Impact of Prior Kidney Transplantation on Symptom Burden and Health-Related Quality of Life in Incident Dialysis Patients

Abstract

Rationale & Objective: Data on symptom burden and health-related quality of life (HRQoL) in patients with kidney graft failure returning to dialysis are limited. This study therefore assessed these parameters during the first year of dialysis in prior-transplant patients and compared them to transplant-naïve incident dialysis patients. Study Design: Multicenter prospective cohort study: Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO). Setting & Participants: Adult patients who initiated dialysis treatment. Exposure: Prior kidney transplantation or transplant-naïve status. Outcomes: Symptom burden (Dialysis Symptom Index) and HRQoL (Short Form-12) at dialysis initiation and 3, 6, and 12 months later. Analytical Approach: Linear mixed models, adjusted for confounders such as age and comorbid conditions. Results: A total of 161 prior-transplant and 1,475 transplant-naïve patients were included. Symptom burden did not differ between prior-transplant and transplant-naïve patients (mean differences during first year of dialysis treatment: number of symptoms, 0.1 [95% CI, −0.6 to 0.8]; overall symptom severity score, 0.8 [95% CI, −1.5 to 3.0]). However, prior-transplant patients had lower HRQoL scores at dialysis initiation (physical, −2.6 [95% CI, −4.2 to −0.9]; mental, −2.0 [95% CI, −3.7 to −0.3]), which persisted during the first year of dialysis for physical HRQoL (mean difference in first year, −2.1; 95% CI, −3.3 to −0.8). Mental HRQoL was no longer different between prior-transplant and transplant-naïve patients (−0.8; 95% CI, −1.9 to 0.4). Limitations: Detailed data regarding the kidney transplantations were not available. Data on psychosocial counseling and guidance were not collected. Conclusions: We observed lower HRQoL in prior-transplant compared with transplant-naïve patients at dialysis initiation, which may be related to graft rejection and an immunosuppressed state. These findings suggest that patients with graft loss could benefit from additional support to address physical and mental well-being during the transition to dialysis treatment. Plain-language Summary: This study aimed to better understand the challenges faced by kidney transplant patients who return to dialysis after their graft fails. We compared their symptoms and quality of life with those of patients who have never had a transplant. Our findings show that although both groups had similar symptom burdens, prior-transplant patients reported lower physical and mental health at the start of dialysis. By the end of the first year of dialysis treatment, the mental health no longer differed between the 2 groups, but physical health was still lower in prior-transplant patients. In conclusion, the results of this study suggest that prior-transplant patients may benefit from extra support to help manage both their physical and emotional well-being during the transition to dialysis.