In-Hospital Rehabilitation for Frailty Management May Improve Quality of Life in Patients Receiving Maintenance...

Background Quality of life (QOL) is defined as an individual's perception of his or her position in life in the context of culture and value systems. Previous studies have shown that hemodialysis markedly affects patients' QOL, and health-related QOL has been increasingly recognized as an important medical outcome in patients undergoing maintenance hemodialysis (MHD). Methods A two-week hospitalization program for patients undergoing MHD was introduced in 2023 to evaluate frailty, along with comprehensive geriatric assessment (CGA) and evaluation of motor and oral cavity functions. During this program, QOL was assessed using the Kidney Disease Quality of Life-36 (KDQOL-36) questionnaire, and physical exercise was instructed according to the Japanese Renal Rehabilitation Guideline. After the incidence of each item was determined, the associations between these factors were retrospectively analyzed to identify the specific factors affecting QOL. Results QOL, as determined using the physical component summary (PCS) and mental component summary (MCS), decreased in more than 40% of the enrolled patients. Motor function was often impaired in patients undergoing MHD. In univariate analyses, the PCS score was strongly correlated with seven variables, including lower-limb strength/body weight (%), gait speed (5 m), the 6-minute walk test (6MWT), the Short Physical Performance Battery (SPPB), the Eating Assessment Tool-10 (EAT-10) score, the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence, and the Geriatric Depression Scale-15 (GDS-15) score, but not with age, sex, dialysis duration, primary disease, comorbidities, or nutritional status. For the MCS, only gait speed (m/s) and the GDS-15 score were significantly correlated. In the multivariate analysis, the PCS score remained independently associated with the 6MWT (β = 0.0727, p = 0.0109) and GDS-15 score (β = -2.14, p = 0.0068), whereas the GDS-15 score was the sole independent determinant of the MCS score (β = -2.81, p = 0.0047). Conclusions A decline in physical function was commonly observed in patients undergoing MHD. Among the KDQOL components, the PCS score worsened with decreasing motor function, especially walking ability. Moreover, depressive symptoms appeared to significantly impact QOL in this population. These findings suggest that physical exercise guidance provided to patients according to the Japanese Renal Rehabilitation Guideline, referred to as Japanese rehabilitation, may be helpful for enhancing the overall QOL of patients undergoing MHD through the dual action of improving walking ability and alleviating depressive symptoms.