Social support predicts survival in dialysis patients

Background. Social support is a consistent predictor of survival, as evidenced in empirical studies in patients with cancer or cardiovascular disease. In the area of renal diseases, this topic has not yet been studied extensively. This study, therefore, aimed to investigate the association between social support and survival for patients on dialysis. Methods. Between December 1998 and January 2002, 528 incident haemodialysis (HD) and peritoneal dialysis (PD) patients from multiple centres in The Netherlands were consecutively recruited as part of the NECOSAD-2 study. Patients completed the Social Support List (SSL) at 3 months after the start of dialysis. The SSL measured two aspects of social support: interaction and discrepancy. Cox regression analysis was used to estimate all-cause mortality risk from baseline till censor date on 1 January 2005. Results. Perceiving a discrepancy between expected and received social support was associated with increased mortality: social companionship (RRadj: 1.06, 95% CI: 1.00-1.13), daily emotional support (RRadj: 1.10, 95% CI: 1.02-1.18), and total support (RRadj: 1.02, 95% CI: 1.00-1.04). This association was similar for PD and HD patients. Social support (interaction) was not associated with survival, neither in the whole sample nor when stratified by therapy modality. Conclusions. These results point to the importance of psychosocial risk factors for mortality in patients on dialysis. More efforts are needed to improve support for these patients.