Skip to main content

Advertisement

SpringerLink
Log in

Quality of life and dialysis decisions in critically ill patients with acute renal failure

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To determine whether health-related quality of life (HRQL) in survivors of acute renal failure (ARF) occurring in intensive care is predictable from data available at the time of acute illness.

Design and setting

Prospective pilot study in academic intensive care units.

Patients and methods

Patients requiring renal replacement therapy for ARF while in intensive care over a 6-month enrollment period were included. The primary outcome measure was HRQL among survivors 6 months following hospital discharge, as assessed by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and its association with Acute Physiology and Chronic Health Evaluation (APACHE) III score. We also asked survivors whether, in retrospect, they would choose to have dialysis again and what factors influenced this decision.

Results

Ninety-two percent (12/13) of participants surviving 6 months completed the follow-up interview. The mean mental and physical components of the SF-36 were comparable to and slightly lower than the age-matched general population, respectively. There was no correlation between APACHE III score at the time of dialysis initiation and SF-36 score at 6 months. Almost all patients, regardless of their HRQL, stated they would choose dialysis again.

Conclusions

HRQL may not be predictable from data available at the time of dialysis initiation in this population. In retrospect, surviving patients agree with the decision to accept dialysis, even when their HRQL is poor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gopal I, Bhonagiri S, Ronco C, Bellomo R (1997) Out of hospital outcome and quality of life in survivors of combined acute multiple organ and renal failure treated with continuous venovenous hemofiltration/hemodiafiltration. Intensive Care Med 23:766–772

    CAS  PubMed  Google Scholar 

  2. Neveu H, Kleinknecht D, Brivet F, Loirat P, Landais P (1996) Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study. The French Study Group on Acute Renal Failure. Nephrol Dial Transplant 11:293–299

    CAS  Google Scholar 

  3. Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ (1996) Acute renal failure in intensive care units—causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med 24:192–198

    Google Scholar 

  4. Hamel MB, Phillips RS, Davis RB, Desbiens N, Connors AF, Jr., Teno JM, Wenger N, Lynn J, Wu AW, Fulkerson W, Tsevat J (1997) Outcomes and cost-effectiveness of initiating dialysis and continuing aggressive care in seriously ill hospitalized adults. SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. Ann Intern Med 127:195–202

    CAS  PubMed  Google Scholar 

  5. Angus DC, Carlet J (2003) Surviving intensive care: a report from the 2002 Brussels roundtable. Intensive Care Med 29:368–377

    PubMed  Google Scholar 

  6. Clinical practice guideline on shared decision-making in the appropriate initiation of and withdrawal from dialysis. In: Renal Physicians Association and American Society of Nephrology clinical practice guideline, 2000

  7. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A, et al (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636

    CAS  PubMed  Google Scholar 

  8. Douma CE, Redekop WK, van der Meulen JH, van Olden RW, Haeck J, Struijk DG, Krediet RT (1997) Predicting mortality in intensive care patients with acute renal failure treated with dialysis. J Am Soc Nephrol 8:111–117

    CAS  PubMed  Google Scholar 

  9. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    CAS  PubMed  Google Scholar 

  10. Katz S (1983) Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31:721–727

    CAS  PubMed  Google Scholar 

  11. Ware JE (1994) SF-36 Physical and mental health summary scales: a manual for users of version 1

  12. Eddleston JM, White P, Guthrie E (2000) Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 28:2293–2299

    Google Scholar 

  13. Chrispin PS, Scotton H, Rogers J, Lloyd D, Ridley SA (1997) Short Form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire. Anaesthesia 52:15–23

    CAS  PubMed  Google Scholar 

  14. Meyer KB, Espindle DM, DeGiacomo JM, Jenuleson CS, Kurtin PS, Davies AR (1994) Monitoring dialysis patients' health status. Am J Kidney Dis 24:267–279

    CAS  PubMed  Google Scholar 

  15. Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30:2051–2058

    PubMed  Google Scholar 

  16. Korkeila M, Ruokonen E, Takala J (2000) Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care. Intensive Care Med 26:1824–1831

    Article  Google Scholar 

  17. Schiffl H, Lang SM, Fischer R (2002) Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 346:305–310

    Google Scholar 

  18. Tian ZM, Miranda DR (1995) Quality of life after intensive care with the sickness impact profile. Intensive Care Med 21:422–428

    CAS  PubMed  Google Scholar 

  19. Hurel D, Loirat P, Saulnier F, Nicolas F, Brivet F (1997) Quality of life 6 months after intensive care: results of a prospective multicenter study using a generic health status scale and a satisfaction scale. Intensive Care Med 23:331–337

    Article  CAS  Google Scholar 

  20. Chatila W, Kreimer DT, Criner GJ (2001) Quality of life in survivors of prolonged mechanical ventilatory support. Crit Care Med 29:737–742

    CAS  PubMed  Google Scholar 

  21. Short TG, Buckley TA, Rowbottom MY, Wong E, Oh TE (1999) Long-term outcome and functional health status following intensive care in Hong Kong. Crit Care Med 27:51–57

    CAS  PubMed  Google Scholar 

  22. Vazquez Mata G, Rivera Fernandez R, Gonzalez Carmona A, Delgado-Rodriguez M, Torres Ruiz JM, Raya Pugnaire A, Aguayo de Hoyos E (1992) Factors related to quality of life 12 months after discharge from an intensive care unit. Crit Care Med 20:1257–1262

    Google Scholar 

  23. Danis M, Patrick DL, Southerland LI, Green ML (1988) Patients' and families' preferences for medical intensive care. JAMA 260:797–802

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the valuable assistance of Ms. Joanne Smutko in conducting the follow-up interviews.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Sharon E. Maynard

  2. Section of General Internal Medicine, Veteran's Administration Pittsburgh Healthcare System, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Jeffrey Whittle

  3. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Lakshmipathi Chelluri

  4. Leo H. Criep Chair in Patient Care, Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine. Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Robert Arnold

Authors
  1. Sharon E. Maynard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey Whittle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lakshmipathi Chelluri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert Arnold
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sharon E. Maynard.

Additional information

This study was supported by a grant from the General Medicine Housestaff Research Fund of the Veteran's Administation Pittsburgh Healthcare System. Dr. Arnold was supported by the Project on Death in America Faculty Scholars Program, the Greenwall Foundation, Ladies Hospital Aid Society of Western Pennsylvania, the International Union Against Cancer Yamagiwa-Yoshida Memorial International Cancer Study Grant Fellowship, and the LAS Trust Foundation.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maynard, S.E., Whittle, J., Chelluri, L. et al. Quality of life and dialysis decisions in critically ill patients with acute renal failure. Intensive Care Med 29, 1589–1593 (2003). https://doi.org/10.1007/s00134-003-1837-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-003-1837-5

Keywords

Search

Navigation