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Background: Patients who are on dialysis report multiple symptoms. The aim of the study was to explore and identify symptom clusters (co-occurring symptoms) in patients on dialysis and their possible associations with depressive symptoms and health-related quality-of-life (HRQOL) outcomes., Methods: In a cross-sectional study of 301 prevalent patients on dialysis, physical symptoms, depressive symptoms and HRQOL were assessed using the Beck Depression Inventory (BDI) and the Kidney Disease and Quality-of-Life-Short Form version 1.3 (KDQOL-SF36) questionnaires. Symptom clusters were identified using principal component analysis with varimax rotation. Multivariate linear regression analyses were carried out to evaluate the relationships between symptom clusters and depressive symptoms and HRQOL outcomes., Results: The majority of patients (63.5%) rated their symptoms in the 'very much' to 'extremely bothersome' range, and 29.4% had significant depressive symptoms. Three symptom clusters were identified and were named uraemic (nausea, lack of appetite, dizziness/faintness, feeling squeezed out, shortness of breath, chest pain), neuromuscular (numbness in extremities, sore muscles, cramps) and skin (itching, dry skin) clusters. The three clusters were associated with BDI, physical component summary (PCS) and mental component summary (MCS) scores. After multiple adjustments, the uraemic and neuromuscular clusters remained independently associated with BDI and PCS scores and the uraemic and skin clusters with MCS scores., Conclusion: The strong associations between symptom clusters and depressive symptoms and the physical and mental domains of HRQOL should lead to an increased focus on symptom-alleviating interventions. Additional research is warranted to determine whether treatment of symptom clusters rather than single symptoms will improve HRQOL., (© 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Sleep complaints are prevalent and associated with poor health-related quality of life (HRQoL), depression and possibly mortality in dialysis patients. This study aimed to explore possible associations between sleep quality, daytime sleepiness and mortality in dialysis patients. In this study, 301 dialysis patients were followed up to 4.3 years. HRQoL was evaluated at baseline with the Kidney Disease and Quality of Life--Short Form (KDQoL-SF), depression with Beck Depression Inventory (BDI), sleep quality with Pittsburgh Sleep Quality Index and daytime sleepiness with Epworth Sleepiness Scale. The single item "on a scale from 0-10, how would you evaluate your sleep?" in the sleep subscale in KDQoL-SF was used to identify poor (0-5) and good sleepers (6-10). A total of 160 patients (53.3%) were characterized as poor sleepers. They were younger (r = 0.241, P < 0.001), had more depression (BDI: 8.72 ± 6.79 vs. 13.60 ± 8.04, P < 0.001), a higher consumption of hypnotics and antidepressants and reduced HRQoL (Mental Component Summary score: 45.4 ± 11.0 vs. 50.0 ± 10.4, P < 0.001. Physical Component Summary score: 35.0 ± 9.9 vs. 38.5 ± 10.5, P = 0.004). In multivariate analyses, poor sleepers had nearly a twofold increase in mortality risk (hazard ratio [HR] 1.92, confidence interval [CI] 1.10-3.35, P = 0.022). Daytime sleepiness was not related to mortality (HR 1.01, CI 0.95-1.08, P = 0.751). Sleep complaints predicted increased mortality risk in dialysis patients and should therefore be routinely assessed. Further studies are needed to find suitable treatment options for poor sleep in dialysis patients as it may affect both HRQoL and survival., (© 2013 International Society for Hemodialysis.)

Objective: To examine the associations between depressive/anxiety disorders (DAs), perceived health-related quality of life (HRQOL) and mortality in dialysis patients., Methods: Patients were assessed for depressive and DAs with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. The HRQOL was assessed with the Medical Outcome Short Form 36 (MOS SF-36), and the Beck Depression Inventory and Hospital Anxiety and Depression Scale were also applied. Sociodemographic, clinical and laboratory data were also collected., Results: Patients with depressive disorders reported more impaired HRQOL on four of the eight subscales, while those with a depressive disorder comorbid with DA reported more impairment on all MOS SF-36 subscales compared to those without any psychiatric disorder. During the observation period, 50% of those with depression, 28% of those with anxiety and 33% of patients with DA disorder died. A survival analysis did not indicate that patients with depressive or DAs had a higher mortality than patients without such disorders., Conclusion: Dialysis patients with depressive disorders reported impaired HRQOL, whereas those with DAs did not. Patients with DA reported the most serious HRQOL impairment. No evidence was obtained to support the hypothesis that depressive and DAs contributed to compromised survival in dialysis patients. In patients with depression, DAs should also be assessed as they significantly contribute to impaired HRQOL., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: This study explores sleep problems in dialysis patients and the associations to health-related quality of life (HRQoL) and depression. A comparison between different validated sleep questionnaires was done in order to find an appropriate diagnostic tool in clinical practice., Methods: In a cross-sectional study of 301 prevalent dialysis patients, sleep problems were elaborated with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Poor sleep was defined as PSQI score > 5 and daytime sleepiness as ESS > 10. HRQoL, including quality of sleep, was evaluated with the Kidney Disease and Quality of Life - Short Form (KDQoL-SF), and physical (PCS) and mental component summary scores (MCS) were computed. Depression was assessed with Beck Depression Inventory (BDI)., Results: Poor sleep and excessive daytime sleepiness was found in 74.3% and 22.2%, respectively. Depression was common (29.5%) and associated with reduced sleep quality (ρ = 0.49, p < 0.001). Poor sleepers had significantly lower MCS (51.8 ± 9.6 vs. 46.6 ± 10.6, p = 0.001) and PCS (41.8 ± 9.6 vs. 35.2 ± 10.0, p < 0.001) compared to good sleepers. PSQI scores were independently associated with PCS (p = 0.001), but not MCS (p = 0.468) in multivariate analyses. The sleep subscale from KDQoL-SF was strongly correlated to PSQI (r = -0.75, p < 0.001)., Conclusions: As sleep complaints, daytime sleepiness and depression were prevalent, all dialysis patients should routinely be screened for self-perceived sleep problems with a simple Questionnaire.

Background: This study tests the hypotheses that health-related quality of life (HRQOL) in prevalent dialysis patients with diabetes is lower than in dialysis patients without diabetes, and is at least as poor as diabetic patients with another severe complication, i.e. foot ulcers. This study also explores the mortality risk associated with diabetes in dialysis patients., Methods: HRQOL was assessed using the Short Form-36 Health Survey (SF-36), in a cross-sectional study of 301 prevalent dialysis patients (26% with diabetes), and compared with diabetic patients not on dialysis (n = 221), diabetic patients with foot ulcers (n = 127), and a sample of the general population (n = 5903). Mortality risk was assessed using a Kaplan-Meier plot and Cox proportional hazards analysis., Results: Self-assessed vitality, general and mental health, and physical function were significantly lower in dialysis patients with diabetes than in those without. Vitality (p = 0.011) and general health (p <0.001) was impaired in diabetic patients receiving dialysis compared to diabetic patients with foot ulcers, but other subscales did not differ. Diabetes was a significant predictor for mortality in dialysis patients, with a hazard ratio (HR) of 1.6 (95% CI 1.0-2.5) after adjustment for age, dialysis vintage and coronary artery disease. Mental aspects of HRQOL were an independent predictor of mortality in diabetic patients receiving dialysis after adjusting for age and dialysis vintage (HR 2.2, 95% CI 1.0-5.0)., Conclusions: Physical aspects of HRQOL were perceived very low in dialysis patients with diabetes, and lower than in other dialysis patients and diabetic patients without dialysis. Mental aspects predicted mortality in dialysis patients with diabetes. Increased awareness and measures to assist physical function impairment may be particularly important in diabetes patients on dialysis.

Health-related quality of life (HRQOL) and depression in chronic dialysis patients, accepted (n = 122) or rejected (n = 93) for renal transplantation (Tx), were compared, whereas dialysis patients with pending acceptance status (n = 86) were followed for a median time of 3.6 years to assess whether HRQOL or depression predicted the likelihood of receiving a transplant. Clinical significant depression was present in 30% of the study patients. Less depression and better HRQOL were associated with being on the waiting list for Tx after adjusting for comorbidity, age, gender and dialysis vintage. During follow-up, 55% of the dialysis patients in the group with pending acceptance were transplanted. The likelihood of receiving a renal graft was based on comorbidity and not on impaired HRQOL or depression. Follow-up studies should investigate whether improved renal health after Tx translates into further improvement of HRQOL and less depression. Whether clinical depression and impaired HRQOL will impact graft survival needs to be explored., (© 2012 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Background: To assess health- related quality of life (HRQOL) with SF-12 and SF-36 and compare their abilities to predict mortality in chronic dialysis patients, after adjusting for traditional risk factors., Methods: The Short-Form Health Survey (SF-36) with the embedded SF-12 was applied in 301 dialysis patients cross-sectionally. Physical and mental component summary (PCS-36, MCS-36, PCS-12, and MCS-12) scores were calculated. Clinical and demographic data were collected. Mortality (followed for up to 4.5 years) was analyzed with Kaplan Meier plots and Cox proportional hazards, after censoring for renal transplantation. Exclusion factors were observation time <2 months (n = 21) and missing component summary scores (n = 10 for SF-36; n = 28 for SF-12), thus 252 patient were included in the analyses., Results: In 252 patients (60.2 ± 15.5 years, 65.9% males, dialysis vintage 9.0, IQR 5.0-23.0 months), mortality during follow-up was 33.7%.(85 deaths). Significant correlations were observed between PCS-36 and PCS-12 (ρ = 0.93, p < 0.001) and between MCS-36 and MCS-12 (ρ = 0.95, p < 0.001). Mortality rate was highest in patients in the lowest quartile of PCS-12 (χ² = 15.3, p = 0.002) and PCS-36 (χ² = 16.7, p = 0.001). MCS was not associated with mortality. Adjusted hazard ratios for mortality were 2.5 (95% CI 1.0-6.3, PCS-12) and 2.7 (1.1 - 6.4, PCS-36) for the lowest compared with the highest ("best perceived") quartile of PCS., Conclusion: Compromised HRQOL is an independent predictor of poor outcome in dialysis patients. The SF-12 provided similar predictions of mortality as SF-36, and may serve as an applicable clinical tool because it requires less time to complete.

Objective: The study explored health-related quality of life (HRQoL) and depression in a culturally homogeneous dialysis patient population. Furthermore, the associations between HRQoL and depression with current smoking were elaborated., Material and Methods: In a cross-sectional study of 301 dialysis patients from 10 dialysis centres in Norway, HRQoL was evaluated with the Kidney Disease and Quality of Life Short Form, version 1.3. Physical component summary scores (PCS) and mental component summary scores (MCS) were computed. Depression was assessed using the Beck Depression Inventory (BDI), and Cognitive Depression Index (CDI) was calculated. Depression was defined as a BDI score greater than 14., Results: HRQoL was poorer in dialysis patients compared with population norms. Depression was prevalent (33.2%), and differed significantly between smokers and non-smokers (52.8 vs 26.4%, p < 0.001). MCS was significantly reduced in smokers compared with non-smokers (44.1 +/- 12.2 vs 48.7 +/- 10.3, p < 0.001), but there was no difference in PCS (35.7 +/- 10.2 vs 37.1 +/- 10.4, not significant). Current smoking was independently associated with higher BDI score (p = 0.039), as well as with higher CDI score (p = 0.005) and worse score on MCS (p = 0.002), after adjustments for multiple covariates., Conclusions: HRQoL is lower in Norwegian dialysis patients than in the general population, and depression is prevalent. The study suggests that poor perceived mental aspects of HRQoL and depression are associated with current smoking in dialysis patients, but a causal relationship remains to be shown.

Objective: Little is known about health-related quality of life (HRQoL) in non-cardiac chest pain patients with (PD) or without panic disorder (NoPD). The aims of the study were: (1) to compare the HRQoL scores in chest pain patients with and without PD and compare their scores with those from the general population; (2) to compare the 36-item Short Form Health Survey (SF-36) scores of PD patients with those of PD patients in other studies; and (3) to identify predictors of HRQoL., Method: We assessed HRQoL in 167 patients consecutively referred for outpatient investigation of chest pain but who proved to have no cardiac condition (non-cardiac chest pain). HRQoL was assessed with the SF-36 and compared with Norwegian population norms. Factors affecting HRQoL were examined using multiple linear regression models., Results: SF-36 scores were lower in PD patients compared to NoPD patients for all domains. Both groups were significantly more impaired than the normal population. Gender, age, being married, years of education, the sum of chronic illnesses, neuroticism, and the presence of panic disorder and depression symptoms accounted for 17-67% of the variance in three selected SF-36 scales., Conclusions: Non-cardiac chest pain patients reported significantly impaired HRQoL. Chest pain patients with PD exhibited significant impairment, similar to PD patients seeking treatment in psychiatric care. Non-cardiac chest pain patients with PD should therefore be identified and offered treatment.

Aims: The aim was to assess the association between panic disorder (PD) and the long-term outcome of chest pain patients with or without coronary artery disease (CAD)., Methods: Patients (n = 199) consecutively referred to a cardiology outpatient clinic because of chest pain were reassessed after 9 years. At the initial examination 16% suffered from CAD and 38% from PD. Data were collected on mortality, cardiac events, cardiac risk factors, chest pain, anxiety and depression (SCL-90-R), and health-related quality of life (SF-36)., Results: The death rate in the study population was not significantly different from that in the general population and no significant associations were found between PD at baseline and mortality and cardiac morbidity at follow-up. PD was associated with significantly higher follow-up scores of chest pain intensity (p = 0.025), depression (p = 0.005), anxiety (p = 0.039), and poorer health-related quality of life: physical functioning (p = 0.004), role physical (p = 0.001), body pain (p = 0.007), and general health (p < 0.001)., Conclusions: PD has a negative long-term effect on psychological and physical well-being of chest pain patients which emphasizes the necessity of identifying PD patients and offering them adequate treatment.