Dialysis patients' health: Poor social support increases risk of early death, worse quality of life, study finds

Kidney disease patients on dialysis often feel stressed because they must take time away from family and friends to undergo treatments. In many cases, they may feel guilty about being ill and be reluctant to ask for support.

Aurélie Untas (Université de Bordeaux, in Bordeaux, France), Christian Combe, MD, PhD (Université de Bordeaux and the Centre Hospitalier Universitaire de Bordeaux), and colleagues investigated the influence of social support on patient survival, adherence to medical recommendations, and quality of life. They analyzed data on 32,332 dialysis patients enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) conducted between 1996 and 2008. (DOPPS is a prospective study of adult dialysis patients randomly selected from 930 dialysis facilities in 12 countries.) Patients answered questions related to social activities, whether they felt isolated, considered themselves burdens, and what kinds of support they received from family and dialysis staff.

Patients who said that their ill health had interfered with social activities, isolated them, or created a burden to family, and who lacked family support, were more likely to die during the study period. These patients were also less likely to follow their doctors' orders (such as controlling weight), maintain dialysis, or possess physical quality of life. Surprisingly, staff encouragement and support did not help patients follow medical orders. The investigators also noted some country-to-country differences; for example, Japanese patients had a particularly high risk of dying during the study if they felt dissatisfied with family support.

"The presence of supportive people who can participate in care is an important source of strength for patients faced with hemodialysis," said Dr. Combe. "These study results raise the possibility that social-support interventions may improve patient care. Such interventions could strengthen other psychosocial factors, improve survival and enhance quality of life."

Study co-authors include Jyothi Thumma, Donna Mapes, Bruce Robinson, MD, Ronald Pisoni PhD (Arbor Research Collaborative for Health); Nicole Rascle (Université de Bordeaux, in Bordeaux, France); Hugh Rayner, MD, FRCP (Birmingham Heartlands Hospital, in Birmingham, the United Kingdom); Antonio Lopes, MD, PhD (Universidade Federal da Bahia, in Salvador, Brazil); Shunichi Fukuhara, MD, DMSc (Kyoto University Graduate School of Medicine and Public Health, in Kyoto, Japan); Tadao Akizawa, MD, PhD (Showa University School of Medicine, in Tokyo, Japan); and Hal Morgenstern, PhD (University of Michigan, School of Public Health).