Longitudinal associations of depressive symptoms and pain with quality of life in patients receiving chronic hemodialysis

Depressive symptoms and pain are common in patients on chronic hemodialysis ( HD ), yet their associations with quality of life ( QOL ) are not fully understood. We sought to characterize the longitudinal associations of these symptoms with QOL . As part of a trial comparing two symptom management strategies in patients receiving chronic HD , we assessed depressive symptoms using the P atient H ealth Q uestionnaire‐9 ( PHQ ‐9), and pain using the S hort F orm M c G ill P ain Q uestionnaire ( SF ‐ MPQ ) monthly over 24 months. We assessed health‐related QOL ( HR ‐ QOL ) quarterly using the S hort F orm 12 ( SF ‐12) and global QOL ( G ‐ QOL ) using a single‐item survey. We used random effects linear regression to analyze the independent associations of depressive symptoms and pain, scaled based on 5‐point increments in symptom scores, with HR ‐ QOL and G ‐ QOL . Overall, 286 patients completed 1417 PHQ ‐9 and SF ‐ MPQ symptom assessments, 1361 SF ‐12 assessments, and 1416 G ‐ QOL assessments. Depressive symptoms were independently and inversely associated with SF ‐12 physical HR ‐ QOL scores (β = −1.09; 95% confidence interval [ CI ]: −1.69, −0.50, P < 0.001); SF ‐12 mental HR ‐ QOL scores (β = −4.52; 95% CI : −5.15, −3.89, P < 0.001); and G ‐ QOL scores (β = −0.64; 95% CI : −0.79, −0.49, P < 0.001). Pain was independently and inversely associated with SF ‐12 physical HR ‐ QOL scores (β = −0.99; 95% CI : −1.30, −0.68, P < 0.001) and G ‐ QOL scores (β = −0.12; 95% CI : −0.20, −0.05, P = 0.002); but not with SF ‐12 mental HR ‐ QOL scores (β = −0.16; 95% CI : −0.050, 0.17, P = 0.34). In patients receiving chronic HD , depressive symptoms and to a lesser extent pain, are independently associated with reduced HR ‐ QOL and G ‐ QOL . Interventions to alleviate these symptoms could potentially improve patients' HR ‐ QOL and G ‐ QOL .