors. No age interaction with SRH was found.

Limitations

Although the SRH-mortality association remained strong despite extensive adjustments, unknown residual confounding could still exist.

Conclusion

SRH is an independent predictor of mortality in incident dialysis patients. Patients with poor SRH in both age strata had a significantly increased risk of mortality even after controlling for demographic and clinical confounders. Patient self-assessment of health can be an invaluable and economical complement to clinical measures in risk assessment.

Section snippets

Patient Sample

The Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD-2)19, 20 is a prospective observational study investigating the adequacy and quality of care for patients on dialysis treatment in The Netherlands. Between January 1997 and December 2004, incident patients from 38 dialysis centers throughout The Netherlands were recruited with informed consent. Eligibility included age older than 18 years, no previous renal replacement therapy, and survival of the initial 3 months of

Results

Of 1,672 eligible patients, 190 (11%) with missing SRH and 39 (2%) without data for length of follow-up or age were excluded, resulting in a sample of 1,443 patients. Patients were followed up for an average of 2.7 ± 1.8 years. Mean age was 59.7 ± 14.8 years, with 61% men and 69% married or living together (Table 1). Forty-six percent of the sample rated their health as excellent/very good or good. These patients tended to be men and younger, had a higher level of education, were more likely to

Discussion

Our study shows that an SRH item is an independent predictor of mortality in a large sample of incident patients with end-stage renal disease. Patients who rated their health as poor had a significantly increased risk of death, even after controlling for a range of demographic and clinical confounders. This effect was apparent in both age strata (younger and older participants).

The strong associations between SRH and mortality in our study are in line with findings reported by Kutner et al.7

Acknowledgements

The members of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) Study Group include A.J. Apperloo, J.A. Bijlsma, M. Boekhout, W.H. Boer, P.J.M. van der Boog, H.R. Büller, M. van Buren, F.Th. de Charro, C.J. Doorenbos, M.A. van den Dorpel, A. van Es, W.J. Fagel, G.W. Feith, C.W.H. de Fijter, L.A.M. Frenken, W. Grave, J.A.C.A. van Geelen, P.G.G. Gerlag, J.P.M.C. Gorgels, R.M. Huisman, K.J. Jager, K. Jie, W.A.H. Koning-Mulder, M.I. Koolen, T.K. Kremer Hovinga, A.T.J.

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    Originally published online as doi:10.1053/j.ajkd.2008.04.001 on May 22, 2008.

    A list of the members of the NECOSAD Study Group appears at the end of this article.

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