Changes in Health-Related Quality of Life and Home Dialysis Modality Selection in Predialysis
Bibliographic record
Abstract
Background: Patients with advanced chronic kidney disease (CKD) have lower health-related quality of life (HRQOL) than the general population. There are still few data on patterns and predictors of HRQOL changes before dialysis initiation. We aimed to characterize HRQOL trajectory and assess its association with selected dialysis modality in advanced CKD. Methods: In this prospective study, adult with an eGFR ≤15ml/min/1.73m2 completed Kidney Disease Quality of Life-Short Form at baseline and every 6-month until dialysis initiation. Planned dialysis modality, our main exposure, was based on patient's choice, with home dialysis defined as selection of peritoneal dialysis or home hemodialysis. Predictors of changes in KDQOL components, including Physical Component scores (PCS), Mental Component scores (MCS) and Symptoms/Problems of kidney disease (SPKD) were modelled using mixed effect multivariable linear regressions to account for within-patient changes over time. Results: One hundred nine patients were included. Patients selecting home dialysis (n=41) were younger (61±15 vs. 76±11 yrs) and had less cardiovascular disease (34% vs 60%). At baseline, crude PCS (45±10 vs. 39±8) was significantly higher in patients choosing home dialysis, while MCS and SPKD were similar in both groups. (Figure) After adjustment for demographics, comorbidities and psychosocial characteristics, patients choosing home dialysis had an 8-point higher MSC for each year of follow-up (B 8.1 per year, p=0.002) compared to those selecting in-center HD or undecided. Similarly, the decrease in SPKD score through time was attenuate (i.e. lower burden) for patients selecting home dialysis compared to others (B 12.4 per year, p<0.001). These differences were clinically significant considering the minimal important difference of 3-point for this instrument. Conclusions: Patients choosing home dialysis had improved HRQOL scores in predialysis compared to those not selecting home dialysis. More work is needed to determine if differences in process of care (e.g. enhanced multidisciplinary team support) or unmeasured patient characteristics modulate this association.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".