Prepare; before starting dialysis : outcomes in patients with CKD stage 4-5

This thesis aimed to provide insight in quality of life (QOL) as an outcome in pre-dialysis patients by investigating appropriate ways to measure this construct and by investigating factors affecting QOL. The second aim was to increase the understanding of the different associations between several cardiovascular risk factors and traditional outcomes in pre-dialysis and dialysis patients. In elderly pre-dialysis patients symptoms have a substantial impact on QOL. The effect of symptoms on a relevant outcome measure indicates symptoms which in turn affect other important outcomes, should have a more prominent role in clinical decision making. An appropriate way to measure the construct QOL in pre-dialysis patients with a short questionnaire is by using the SF-12. No association between dyslipidemia and start of dialysis in pre-dialysis patients was found. In pre-dialysis patients, both dual RAS blockade and single ACEi-use were associated with a lower risk of RRT or death, as compared with no RAS blockade. There is no association between vitamin K antagonist use and rate of renal function decline or time until start of dialysis in the pre-dialysis population. Vitamin K-antagonist use compared to no vitamin K-antagonist use is associated with an increased all-cause mortality risk in dialysis patients.