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Wu M, Li MT, Zhang LP, Wei D, Han YC, Gao M. The impact of vascular access satisfaction on health-related quality of life in patients receiving maintenance hemodialysis: A 2-year follow-up study. J Vasc Access 2024; 25:1467-1473. [PMID: 36971399 DOI: 10.1177/11297298231163224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) has been demonstrated to predict mortality in patients receiving maintenance hemodialysis (MHD). Vascular access (VA) is critical for MHD patients. The aim of this study was to investigate the change in HRQoL among MHD patients with a 2-year follow-up and to explore the impact of VA satisfaction on HRQoL in this population. METHODS 229 MHD patients in two dialysis centers were included in this observational prospective study. VA satisfaction was assessed using the Vascular Access Questionnaire (VAQ). The 36 Item Short-Form Health Survey (SF-36) questionnaire was employed to evaluate HRQoL scores. Multiple logistic regression analysis was used to evaluate the influencing factors of HRQoL. RESULTS A total of 229 MHD patients were enrolled in the study, and 198 individuals (86.46%) completed the 2-year follow-up. HRQoL decreased statistically significantly from baseline to the 2-year follow-up across all dimensions. Multivariable analyses showed that the overall score, social functioning score, dialysis-related complication score of VAQ influenced HRQoL in the study population. Furthermore, HRQoL total scores and scores on the physical component summary (PCS) and mental component summary (MCS) domains were significantly higher in the satisfied VA group than in the dissatisfied group at baseline. After the 2-year follow-up, patients with a higher level of VA satisfaction reported higher HRQoL than patients with lower VA satisfaction. CONCLUSION Our data suggested that VA satisfaction was significantly associated with HRQoL in MHD patients. These findings imply that surgeons and nephrologists should incorporate patient satisfaction into VA surgical decision-making.
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Affiliation(s)
- Min Wu
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing City, China
| | - Meng-Ting Li
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing City, China
| | - Liu-Ping Zhang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing City, China
| | - Dong Wei
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing City, China
| | - Yu-Chen Han
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing City, China
| | - Min Gao
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing City, China
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Tarca B, Jesudason S, Bennett PN, Wycherley TP, Ferrar KE. Modifiable Physical Factors That Influence Physical Function for People Receiving Peritoneal Dialysis. Kidney Int Rep 2024; 9:1298-1309. [PMID: 38707811 PMCID: PMC11068959 DOI: 10.1016/j.ekir.2024.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/13/2023] [Accepted: 01/29/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction People receiving peritoneal dialysis experience physical function decline, impairing their ability to complete everyday activities, leading to poorer quality of life. Physical factors, including cardiorespiratory fitness, muscle strength, physical activity, and sedentary behavior are associated with physical function. However, little is known about this relationship, or temporal changes of these factors in this cohort. This study aimed to explore modifiable physical factors that are associated with physical function, identify which factor has the strongest influence, and explore temporal changes. Methods Adults receiving peritoneal dialysis underwent objective and self-reported physical function, cardiorespiratory fitness, muscle strength, physical activity and sedentary behavior assessments 3 times over a 12-month observation period (at baseline, 6 months, and 12 months). Results Eighty-two participants underwent assessments. All modifiable physical factors were predominantly moderate to strongly associated with physical function at baseline. Cardiorespiratory fitness had the strongest and most consistent influence with every meter conferring a 0.08-unit (P < 0.01) and 0.01-unit (P < 0.05) increase in self-report and objective physical function score, respectively. Temporal changes were observed for modifiable physical factors with significant mean changes in cardiorespiratory fitness (-9.8%), quadricep strength (-5%), moderate-to-vigorous (-25.9%) and total (-16.2%) physical activity, and sedentary behavior (+7.1%). Conclusion The results of this study indicate that cardiorespiratory fitness could be routinely monitored to detect risk of physical function decline and targeted through intervention to enhance physical function for people receiving peritoneal dialysis. Nevertheless, all factors should be considered when designing interventions to mitigate temporal changes and induce the numerous health benefits offered by being physically active.
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Affiliation(s)
- Brett Tarca
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service Clinical Research Group, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Paul N. Bennett
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Medical and Clinical Affairs, Satellite Healthcare, San Jose, California, USA
| | - Thomas P. Wycherley
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Katia E. Ferrar
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Ritschl V, Stamm T, Selzer A, Boesendorfer A, Eibensteiner F, Kaltenegger L, Mosor E, Omara M, Vachuda N, Sperl L, Masel EK, Aufricht C, Boehm M. Life outcomes after paediatric kidney transplantation: a qualitative, biographical study in long-term survivors. Arch Dis Child 2024; 109:240-246. [PMID: 38212079 PMCID: PMC10894829 DOI: 10.1136/archdischild-2023-326432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The objective of this study was to analyse the narrative life stories of children with end-stage kidney disease (ESKD) and their families to determine how health professionals can effectively support these children to achieve better life outcomes. DESIGN Qualitative narrative biographic study. SETTING We invited every long-term survivor of paediatric kidney transplants and their families at the Medical University of Vienna between 2008 and 2013 to participate in this study. PARTICIPANTS Nineteen patients (women: n=8, 42%) and 34 family members (women: n=22, 65%) were interviewed. The patients had a mean age of 7.6 (SD±5.6) years at the time of transplantation and 22.2 (SD±5.4) at the time of interview. MAIN OUTCOMES MEASURES A qualitative narrative biographical analysis was combined with computational structured topic models using the Latent Dirichlet Allocation. RESULTS The overarching finding was the desire for normality in daily life in long-term survivors and their families but with different perceptions of what normality looks like and predominance of this aspect evolving. Different strategies were used by patients (focused on their advancement) and caregivers (normality for all family members). Siblings played a major role in supporting survivors' social inclusion. CONCLUSIONS The strong desire for normality confirms recent findings of the Standardised Outcomes in Nephrology Group initiative, which proposes survival and life participation as core outcomes in children with chronic kidney disease. Our study should be a starting point for an international effort to identify typologies and stratified interventions for children with ESKD and their families, particularly siblings.
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Affiliation(s)
- Valentin Ritschl
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Tanja Stamm
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Axana Selzer
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Anna Boesendorfer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Wien, Austria
| | - Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Lukas Kaltenegger
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Erika Mosor
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Maisa Omara
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
| | - Natalie Vachuda
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Lisa Sperl
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Eva K Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Wien, Austria
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Michael Boehm
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
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Ali I, Haddad D, Soliman MA, Al-Sabi A, Jebreen K, Abuzahra D, Shrara B, Ghanayem D, Natour N, Hassan M, Alsedfy MY, Shellah D, Nawajah I. Quality of life and nutritional status in peritoneal dialysis patients: a cross-sectional study from Palestine. BMC Nephrol 2024; 25:20. [PMID: 38216880 PMCID: PMC10787467 DOI: 10.1186/s12882-023-03422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/03/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) is a growing cause of morbidity worldwide. Protein malnutrition is common among patients with ESRD. Peritoneal dialysis (PD) offers greater lifestyle flexibility and independence compared to the widely used treatments for ESRD. This study aimed to assess the nutritional status and the quality of life (QOL) of Palestinian patients undergoing PD, as well as the variables affecting these two outcomes. METHODS A cross-sectional study was conducted on patients receiving PD at An-Najah National University Hospital, Palestine. The malnutrition-inflammation scale (MIS) was used to measure malnutrition, and the QOL score was evaluated using the Dutch WHOQOL-OLD module. Univariate and multivariate linear regressions were performed to check the association between the QOL and MIS scores. RESULTS The study included 74 patients who were undergoing PD, with an average age of 50.5 ± 16.38. The majority of the patients were females. The study found a significant correlation between malnutrition and lower quality of life (QOL) scores, as measured by the WHOQOL-OLD questionnaire (p < 0.001). Furthermore, younger patients and those who had an occupation were more likely to report a good QOL (p = 0.01). Conversely, patients with pitting edema and diabetes were at higher risk of reporting a lower QOL (p < 0.001). CONCLUSIONS Given the elevated risk of malnutrition and diminished QOL among elderly patients, those with pitting edema, and individuals with diabetes, it is imperative to conduct thorough assessments for these groups. We strongly recommend that general practitioners, dietitians, and specialists collaborate to develop tailored programs and interventions to provide these patients with the focused care and attention they require.
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Affiliation(s)
- Iyad Ali
- Department of Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Dania Haddad
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Dasman, 15462, Kuwait
| | | | - Ahmed Al-Sabi
- College of Engineering and Technology, American University of the Middle East, Egaila, 54200, Kuwait
| | - Kamel Jebreen
- Unité de Recherche Clinique Saint-Louis Fernand-Widal Lariboisière, APHP, Paris, France
- Department of Mathematics, An-Najah National University, Nablus, Palestine
- Department of Mathematics, Palestine Technical University Kadoorie, Hebron, Palestine
| | - Dana Abuzahra
- Department of Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Bakrieh Shrara
- Department of Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Diana Ghanayem
- Department of Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nihal Natour
- Department of Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mohanad Hassan
- Department of Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - M Yasser Alsedfy
- Alexandria University Cancer Research Cluster, 21561, Alexandria, Egypt
| | - Duha Shellah
- Department of Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Inad Nawajah
- Department of Mathematics, College of Science and Technology, Hebron University, Hebron, Palestine
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Meyer TW, Bargman JM. The Removal of Uremic Solutes by Peritoneal Dialysis. J Am Soc Nephrol 2023; 34:1919-1927. [PMID: 37553867 PMCID: PMC10703087 DOI: 10.1681/asn.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] Open
Abstract
ABSTRACT Peritoneal dialysis (PD) is now commonly prescribed to achieve target clearances for urea or creatinine. The International Society for Peritoneal Dialysis has proposed however that such targets should no longer be imposed. The Society's new guidelines suggest rather that the PD prescription should be adjusted to achieve well-being in individual patients. The relaxation of treatment targets could allow increased use of PD. Measurement of solute levels in patients receiving dialysis individualized to relieve uremic symptoms could also help us identify the solutes responsible for those symptoms and then devise new means to limit their accumulation. This possibility has prompted us to review the extent to which different uremic solutes are removed by PD.
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Affiliation(s)
- Timothy W. Meyer
- Departments of Medicine, Stanford University and VA Palo Alto HCS, Palo Alto, California
| | - Joanne M. Bargman
- Division of Nephrology and Department of Medicine, University Health Network and the University of Toronto, Canada
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Aljenaidi H, Alayoobi L, Alqassab W, Alfehaid A, Albuainain M, AlMuhanadi R, Alotaibi S, Almutiri M, Jaradat A, El-Agroudy AE. Quality of Life in Hemodialysis Versus Peritoneal Dialysis Patients in Bahrain. Cureus 2023; 15:e49408. [PMID: 38149127 PMCID: PMC10750137 DOI: 10.7759/cureus.49408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION Chronic diseases, including chronic kidney disease, affect patients' quality of life (QOL). Hemodialysis (HD) and peritoneal dialysis (PD) are renal replacement methods in these patients. This work aimed to study the relationship between QOL scores in patients with end-stage renal disease (ESRD) on HD and PD. METHODS This study was done at Salmaniya Medical Complex (SMC), Bahrain, from May to July 2023. A standard QOL index score instrument in Arabic form was used on 76 HD and 38 PD patients. The inclusion criteria included dialysis for at least three months and an age of more than 18 years with no severe morbidities or psychological diseases. RESULTS The mean age of HD and PD patients was 58.7 ± 11.2 and 55.9 ± 12.1 years, respectively. Thirty-five (46.1%) of the HD patients and 17 (44.7%) of the PD patients were females. In most dimensions, the QOL score of the patients treated with PD was better than that of the HD group. The number of hospital admissions was statistically significantly higher in the HD group (p = 0.007); however, there was no significant difference in the causes of admissions (p = 0.131). In this study, we observed the highest QOL score in the family subscale (93.2 ± 9.2 and 98.6 ± 4.7), followed by the psychological/spiritual subscale (81.1 ± 16.7 and 97.6 ± 3.9) in the HD and PD groups, respectively), but it was statistically significantly higher in the PD group (p < 0.001). CONCLUSION Our findings show that patients starting PD had better QOL scores in all domains than patients starting HD. Moreover, patients on PD maintained more active social support and ultimately felt better emotional well-being and physical health than those undergoing HD.
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Affiliation(s)
| | | | | | - Ali Alfehaid
- Internal Medicine, Arabian Gulf University, Manama, BHR
| | | | | | - Saad Alotaibi
- Internal Medicine, Arabian Gulf University, Manama, BHR
| | | | - Ahmed Jaradat
- Family and Community Medicine, Arabian Gulf University, Manama, BHR
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Haapio M, van Diepen M, Steenkamp R, Helve J, Dekker FW, Caskey F, Finne P. Predicting mortality after start of long-term dialysis-International validation of one- and two-year prediction models. PLoS One 2023; 18:e0280831. [PMID: 36812268 PMCID: PMC9946236 DOI: 10.1371/journal.pone.0280831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Mortality prediction is critical on long-term kidney replacement therapy (KRT), both for individual treatment decisions and resource planning. Many mortality prediction models already exist, but as a major shortcoming most of them have only been validated internally. This leaves reliability and usefulness of these models in other KRT populations, especially foreign, unknown. Previously two models were constructed for one- and two-year mortality prediction of Finnish patients starting long-term dialysis. These models are here internationally validated in KRT populations of the Dutch NECOSAD Study and the UK Renal Registry (UKRR). METHODS We validated the models externally on 2051 NECOSAD patients and on two UKRR patient cohorts (5328 and 45493 patients). We performed multiple imputation for missing data, used c-statistic (AUC) to assess discrimination, and evaluated calibration by plotting average estimated probability of death against observed risk of death. RESULTS Both prediction models performed well in the NECOSAD population (AUC 0.79 for the one-year model and 0.78 for the two-year model). In the UKRR populations, performance was slightly weaker (AUCs: 0.73 and 0.74). These are to be compared to the earlier external validation in a Finnish cohort (AUCs: 0.77 and 0.74). In all tested populations, our models performed better for PD than HD patients. Level of death risk (i.e., calibration) was well estimated by the one-year model in all cohorts but was somewhat overestimated by the two-year model. CONCLUSIONS Our prediction models showed good performance not only in the Finnish but in foreign KRT populations as well. Compared to the other existing models, the current models have equal or better performance and fewer variables, thus increasing models' usability. The models are easily accessible on the web. These results encourage implementing the models into clinical decision-making widely among European KRT populations.
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Affiliation(s)
- Mikko Haapio
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jaakko Helve
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fergus Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Helsinki, Finland
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Abstract
The practice and clinical outcomes of peritoneal dialysis (PD) have demonstrated significant improvement over the past 20 years. The aim of this review is to increase awareness and update healthcare professionals on current PD practice, especially with respect to patient and technique survival, patient modality selection, pathways onto PD, understanding patient experience of care and use prior to kidney transplantation. These improvements have been impacted, at least in part, by greater emphasis on shared decision-making in dialysis modality selection, the use of advanced laparoscopic techniques for PD catheter implantation, developments in PD connecting systems, glucose-sparing strategies, and modernising technology in managing automated PD patients remotely. Evidence-based clinical guidelines such as those prepared by national and international societies such as the International Society of PD have contributed to improved PD practice underpinned by a recognition of the place of continuous quality improvement processes.
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Affiliation(s)
- Ayman Karkar
- Medical Affairs - Renal Care, Scientific Office, Baxter A.G., Dubai, United Arab Emirates
| | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, UK
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Impact of malnutrition on health-related quality of life in persons receiving dialysis: a prospective study. Br J Nutr 2022; 127:1647-1655. [PMID: 34218825 PMCID: PMC9201831 DOI: 10.1017/s000711452100249x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Health-related quality of life (HRQoL) is severely impaired in persons receiving dialysis. Malnutrition has been associated with some measures of poor HRQoL in cross-sectional analyses in dialysis populations, but no studies have assessed the impact of malnutrition and dietary intake on change in multiple measures of HRQoL over time. We investigated the most important determinants of poor HRQoL and the predictors of change in HRQoL over time using several measures of HRQoL. We enrolled 119 haemodialysis and thirty-one peritoneal dialysis patients in this prospective study. Nutritional assessments (Subjective Global Assessment (SGA), anthropometry and 24-h dietary recalls) and HRQoL questionnaires (Short Form-36 (SF-36) mental (MCS) and physical component scores (PCS) and European QoL-5 Dimensions (EQ5D) health state (HSS) and visual analogue scores (VAS)) were performed at baseline, 6 and 12 months. Mean age was 64 (14) years. Malnutrition was present in 37 % of the population. At baseline, malnutrition assessed by SGA was the only factor independently (and negatively) associated with all four measures of HRQoL. No single factor was independently associated with decrease in all measures of HRQoL over 1 year. However, prevalence/development of malnutrition over 1 year was an independent predictor of 1-year decrease in EQ5D HSS, and 1-year decrease in fat intake independently predicted the 1-year decline in SF-36 MCS and PCS, and EQ5D VAS. These findings strengthen the importance of monitoring for malnutrition and providing nutritional advice to all persons on dialysis. Future studies are needed to evaluate the impact of nutritional interventions on HRQoL and other long-term outcomes.
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Nowicka M, Górska M, Edyko K, Szklarek-Kubicka M, Kazanek A, Prylińska M, Niewodniczy M, Kostka T, Kurnatowska I. Association of Physical Performance, Muscle Strength and Body Composition with Self-Assessed Quality of Life in Hemodialyzed Patients: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11092283. [PMID: 35566409 PMCID: PMC9103996 DOI: 10.3390/jcm11092283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/26/2022] [Accepted: 04/04/2022] [Indexed: 12/03/2022] Open
Abstract
(1) Patients on chronic hemodialysis (HD) experience impaired quality of life (QoL). We analyzed HD’s relationship with physical performance, body composition, and muscle strength; (2) QoL was assessed with the Short Form-36, composed of physical (PCS) and mental (MCS) health dimensions. Physical performance was assessed with the Short Physical Performance Battery (SPPB), body composition (lean tissue mass% (LTM%), fat tissue mass% (FTM%), and skeletal muscle mass% (SMM%)) was assessed with bioelectrical impedance, and lower extremity strength was assessed with a handheld dynamometer; and (3) we enrolled 76 patients (27 F, 49 M), age 62.26 ± 12.81 years, HD vintage 28.45 (8.65−77.49) months. Their QoL score was 53.57 (41.07−70.64); their PCS and MCS scores were 52.14 (38.69−65.95) and 63.39 (44.64−76.79) and strongly correlated (p < 0.0001, R = 0.738). QoL correlated positively with SPPB (R = 0.35, p ≤ 0.001), muscle strength (R from 0.21 to 0.41, p < 0.05), and LTM% (R = 0.38, p < 0.001) and negatively with FTM% (R = −0.32, p = 0.006). PCS correlated positively with SPPB (R = 0.42 p < 0.001), muscle strength (R 0.25−0.44, p < 0.05), and LTM% (R = 0.32, p = 0.006) and negatively with FTM% (R = −0.25, p = 0.031). MCS correlated positively with SPPB (R = 0.23, p = 0.047), SMM% (R = 0.25; p = 0.003), and LTM% (R = 0.39, p < 0.001) and negatively with FTM% (R = −0.34; p = 0.003). QoL was unrelated to sex (p = 0.213), age (p = 0.157), HD vintage (p = 0.156), and BMI (p = 0.202); (4) Better physical performance, leaner body composition, and higher muscle strength are associated with better mental and physical QoL in HD.
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Affiliation(s)
- Maja Nowicka
- Department of Internal Medicine and Transplant Nephrology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Monika Górska
- Department of Internal Medicine and Transplant Nephrology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Krzysztof Edyko
- Department of Internal Medicine and Transplant Nephrology, Medical University of Lodz, 90-153 Lodz, Poland
| | | | - Adam Kazanek
- Therapeutic Rehabilitation Outpatient Clinic, Medical Center Lodz Baluty, 91-745 Lodz, Poland
| | - Malwina Prylińska
- Therapeutic Rehabilitation Outpatient Clinic, Medical Center Lodz Baluty, 91-745 Lodz, Poland
| | - Maciej Niewodniczy
- Rehabilitation Department, Norbert Barlicki Memorial Teaching Hospital No. 1, 90-153 Lodz, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Healthy Ageing Research Center, Medical University of Lodz, 90-647 Lodz, Poland
| | - Ilona Kurnatowska
- Department of Internal Medicine and Transplant Nephrology, Medical University of Lodz, 90-153 Lodz, Poland
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Manns BJ, Garg AX, Sood MM, Ferguson T, Kim SJ, Naimark D, Nesrallah GE, Soroka SD, Beaulieu M, Dixon SN, Alam A, Allu S, Tangri N. Multifaceted Intervention to Increase the Use of Home Dialysis: A Cluster Randomized Controlled Trial. Clin J Am Soc Nephrol 2022; 17:535-545. [PMID: 35314481 PMCID: PMC8993468 DOI: 10.2215/cjn.13191021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Home dialysis therapies (peritoneal and home hemodialysis) are less expensive and provide similar outcomes to in-center hemodialysis, but they are underutilized in most health systems. Given this, we designed a multifaceted intervention to increase the use of home dialysis. In this study, our objective was to evaluate the effect of this intervention on home dialysis use in CKD clinics across Canada. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a cluster randomized controlled trial in 55 CKD clinic clusters in nine provinces in Canada between October 2014 and November 2015. Participants included all adult patients who initiated dialysis in the year following the intervention. We evaluated the implementation of a four-component intervention, which included phone surveys from a knowledge translation broker, a 1-year center-specific audit/feedback on home dialysis use, delivery of an educational package (including tools aimed at both providers and patients), and an academic detailing visit. The primary outcome was the proportion of patients using home dialysis at 180 days after dialysis initiation. RESULTS A total of 55 clinics were randomized (27 in the intervention and 28 in the control), with 5312 patients initiating dialysis in the 1-year follow-up period. In the primary analysis, there was no difference in the use of home dialysis at 180 days in the intervention and control clusters (absolute risk difference, 4%; 95% confidence interval, -2% to 10%). Using a difference-in-difference comparison, the use of home dialysis at 180 days was similar before and after implementation of the intervention (difference of 0% in intervention clinics; 95% confidence interval, -2% to 3%; difference of 0.8% in control clinics; 95% confidence interval, -1% to 3%; P=0.84). CONCLUSIONS A multifaceted intervention did not increase the use of home dialysis in adults initiating dialysis. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER A Cluster Randomized Trial to Assess the Impact of Patient and Provider Education on Use of Home Dialysis, NCT02202018.
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Affiliation(s)
- Braden J Manns
- Department of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Public Health Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Manish M Sood
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas Ferguson
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S Joseph Kim
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - David Naimark
- Division of Nephrology, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
| | - Gihad E Nesrallah
- Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Steven D Soroka
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Monica Beaulieu
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie N Dixon
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Ahsan Alam
- Division of Nephrology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Selina Allu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Navdeep Tangri
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
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12
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Waheed H, Farrukh S, Hussain A, Mukhtar A, Mubashir M, Saqib S, Ullah S, Peter AP, Khoo KS, Show PL. Green synthesized nano-cellulose polyethylene imine-based biological membrane. Food Chem Toxicol 2021; 160:112773. [PMID: 34953965 DOI: 10.1016/j.fct.2021.112773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/30/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022]
Abstract
In hemodialysis process, membrane serves as a barrier between blood and the dialysate. The barrier when contacted by blood accompanied activation of coagulation, immunity, and cellular passageways. In the recent years, hemodialysis membrane's biocompatibility has become a issue which leads to reduce the performance during the separation process. In previous work, we developed and evaluated a cellulose-based membrane blended with polyaziridine or polyetyleneimine in formic acid for hydrophilicity, pure water flux, surface morphology, and permeation efficiency. Biocompatibility was accessed, by conducting cellular viability and cellular attachments tests. In this study, the membrane compared to a non-treated control, and cell viability revealed active and growing cell cultures after 14 days. During the cellular attachment experiment, cell cultures attached to the fabricated membrane simulated the formation of cell junctions, proving that the membrane is non-toxic and biocompatible. CA + PEI + FA membrane tested with a blood mimic fluid having density identical to renal patient's blood. The BSA concentration in the feed solution was the same as that in the blood of the renal patient. The results revealed that the CA + PEI + FA membrane was able to reject 99% bovine serum albumin (BSA) and 69.6% urea. Therefore, from biocompatibility and blood mimic fluid testing, it is confirmed that the CA + PEI + FA membrane is the finest implant for dialysis applications.
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Affiliation(s)
- Hizba Waheed
- Department of Chemical Engineering, Wah Engineering College, University of Wah, Wah Cantt, Pakistan
| | - Sarah Farrukh
- School of Chemical and Materials Engineering (SCME), National University of Sciences and Technology (NUST), Islamabad, Pakistan.
| | - Arshad Hussain
- Department of Chemical Engineering, Pak-Austria Fachhochschule, IAST, KPK, Pakistan
| | - Amir Mukhtar
- School of Chemical and Materials Engineering (SCME), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Muhammad Mubashir
- Department of Petroleum Engineering, School of Engineering, Asia Pacific University of Technology and Innovation, 57000, Kuala Lumpur, Malaysia
| | - Sidra Saqib
- Department of Chemical Engineering, COMSATS University Islamabad, Lahore Campus, 54000, Pakistan
| | - Sami Ullah
- Department of Chemistry, King Khalid University, Abha, Saudi Arabia
| | - Angela Paul Peter
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, Semenyih, 43500, Selangor Darul Ehsan, Malaysia
| | - Kuan Shiong Khoo
- Faculty of Applied Sciences, UCSI University, UCSI Heights, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Pau Loke Show
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, Semenyih, 43500, Selangor Darul Ehsan, Malaysia.
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13
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Bauer A, Blanchette E, Taylor Zimmerman C, Wightman A. Caregiver burden in pediatric dialysis: application of the Paediatric Renal Caregiver Burden Scale. Pediatr Nephrol 2021; 36:3945-3951. [PMID: 34128095 DOI: 10.1007/s00467-021-05149-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/19/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Caring for a child with kidney failure on dialysis profoundly impacts caregivers' lives, yet the depth of this burden is not well understood. The Paediatric Renal Caregiver Burden Scale (PR-CBS) is a recently validated instrument used to measure caregiver burden in this population. METHODS We performed a cross-sectional study of caregiver burden for caregivers of children with kidney failure receiving dialysis at three pediatric centers. Caregivers completed the PR-CBS instrument as part of a larger qualitative study of caregiver experience. We performed descriptive statistics. T-tests were used to examine differences between dialysis modality and within key demographics. Multivariate linear regression was utilized to assess associations between significant factors and total score. RESULTS Ten caregivers of children receiving peritoneal dialysis (PD) and 21 receiving hemodialysis (HD) participated. Total burden score and mean score for every domain was higher for caregivers of children on HD compared to PD. PR-CBS score was significantly associated with younger child age and married status in caregivers. In adjusted multivariate analysis, dialysis modality and married marital status were significantly associated with PR-CBS score. CONCLUSIONS This study found that dialysis caregivers experience significant caregiver burden and demonstrates the utility of the PR-CBS in an American population. We found higher burdens among HD caregivers, younger children, and married caregivers. While these findings must be replicated on a larger scale, they suggest possible areas for targeted interventions to improve the quality of life of children with kidney failure and their families. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Abbie Bauer
- Department of Pediatrics, Division of Nephrology, Oregon Health and Science University, Portland, OR, USA.
| | - Eliza Blanchette
- Department of Pediatrics, Division of Nephrology, University of Colorado, Aurora, CO, USA
| | - Cortney Taylor Zimmerman
- Baylor College of Medicine Department of Pediatrics, Houston, TX, USA.,Texas Children's, Renal Service and Psychology Section, Houston, TX, USA
| | - Aaron Wightman
- Department of Pediatrics, Division of Nephrology, University of Washington, Seattle, WA, USA
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14
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Hejazi SS, Hosseini M, Ebadi A, Alavi Majd H. Components of quality of life in hemodialysis patients from family caregivers' perspective: a qualitative study. BMC Nephrol 2021; 22:379. [PMID: 34774021 PMCID: PMC8590210 DOI: 10.1186/s12882-021-02584-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with end-stage kidney disease experience serious complications which affect their lives. Few studies have investigated the patients' quality of life qualitatively from the perspective of family caregivers as the closest individuals to the patients. The family caregivers are directly involved in the patients' disease progression and observe the changes, problems, and complications of disease and hemodialysis. This study aimed to explain the components of quality of life in hemodialysis patients from the family caregivers' perspective. METHODS In this qualitative inductive content analysis, 16 family caregivers of hemodialysis patients, presenting to the teaching hospitals of Tehran, Iran, were enrolled via maximum-variation purposive sampling; sampling continued until reaching data saturation. The data collection method included in-depth semi-structured interviews. Also, an inductive content analysis was carried out based on Elo and Kyngas' method. RESULTS A total of 311 codes, 19 subcategories, eight generic categories, and three main categories were extracted in this study. The main (and the generic categories) included mental and psychological problems (depressive mood, incompatibility and reduced tolerance, mental exhaustion, and deprivation of basic needs), social disruption (social isolation and social threats), and physical problems (general complications and disabilities and defects in the normal functioning of organs). CONCLUSION Family caregivers can be valuable information sources for formal caregivers to plan treatment for chronically ill patients who are mainly cared for at home. The present results can help us increase the existing knowledge on the impact of end-stage kidney disease and hemodialysis on the patients' quality of life. It seems that addressing the issues related to quality of life, mentioned by the caregivers, can positively affect the patients' quality of life and even reduce the caregivers' burden.
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Affiliation(s)
- Sima Sadat Hejazi
- Ph.D. Student in Nursing, Student Research Committee, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meimanat Hosseini
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali Asr Ave., Niayesh Cross Road, Niayesh Complex, Tehran, Iran.
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Chrifi Alaoui A, Touti W, Al Borgi Y, Sqalli Houssaini T, El Rhazi K. Comparison of quality of life in end-stage renal disease patients undergoing hemodialysis and peritoneal dialysis in a Moroccan city. Semin Dial 2021; 35:50-57. [PMID: 34704278 DOI: 10.1111/sdi.13034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE End-stage renal disease patients (ESRD) generally complain about a poor quality of life (QOL). The current study aims to describe and compare ESRD patients' QOL according to dialysis modalities (hemodialysis [HD] and peritoneal dialysis [PD]). METHODS This is a cross-sectional study, conducted in dialysis facilities of a Moroccan university hospital, during October 2018. All adult ESRD patients, treated either by HD or PD for more than 3 months and agreeing to participate, were included. Medical data were collected using a questionnaire, whereas the QOL data were collected using the Kidney Disease Quality of Life Short Form (KDQOL SF v 1.3) scale previously validated in dialectal Arabic. The patients' characteristics and QOL data were compared between dialysis modalities (HD vs. PD), using a linear regression, before and after adjustment on several demographic and medical factors as well as a propensity score created to reduce the effect of confounding factors related to the choice of the treatment. RESULTS Out of the 91 included patients (50.5% of men, median age 52.0 (IQR [36.5; 62.0]) years), 71 were on HD and 20 were on PD. The highest subscale score, for all participants, was the social support's one with a median of 83.3 (IQR [66.7; 100]), and the lowest one was the kidney disease burden with a median of 25.0 (IQR [0.00; 46.9]). The univariate analysis showed that the Physical Component Score (PCS), the cognitive function, and the dialysis staff encouragement were better in PD patients (p = 0.03, p = 0.04, and p = 0.007, respectively), while the multiple linear regression indicates that the PCS, the dialysis Staff encouragement, and the patient's satisfaction subscores decreased within patients on HD compared with those on PD (p = 0.01, p = 0.03, and p = 0.02, respectively) and that the burden of the kidney disease and the work status subscores increased within patients on HD against those on PD (p = 0.007 and p = 0.04, respectively). CONCLUSION This study showed a significant difference between dialysis modalities in some sides of quality of life.
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Affiliation(s)
- Amina Chrifi Alaoui
- Department of Epidemiology, Clinical Research and Biostatistics, Faculty of Medicine and Pharmacy, Fez, Morocco
| | - Wiam Touti
- Department of Nephrology and Hemodialysis, Hassan II University Hospital, Fez, Morocco
| | - Yassine Al Borgi
- Department of Nephrology and Hemodialysis, Hassan II University Hospital, Fez, Morocco
| | - Tarik Sqalli Houssaini
- Department of Nephrology and Hemodialysis, Hassan II University Hospital, Fez, Morocco.,Laboratory of Epidemiology and Health Sciences' Researches (ERESS), Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Karima El Rhazi
- Department of Epidemiology, Clinical Research and Biostatistics, Faculty of Medicine and Pharmacy, Fez, Morocco.,Laboratory of Epidemiology and Health Sciences' Researches (ERESS), Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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16
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Tommel J, Evers AWM, van Hamersvelt HW, Jordens R, van Dijk S, Hilbrands LB, van Middendorp H. Predicting health-related quality of life in dialysis patients: Factors related to negative outcome expectancies and social support. PATIENT EDUCATION AND COUNSELING 2021; 104:1474-1480. [PMID: 33293180 DOI: 10.1016/j.pec.2020.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Dialysis patients report a low health-related quality of life (HRQOL) due to high disease burden and far-reaching consequences of dialysis treatment. This study examined several cognitive-behavioral and social factors, with a focus on negative outcome expectancies, that might be relevant for HRQOL in end-stage kidney disease (ESKD) patients treated with dialysis. METHODS Patients treated with hemodialysis or peritoneal dialysis were recruited from Dutch hospitals and dialysis centers. Patients completed self-report questionnaires at baseline (n = 175) and six months follow-up (n = 130). Multiple regression analyses were performed. RESULTS Higher scores on factors related to negative outcome expectancies at baseline, especially helplessness and worrying, and less perceived social support were significantly related to worse HRQOL six months later. When controlling for baseline HRQOL, besides sex and comorbidity, helplessness remained significantly predictive of worse HRQOL six months later, indicating that helplessness is associated with changes in HRQOL over time. CONCLUSIONS Negative outcome expectancies and social support are relevant markers for HRQOL and/or changes in HRQOL over time. PRACTICE IMPLICATIONS Negative outcome expectancies could be prevented or diminished by enhanced treatment information, an improved patient-clinician relationship, and interventions that promote adaptive and realistic expectations. Additionally, increasing supportive social relationships could be a relevant treatment focus.
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Affiliation(s)
- Judith Tommel
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, the Netherlands.
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, the Netherlands.
| | - Henk W van Hamersvelt
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
| | - Rien Jordens
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
| | - Sandra van Dijk
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, the Netherlands.
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, the Netherlands.
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17
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Altun E, Paydas S, Kaya B, Balal M, Seydaoğlu G. Blood pressure, inflammation, and quality of life in patients treated with different renal replacement therapies. Ther Apher Dial 2021; 26:115-121. [PMID: 34032378 DOI: 10.1111/1744-9987.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/28/2022]
Abstract
Our aim was to determine the relationship between the modality of renal replacement therapy and inflammation markers, BP control, and quality of life (QoL). Sixteen hemodialysis, 17 peritoneal dialysis patients, and 27 kidney transplant receivers (KTr) have been included in this study. Short Form-36 (SF-36) for the evaluation of QoL and ambulatory BP monitoring were performed on the same day. Erythrocyte sedimentation rate, CRP, IL-6, and IL-10 were measured. While the mean IL-10, IL-6, and CRP levels were the highest in the dialysis groups, there were no significantly differences any parameters for all groups. QoL was better in the KTr almost as in healthy controls but worse in the dialysis patients. It should be taken into account that hypertension may occur at night even if the daytime BP is normal in KTr.
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Affiliation(s)
- Eda Altun
- Department of Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Saime Paydas
- Department of Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Bülent Kaya
- Department of Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Mustafa Balal
- Department of Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Gülsah Seydaoğlu
- Department of Biostatistics, Faculty of Medicine, Cukurova University, Adana, Turkey
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18
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Beckwith HKS, Adwaney A, Appelbe M, Gaffney HT, Hill P, Moabi D, Prout VL, Salisbury E, Webster P, Tomlinson JAP, Brown EA. Perceptions of Illness Severity, Treatment Goals, and Life Expectancy: The ePISTLE Study. Kidney Int Rep 2021; 6:1558-1566. [PMID: 34169196 PMCID: PMC8207314 DOI: 10.1016/j.ekir.2021.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction A better understanding of factors influencing perceived life expectancy (PLE), interactions between patient prognostic beliefs, experiences of illness, and treatment behavior is urgently needed. Methods Case-notes at 3 hemodialysis units were screened: patients with ≥20% 1-year mortality risk were included. Patients and their health care professionals (HCPs) were invited to complete a structured interview or mixed-methods questionnaire. Four hundred eleven patient notes were screened. Seventy-seven eligible patients were approached and 51 were included. Results Patients predicted significantly higher life expectancies than HCPs (P < 0.0001). Documented cognitive impairment, gender, or increasing age did not affect 1- or 5-year PLE. PLE influenced priorities of care: one-fifth of patients who estimated themselves to have >95% 1-year survival preferred “care focusing on relieving pain and discomfort,” compared with nearly three-quarters of those reporting a ≤50% chance of 1-year survival. Twenty of 51 (39%) patients believed transplantation was an option for them, despite only 4 being waitlisted at the time of the interview. Patients who thought they were transplant candidates were significantly more confident they would be alive at 1 and 5 years and to want resuscitation attempted. Cognitive impairment had no effect on perceived transplant candidacy. A high symptom burden was present and underrecognized by HCPs. High symptom burden was associated with significantly lower PLE at both 1 and 5 years, increased anxiety/depression scores, and treatment choices more likely to prioritize relief of suffering. Conclusion There is a disparity between patient PLE and those of their HCPs. Severity of symptom burden and beliefs regarding PLE or transplant candidacy affect patient treatment preferences.
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Affiliation(s)
- Hannah K S Beckwith
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom.,Department of Renal Medicine, Imperial College London, London, United Kingdom
| | - Anamika Adwaney
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Maura Appelbe
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Helen T Gaffney
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Peter Hill
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Dihlabelo Moabi
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Virginia L Prout
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Emma Salisbury
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Phil Webster
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - James A P Tomlinson
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom.,Department of Renal Medicine, Imperial College London, London, United Kingdom
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19
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Alghamdi AA, Almotairy KA, Aljoaid RM, Al Turkistani NA, Domyati RW, Morsy Abdelrahman MM, Samer Shobain K, Uys CM. The Impact of a Pre-Dialysis Educational Program on the Mode of Renal Replacement Therapy in a Saudi Hospital: A Retrospective Cohort Study. Cureus 2020; 12:e11981. [PMID: 33312832 PMCID: PMC7725448 DOI: 10.7759/cureus.11981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Self-care and peritoneal dialysis (PD) benefits have been underutilized in patients with end-stage renal disease (ESRD). The pre-dialysis education program (PDEP) has been generally introduced as an acceptable tool in increasing the rates of PD and has been reportedly recommended for ESRD patients as part of the introduced care. We aim to study the effect of PDEP on ESRD and whether they would prefer PD of center-based hemodialysis (HD). Methods This is a retrospective cohort study that was done at King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia, in the dialysis center. Data were collected on patients and included demographics, preference of renal replacement therapy modality, and other possible factors that may affect patient choices such as educational level, economic status, and age. Results A total of 213 ESRD patients that met our criteria were included, with a total of 75 patients receiving PDEP. Out of those who received the PDEP, 57.3% and 42.7% of patients decided to perform HD and PD, respectively. There was a significant impact of PDEP on reducing HD choice [OR (95% CI) = 0.11 (0.05-0.24); P-value < 0.001]. Infections did not occur in 50.5% of the included patients while 45.8%, 3.3%, and 0.5% had central line-associated bloodstream infection (CLABSI), other infections, and peritonitis, respectively. Most of the PD patients (81.8%) did not have an infection as compared to 42.3% of the HD patients. HD was also associated with increased admission days [OR (95% CI) = 1.27 (1.07-1.51); P-value = 0.007]. Conclusion We found that PDEP positively impacted the rate of PD while PD was associated with favorable outcomes and lower infection rates, emphasizing the importance of an educational program.
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Affiliation(s)
- Ahlam A Alghamdi
- Health Education Department, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Khalid A Almotairy
- Family Medicine: Health Education Department, King Fahad Armed Forces Hospital, Jeddah, SAU
| | | | | | | | | | | | - Cathariena M Uys
- Nursing: Quality Department, King Fahad Armed Forces Hospital, Jeddah, SAU
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20
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Chuasuwan A, Pooripussarakul S, Thakkinstian A, Ingsathit A, Pattanaprateep O. Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis: a systematic review and meta-analysis. Health Qual Life Outcomes 2020; 18:191. [PMID: 32552800 PMCID: PMC7302145 DOI: 10.1186/s12955-020-01449-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/11/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE End-stage renal disease (ESRD) leads to renal replacement therapy and certainly has an impact on patients' health-related quality of life (HRQoL). This study aimed to review and compare the HRQoL between peritoneal dialysis (PD) and hemodialysis (HD) patients using the 36-Item Short Form Health Survey (SF-36), EuroQoL-5-dimension (EQ-5D) and the Kidney Disease Quality of Life Instrument (KDQOL). METHODOLOGY Systematic review was conducted by identify relevant studies through MEDLINE and SCOPUS up to April 2017. Studies were eligible with following criteria: studied in ESRD patients, compare any pair of renal replacement modalities, and reported HRQoL. The unstandardized mean differences (USMD) of HRQoL among modalities were calculated and pooled using a random-effect models if heterogeneity was present, otherwise a fixed-effect model was applied. RESULTS A total of twenty-one studies were included with 29,000 participants. Of them, mean age and percent male were 48.1 years and 45.1, respectively. The pooled USMD (95% CI) of SF-36 between PD and HD (base) were 1.86 (0.47, 3.24) and 0.42 (- 1.99, 2.82) for mental component and physical component summary scores, respectively. For EQ-5D, the pooled USMD of utility and visual analogue scale (VAS) score were 0.02 (- 0.06, 0.10) and 3.56 (1.73, 5.39), respectively. The pooled USMD of KDQOL were 9.67 (5.67, 13.68), 6.71 (- 5.92, 19.32) 6.30 (- 0.41, 12.18), 2.35 (- 4.35, 9.04), 2.10 (0.07, 4.13), and 1.21 (- 2.98, 5.40) for burden of kidney disease, work status, effects of kidney disease, quality of social interaction, symptoms, and cognitive function. CONCLUSION Patients with chronic kidney disease (CKD) stage 5 or ESRD treated with PD had better generic HRQoL measured by SF-36 and EQ-5D than HD patients. In addition, PD had higher specific HRQoL by KDQOL than HD patients in subdomain of physical functioning, role limitations due to emotional problems, effects and burden of kidney disease.
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Affiliation(s)
- Anan Chuasuwan
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, Thailand.,Nephrology Division, Department of Medicine, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Siriporn Pooripussarakul
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, Thailand
| | - Atiporn Ingsathit
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, Thailand.,Nephrology Division, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, Thailand.
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21
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Moore C, Carter LA, Mitra S, Skevington S, Wearden A. Quality of life improved for patients after starting dialysis but is impaired, initially, for their partners: a multi-centre, longitudinal study. BMC Nephrol 2020; 21:185. [PMID: 32423378 PMCID: PMC7236460 DOI: 10.1186/s12882-020-01819-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background Quality of life (QOL) is important to patients with end stage renal disease and their partners. Despite the first 12 weeks being a critical time in the treatment pathway, limited research exists which examines how the transition onto dialysis impacts QOL. In this study we measured QOL in patients and their partners at pre-dialysis and over the first 12 weeks on dialysis to investigate QOL during this crucial period. Methods Patients and their partners, recruited from 10 renal units in England, completed questionnaires at pre-dialysis (n = 166 participants, 83 couples), 6 weeks (n = 90 participants, 45 couples) and 12 weeks (n = 78, 39 couples) after starting dialysis. On each occasion participants completed a QOL questionnaire (WHOQOL-BREF). Multilevel modelling accommodated the nested structure of couples with repeated measures within participants. Three-level random intercept models estimated changes in WHOQOL general QOL and its four domains (Physical, Psychological, Social and Environment). Two-level random intercept models assessed the relationship between baseline clinical and socio-demographic variables with changes in general QOL. Results Patients reported positive changes in general QOL from pre-dialysis to 6 weeks (β = 0.42, p < 0.001, 95% CI 0.19, 0.65) and from pre-dialysis to 12 weeks (β = 0.47, p < 0.001, 95% CI 0.24, 0.71). Partners’ general QOL decreased significantly from pre-dialysis to 6 weeks (β = − 0.24, p = 0.04, 95% CI -0.47, − 0.01) but returned to its original level at 12 weeks. Patients reported improvements in the physical domain between pre-dialysis and 12 weeks (β = 6.56, p < 0.004, 95% CI 2.10, 11.03). No other domains changed significantly in patients or partners. Only in patients were there significant associations between moderator variables and general QOL. High comorbidity risk level and diabetes were associated with poorer QOL at pre-dialysis whereas being female and having an arteriovenous fistula were linked with improvements in general QOL. Conclusions Patients reported significant improvements in their general and physical QOL after starting dialysis. Partners’ general QOL worsened after patients started dialysis but improved by 12 weeks. Both patients and partners may benefit from additional educational and counselling services in the lead up to, and immediately after starting dialysis, which could facilitate the transition onto dialysis and improve QOL in both. Study registration This study was adopted on the NIHR Clinical Research Network (UK). The details of this study are registered on the Research Registry website (www.researchregistry.com). The identifier for this study is researchregistry2574.
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Affiliation(s)
- Currie Moore
- School of Health Sciences, Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, UK. .,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Lesley-Anne Carter
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Sandip Mitra
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK.,NIHR Devices for Dignity MedTech Cooperative, Sheffield, UK
| | - Suzanne Skevington
- School of Health Sciences, Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Alison Wearden
- School of Health Sciences, Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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22
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Lim JH, Park Y, Yook JM, Choi SY, Jung HY, Choi JY, Park SH, Kim CD, Kim YL, Cho JH. Randomized controlled trial of medium cut-off versus high-flux dialyzers on quality of life outcomes in maintenance hemodialysis patients. Sci Rep 2020; 10:7780. [PMID: 32385307 PMCID: PMC7210312 DOI: 10.1038/s41598-020-64622-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/20/2020] [Indexed: 11/12/2022] Open
Abstract
Medium cut-off (MCO) dialyzers help remove larger middle molecules associated with symptoms related to the accumulation of uremic retention solutes. We investigated the effect of an MCO dialyzer on the improvement of quality of life (QOL) in maintenance hemodialysis (HD) patients. Forty-nine HD patients with high-flux dialysis were randomly assigned to either an MCO (Theranova 400, Baxter) or a high-flux (FX CorDiax 80 or 60, Fresenius Medical Care) dialyzer and completed the study. QOL was assessed at baseline and after 12 weeks of treatment using the Kidney Disease Quality of Life Short Form-36, and pruritus was assessed using a questionnaire and visual analog scale. The reduction ratios of middle molecules were also evaluated. Laboratory markers, including serum albumin, did not differ between the two groups after 12 weeks. Removals of kappa and lambda free light chains were greater for MCO dialyzer than high-flux dialyzer. The MCO group had higher scores than the high-flux group in the domains of physical functioning and physical role (75.2 ± 20.8 vs. 59.8 ± 30.1, P = 0.042; 61.5 ± 37.6 vs. 39.0 ± 39.6, P = 0.047, respectively), and the MCO group had lower mean scores for morning pruritus distribution and the frequency of scratching during sleep (1.29 ± 0.46 vs. 1.64 ± 0.64, P = 0.034; 0.25 ± 0.53 vs. 1.00 ± 1.47, P = 0.023, respectively). MCO dialyzers may improve patient-reported outcomes, particularly the physical components of QOL and uremic pruritus, in patients with high-flux dialyzers.
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Affiliation(s)
- Jeong-Hoon Lim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Yeongwoo Park
- Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Ju-Min Yook
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Soon-Youn Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Ji-Young Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
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23
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Van Biesen W, Vanholder R, Lameire N. The Role of Peritoneal Dialysis as the First-Line Renal Replacement Modality. Perit Dial Int 2020. [DOI: 10.1177/089686080002000401] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Twenty years after its introduction, peritoneal dialysis (PD) is a well-established alternative to hemodialysis (HD) as a modality of renal replacement therapy. Much debate and research is apparent in the literature, comparing hemodialysis and PD as “opposite” modalities and trying to ascertain which modality should be more optimal.In our opinion, HD and PD are two distinct modalities, each with its own advantages and disadvantages. In addition, it is clear that for both HD and PD, rates of technique failure are high, causing patients to transfer between modalities. The question is thus not which modality is best, but rather, which flow-chart of modalities makes best use of the advantages of each modality, while avoiding its disadvantages. In this respect, HD and PD appear to be complementary modalities.The better preservation of residual renal function, lower risk of infection with hepatitis B and C, better outcome after transplantation, preservation of vascular access, and lower costs are arguments to promote PD as a good initial treatment. When PD-related problems arise (adequacy, ultrafiltration, peritonitis, patient burnout), a timely transfer to HD has to be planned.This editorial tries to review arguments supporting the complementary nature of both modalities, and especially the role of PD as the first-line renal replacement therapy.
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Affiliation(s)
| | | | - N. Lameire
- Renal Division University Hospital Gent Belgium
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24
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Korevaar JC, Jansen MA, Merkus MP, Dekker FW, Boeschoten EW, Krediet RT. Quality of Life in Predialysis End-Stage Renal Disease Patients at the Initiation of Dialysis Therapy. Perit Dial Int 2020. [DOI: 10.1177/089686080002000113] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To assess health-related quality of life (QL) in a group of Dutch predialysis end-stage renal disease (ESRD) patients prior to the initiation of dialysis, and to compare QL between patients with different intended initial dialysis treatments. Design In a prospective cohort study, demographic, clinical, and QL data were obtained from Dutch adult patients who were consecutively enrolled from 27 different centers 0 – 4 weeks prior to the beginning of their chronic dialysis treatment. Patients Of the 301 patients who completed the QL questionnaires (of a possible 337 enrolled patients), 152 intended to start with hemodialysis (pre-HD) and 149 patients with peritoneal dialysis (pre-PD). Main Outcome Measure Perceived QL of pre-HD and pre-PD patients. Quality of life was assessed with two generic health assessment instruments: the SF-36 and the EuroQol. Results After correction for group differences, pre-HD patients scored consistently, but not significantly, lower for all separate dimensions of the SF-36 and the overall health score of the EuroQol compared to pre-PD patients. However, analyzing the dimensions of the SF-36 together, adjusted for case-mix, pre-HD patients scored significantly lower than pre-PD patients. Mean difference was 6.5 points ( p = 0.04). Conclusion Multivariate adjustment for known case-mix differences at the start of dialysis therapy was not sufficient to adjust for all patient selection effects on QL. Consequently, published QL comparisons between HD and PD in nonrandomized cohort studies should be interpreted with caution. Assessment of QL just before start of dialysis therapy and subsequent adjustment for baseline values may be the only valid alternative for randomized studies.
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Affiliation(s)
| | - Johanna C. Korevaar
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Maarten A.M. Jansen
- Department of Nephrology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Maruschka P. Merkus
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Friedo W. Dekker
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | - Raymond T. Krediet
- Department of Nephrology, Academic Medical Center, University of Amsterdam, The Netherlands
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25
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Jansen MA, Korevaar JC, Dekker FW, Jager KJ, Boeschoten EW, Krediet RT. The Relationship between Kt/VUrea and Npna in Anuric Peritoneal Dialysis Patients: A Comparison with Predialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080102100513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective It is unknown whether a given level of urea clearance by the native kidneys provides better or similar control of uremia than the same level of urea clearance by continuous peritoneal dialysis (PD). More insight into possible differences between renal and peritoneal urea clearances is warranted. Therefore, we investigated the relationship between Kt/Vurea and protein equivalent of total nitrogen appearance normalized to body weight (nPNA), the relationship between urea clearance and creatinine appearance, and other nutritional parameters in PD patients without residual renal function, and in predialysis end-stage renal disease patients. Patients All patients participated in the Netherlands Cooperative Study on the Adequacy of Dialysis. This is a prospective cohort study of incident dialysis patients, in whom regular assessments of renal function are done. A group of 75 PD patients was identified at the first follow-up assessment in which their urine production was less than 100 mL/day. These patients were considered the anuric group. This group was compared with a control group of 97 predialysis patients studied 0 – 4 weeks before the start of dialysis treatment. Results Linear relationships were present between Kt/Vurea and nPNA, in both the predialysis patients and the anuric PD patients. A significant difference was present between the slopes of the two regression lines (0.40 vs 0.18, p = 0.007). When Kt/Vurea exceeded 1.3/week, a given level of Kt/Vurea was associated with a higher nPNA in predialysis than in anuric PD patients. Similar relationships were found between Kturea and PNA. Kturea was also significantly related to urine or dialysate creatinine appearance. A significant difference existed between the slopes of the regression lines in the two groups of patients ( p < 0.001). A weekly Kturea of 70 L was associated with a urine creatinine appearance of 11.0 mmol/day and a dialysate creatinine appearance of 8.4 mmol/day. Nutritional status measured with creatinine appearance and Subjective Global Assessment was better in the predialysis population, despite much lower values for Kt/Vurea in these patients. Conclusions The relationship between Kt/Vurea and nPNA in anuric PD patients is different from that in a predialysis population. It follows from our results that, when Kt/Vurea is above 1.3/week, a given level of Kt/Vurea is associated with a higher nPNA in predialysis than in anuric PD patients. This challenges the concept of equivalency between renal and peritoneal Kt/Vurea with respect to control of uremic morbidity.
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Affiliation(s)
| | - Maarten A.M. Jansen
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam
- NECOSAD Foundation; Academic Medical Center, University of Amsterdam, Amsterdam
| | - Johanna C. Korevaar
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kitty J. Jager
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam
- NECOSAD Foundation; Academic Medical Center, University of Amsterdam, Amsterdam
| | - Elisabeth W. Boeschoten
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam
| | - Raymond T. Krediet
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam
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26
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Thodis E, Passadakis P, Vargemezis V, Oreopoulos DG. Peritoneal Dialysis: Better than, Equal to, or Worse than Hemodialysis? Data Worth Knowing before Choosing a Dialysis Modality. Perit Dial Int 2020. [DOI: 10.1177/089686080102100105] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Technological advances such as those that allow the delivery of an adequate dialysis dose to a larger percentage of patients, minimization of peritoneal membrane damage with more biocompatible solutions, and lower peritonitis rates will undoubtedly improve retention of patients on peritoneal dialysis (PD) for longer periods. Currently, only 15% of the world dialysis population is managed by PD. Peritoneal dialysis has many advantages over hemodialysis, and if end-stage renal disease (ESRD) patients are fully informed about them, the proportion of patients who would prefer this treatment would rise to 25% – 30%. An integrated approach to the treatment of ESRD could start with PD in a large percentage of patients, especially those who will receive a kidney transplant within 2 – 3 years. With the present epidemic of ESRD, this approach could lead to a significant saving, relieve the pressure on dialysis units, and allow a larger number of ESRD patients to be treated.
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Affiliation(s)
- Elias Thodis
- Department of Nephrology, Medical School Democritus University of Thrace, Alexandroupolis, Greece
| | - Ploumis Passadakis
- Department of Nephrology, Medical School Democritus University of Thrace, Alexandroupolis, Greece
| | - Vassilis Vargemezis
- Department of Nephrology, Medical School Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios G. Oreopoulos
- The Toronto Western Hospital-University Health Network and University of Toronto, Toronto, Ontario, Canada
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27
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Harris SA, Lamping DL, Brown EA, Constantinovici N. Clinical outcomes and Quality of Life in Elderly Patients on Peritoneal Dialysis versus Hemodialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080202200404] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
♦ Objective To compare clinical outcomes and quality of life (QOL) in elderly patients on peritoneal dialysis (PD) and hemodialysis (HD) in the North Thames Dialysis Study. ♦ Design A 12-month prospective cohort study. ♦ Setting Four hospital-based renal units in London, UK. ♦ Patients 174 patients that were 70 years or older at the start of dialysis, separated into two cohorts: 78 new patients (36 PD, 42 HD) that were recruited after 90 days of chronic dialysis; and 96 stock patients (42 PD, 54 HD) that were already on dialysis during the recruitment period. ♦ Main Outcome Measures 12-month survival and hospitalization rate, and QOL assessed at baseline and at 6 and 12 months by the SF-36 and the Symptoms/Problems scale of the Kidney Disease Quality of Life Questionnaire (KDQOL). ♦ Results Peritoneal dialysis and HD patients were similar for sociodemographic and clinical characteristics. Annual mortality and hospitalization rates in PD versus HD patients were 26.1 versus 26.4 deaths/100 person–years and 1.9 versus 2.0 admissions/person–year, respectively. Adjusted relative risks showed no effect of modality on clinical outcomes. Multiple linear regression analyses of QOL at baseline showed similar SF-36 scores between PD and HD patients, but higher KDQOL scores in PD patients (3.5 points higher, 95% confidence interval 0.3 – 6.6). There was, however, no effect of dialysis modality on QOL at 6 or 12 months. ♦ Conclusions Clinical outcomes and QOL are similar in elderly people on PD and HD. Peritoneal dialysis is a viable option for more than a carefully selected minority of elderly people requiring dialysis.
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Affiliation(s)
| | - Susan A.C. Harris
- Department of Renal Medicine, Charing Cross Hospital, Royal Free and University College Medical School, London, United Kingdom
| | - Donna L. Lamping
- Health Services Research Unit, London School of Hygiene & Tropical Medicine, Royal Free and University College Medical School, London, United Kingdom
| | - Edwina A. Brown
- Department of Renal Medicine, Charing Cross Hospital, Royal Free and University College Medical School, London, United Kingdom
| | - Niculae Constantinovici
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, United Kingdom
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28
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Frimat L, Durand PY, Loos–Ayav C, Villar E, Panescu V, Briançon S, Kessler M. Impact of First Dialysis Modality on Outcome of Patients Contraindicated for Kidney Transplant. Perit Dial Int 2020. [DOI: 10.1177/089686080602600220] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background We compared, in patients contraindicated for kidney transplant, outcomes between those patients who were only on hemodialysis (HD) and those who were given peritoneal dialysis (PD) as first renal replacement therapy (RRT). Design Prospective, population-based cohort study of incident cases of end-stage renal disease between June 1997 and June 1999. Setting A network of dialysis care: NEPHROLOR, that is, all the renal units in Lorraine, one of the 22 French administrative regions (population over 2.3 million people). Participants 387 patients were contraindicated for kidney transplant during the first 2 years of RRT: 284 were on HD, 103 on PD. Mean age was 67.6 ± 11.3 years for HD patients and 70.8 ± 11.4 years for PD patients ( p = 0.015). Main Outcome Measures Mortality until June 2003, hospitalization over the 2 first years of RRT, and Kidney Disease and Quality of Life Short Form (KDQOL-SF) 6 and 12 months after initiation of RRT. Results HD patients were more likely to die from cardiac or cerebrovascular causes, PD from cachexia or withdrawal from dialysis. Whatever mode of RRT, the unadjusted 2-year and 5-year survival rates were similar ( p = 0.98). The rate of total duration of hospital stay per month of RRT was similar in HD and PD groups: 2.7 ± 4.5 and 2.9 ± 4.2 days respectively ( p = 0.7). PD was associated with better quality of life than HD. The dimensions Role limitation due to emotional function, Burden of kidney disease, and Role limitation due to physical function ranked first, second, and third for PD. Conclusion In Lorraine, end-stage renal disease patients who were given PD as first-line RRT had no excess of death risk or hospitalizations, and better quality of life the first year of RRT.
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Affiliation(s)
- Luc Frimat
- Department of Nephrology University Hospital of Lyon Sud, France
- Department of Epidemiology, University Hospital of Nancy
| | | | | | - Emmanuel Villar
- Department of Nephrology, University Hospital of Lyon Sud, France
| | - Victor Panescu
- Department of Nephrology University Hospital of Lyon Sud, France
| | - Serge Briançon
- Department of Epidemiology, University Hospital of Nancy
| | - MicHèle Kessler
- Department of Nephrology University Hospital of Lyon Sud, France
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29
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Groothoff JW, Offringa M, Grootenhuis M, Jager KJ. Long-term consequences of renal insufficiency in children: lessons learned from the Dutch LERIC study. Nephrol Dial Transplant 2019; 33:552-560. [PMID: 28992218 DOI: 10.1093/ndt/gfx190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/28/2017] [Indexed: 11/14/2022] Open
Abstract
Few data exist on the prospects in adulthood for children on chronic renal replacement therapy (RRT). This article summarizes the results of a comprehensive Dutch long-term follow-up study performed in 2000 and 2010 of patients with RRT onset at age <15 years between 1972 and 1992. After a median of 25.5 RRT years, patients had stayed 23% of RRT time on dialysis. We observed a 30 times greater mortality risk compared with age-matched peers with cardiovascular disease (CVD) as the main cause of death during 1972-2000 and infections during 2000-10. The observed shift towards infections was associated with more RRT time with a graft and receiving a stricter CVD protective treatment. For patients >40 years of age, motor disabilities affecting routine activities, skin cancer and severe fatigue were the most disabling sequelae. After 30 years of transplantation, 41% of the survivors had developed cancer, a life-threatening form of squamous cell skin carcinoma being most prevalent. Important delays in autonomy development and educational attainment and a relatively high level of unemployment were observed. Transplanted patients reported a good mental and physical quality of life, but the latter tended to decrease over time. A long period of dialysis was associated with all adverse somatic and psychosocial outcomes. Paediatric nephrologists should aim for transplantation at the earliest possible time and focus on autonomy and educational attainment. Nephrologists should focus on strict CVD prevention, adjustment of immunosuppression to the lowest possible dose and surveillance of malignancy-associated viral infections in patients with childhood end-stage renal disease.
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Affiliation(s)
- Jaap W Groothoff
- Department of Paediatric Nephrology, H7-234, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Martin Offringa
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Martha Grootenhuis
- Paediatric Psychosocial Department, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, Academic Medical Centre, Amsterdam, The Netherlands
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30
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Jung HY, Jeon Y, Park Y, Kim YS, Kang SW, Yang CW, Kim NH, Choi JY, Cho JH, Park SH, Kim CD, Kim YL. Better Quality of Life of Peritoneal Dialysis compared to Hemodialysis over a Two-year Period after Dialysis Initiation. Sci Rep 2019; 9:10266. [PMID: 31312004 PMCID: PMC6635359 DOI: 10.1038/s41598-019-46744-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022] Open
Abstract
This study aimed to compare health-related quality of life (HRQOL) over time in patients initiating hemodialysis (HD) or peritoneal dialysis (PD). A total of 989 incident patients starting HD or PD were included from a prospective nationwide cohort study. HRQOL was assessed 3, 12, and 24 months after the start of dialysis. The scores of questionnaires were adjusted for clinical and socioeconomic parameters. The adjusted three months scores of patients on PD showed better HRQOL in eight end-stage renal disease (ESRD), three physical component summary and one mental component summary domains compared with patients on HD. Both patients on HD and PD experienced significant decreases in different HRQOL domains over two years and the degree of changes in HRQOL over time was not different between dialysis modality. However, the scores of three (effects of kidney disease, burden of kidney disease, and dialysis staff encouragement, all P < 0.05) and two (sexual function and dialysis staff encouragement, all P < 0.05) ESRD domains were still higher in patients on PD compared with patients on HD at one and two years after initiation of dialysis, respectively. PD shows better HRQOL during the initial period after dialysis even after adjusting for clinical and socioeconomic characteristics, and the effect lasts up to two years. It was similar in terms of changes in HRQOL over time between HD and PD.
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Affiliation(s)
- Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Yena Jeon
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Yeongwoo Park
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Yon Su Kim
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Shin-Wook Kang
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul Woo Yang
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Nam-Ho Kim
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Ji-Young Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea. .,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea. .,Bk21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, South Korea.
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Pei M, Aguiar R, Pagels AA, Heimbürger O, Stenvinkel P, Bárány P, Medin C, Jacobson SH, Hylander B, Lindholm B, Qureshi AR. Health-related quality of life as predictor of mortality in end-stage renal disease patients: an observational study. BMC Nephrol 2019; 20:144. [PMID: 31035977 PMCID: PMC6489294 DOI: 10.1186/s12882-019-1318-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/29/2019] [Indexed: 02/08/2023] Open
Abstract
Background Health-related quality of life (HRQoL) is an important component of patient-centered outcomes and a useful parameter for monitoring quality of care. We assessed HRQoL, its determinants, and associations with mortality in patients with end-stage renal disease (ESRD). Methods Short Form-36 was used to assess HRQoL, its domain components, and physical (PCS) and mental (MCS) composite summary scores in altogether 400 (338 incident and 62 prevalent) dialysis patients with median age 64 years, 37% women, 24% diabetes mellitus (DM), 49% cardiovascular disease (CVD), and median estimated glomerular filtration rate (eGFR) of 5.3 (3.0–9.4) ml/min/1.732. Results were analyzed separately for 338 incident patients starting on hemodialysis (HD; 68%) or peritoneal dialysis (PD; 32%), and 62 prevalent PD patients. Mortality risk was analyzed during up to 60 months (median 28 months). Results Linear multivariate regression analysis showed that in incident dialysis patients, 1-SD higher PCS associated negatively with 1-SD higher age, DM and CVD, and positively with 1-SD higher hemoglobin and sodium (adjusted r2 = 0.17). In 62 prevalent PD patients, 1-SD higher PCS was negatively associated with 1-SD higher age. MCS was not associated to any of the investigated factors. Multivariate Cox regression analysis showed that in incident dialysis patients, 1-SD increase of PCS associated with lower all-cause mortality, hazard ratio 0.65 (95% confidence interval 0.52–0.81), after adjustments for age, sex, DM, CVD, plasma albumin, C-reactive protein and eGFR whereas 1-SD lower MCS did not associate with mortality. In PD patients, neither PCS nor MCS associated with mortality. Conclusions MCS did not associate with any of the investigated clinical factors, whereas lower PCS associated with higher age, CVD, DM, and lower hemoglobin and sodium levels. MCS was not associated with mortality, whereas lower PCS associated with increased mortality risk. These results suggest that HRQoL - in addition to its role as patient-centered outcome - matters also for hard clinical outcomes in ESRD patients. Our knowledge about factors influencing MCS in ESRD patients is limited and should motivate further studies. Electronic supplementary material The online version of this article (10.1186/s12882-019-1318-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming Pei
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden.,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Rute Aguiar
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden.,Department of Nephrology, Hospital Espírito Santo, Évora, Portugal
| | - Agneta A Pagels
- Department of Nephrology, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Olof Heimbürger
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Peter Stenvinkel
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Peter Bárány
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Charlotte Medin
- Department of Nephrology, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Stefan H Jacobson
- Department of Clinical Sciences, Division of Nephrology, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Britta Hylander
- Department of Nephrology, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Bengt Lindholm
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden.
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32
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Eneanya ND, Maddux DW, Reviriego-Mendoza MM, Larkin JW, Usvyat LA, van der Sande FM, Kooman JP, Maddux FW. Longitudinal patterns of health-related quality of life and dialysis modality: a national cohort study. BMC Nephrol 2019; 20:7. [PMID: 30621634 PMCID: PMC6325821 DOI: 10.1186/s12882-018-1198-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/28/2018] [Indexed: 12/18/2022] Open
Abstract
Background Health-related quality of life (HrQoL) varies among dialysis patients. However, little is known about the association of dialysis modality with HrQoL over time. We describe longitudinal patterns of HrQoL among chronic dialysis patients by treatment modality. Methods National retrospective cohort study of adult patients who initiated in-center dialysis or a home modality (peritoneal or home hemodialysis) between 1/2013 and 6/2015. Patients remained on the same modality for the first 120 days of the first two years. HrQoL was assessed by the Kidney Disease and Quality of Life-36 (KDQOL) survey in the first 120 days of the first two years after dialysis initiation. Home modality patients were matched to in-center patients in a 1:5 fashion. Results In-center (n=4234) and home modality (n=880) patients had similar demographic and clinical characteristics. In-center dialysis patients had lower mean KDQOL scores across several domains compared to home modality patients. For patients who remained on the same modality, there was no change in HrQoL. However, there were trends towards clinically meaningful changes in several aspects of HrQoL for patients who switched modalities. Specifically, physical functioning decreased for patients who switched from home to in-center dialysis (p< 0.05). Conclusions Among a national cohort of chronic dialysis patients, there was a trend towards different patterns of HrQoL life that were only observed among patients who changed modality. Patients who switched from home to in-center modalities had significant lower physical functioning over time. Providers and patients should be mindful of HrQoL changes that may occur with dialysis modality change. Electronic supplementary material The online version of this article (10.1186/s12882-018-1198-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, 307 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
| | | | | | - John W Larkin
- Fresenius Medical Care North America, Waltham, MA, USA
| | - Len A Usvyat
- Fresenius Medical Care North America, Waltham, MA, USA
| | - Frank M van der Sande
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jeroen P Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
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33
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Aguiar R, Pei M, Qureshi AR, Lindholm B. Health-related quality of life in peritoneal dialysis patients: A narrative review. Semin Dial 2018; 32:452-462. [PMID: 30575128 DOI: 10.1111/sdi.12770] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Health-related quality of life (HRQOL) is an important aspect of patients´ health that should be an integral part of the evaluation of patient-centered outcomes, not least because HRQOL associates with patients´ morbidity and mortality. This applies also to chronic kidney disease patients, including those dependent on renal replacement therapies, the type of which may influence patients´ perception of HRQOL. Several studies have addressed HRQOL in chronic kidney disease patients undergoing renal replacement therapies, especially transplanted patients and hemodialysis patients, while publications concerning peritoneal dialysis (PD) patients are scarcer. This review describes some of the methods used to assess HRQOL, factors influencing HRQOL in PD patients, HRQOL in PD vs hemodialysis, and the relation between HRQOL and patient outcomes. We conclude that assessment of HRQOL-often neglected at present-should be included as a standard measure of patient-centered outcomes and when monitoring the quality and effectiveness of renal care including PD treatment.
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Affiliation(s)
- Rute Aguiar
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden.,Nephrology, Hospital Espírito Santo, Évora, Portugal
| | - Ming Pei
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden.,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Abdul Rashid Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
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34
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Trajceska L, Mladenovska D, Dzekova-Vidimliski P, Sikole A. Quality of Life-Repeated Measurements Are Needed In Dialysis Patients. Open Access Maced J Med Sci 2018; 6:1410-1412. [PMID: 30159066 PMCID: PMC6108791 DOI: 10.3889/oamjms.2018.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND: There is a general agreement that, besides survival, the quality of life is a highly relevant outcome in the evaluation of treatment in patients with the end-stage renal disease. Moreover, it is very important to determine whether the quality of life impacts survival. AIM: This study aims to assess whether changes or absolute scores of the quality of life (QOL) measurements better predict mortality in dialysis patients. MATERIAL AND METHODS: In a longitudinal study comprising 162 prevalent hemodialysis patients QOL was assessed with the 36-item - Short Form Health Survey Questionnaire (SF-36) at baseline and after 12 months. Patients were followed for 60 months. Mortality risk was assessed using Cox proportional hazards analysis for patients with below and above median levels of both physical and mental QOL component scores (PCS and MCS, respectively). RESULTS: At the beginning of the study the mean Physical Component score was 47.43 ± 26.94 and mean Mental Component Score was slightly higher 50.57 ± 24.39. Comparative analysis of the changes during the first year showed a marked deterioration of all quality of life scores in surviving patients. The 5-point decline for PCS was noted in 39 (24%) patients and 42 (26%) for MCS. In the follow-up period of 60 months, 69 (43%) patients died. In the Cox analysis, mortality was significantly associated with lower PCS: HR = 2.554 [95% confidence interval (CI): 1.533-4.258], (P < 0.000) and lower MCS: 2.452 (95% CI: 1.478-4.065), P < 0.001. The patients who had lower levels of PCS and MCS in the second QOL survey 1 year later, had similarly high mortality risk: 3.570 (95% CI: 1.896-6.727, P < 0.000); 2.972 (95% CI: 1.622-5.490, P < 0.000), respectively. The hazard ratios for mortality across categories for the change of PCS and MCS were not significant. In the multivariate model categorising the first and second scores as predictors and adjusted for age, only the second PCS and MCS score were associated with mortality. CONCLUSION: Low QOL scores are associated with mortality in repeated measurements, but only the more recent overwhelmed the power of the decline.
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Affiliation(s)
- Lada Trajceska
- University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Daniela Mladenovska
- University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Pavlina Dzekova-Vidimliski
- University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Aleksandar Sikole
- University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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35
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Raj R, Ahuja K, Frandsen M, Murtagh FEM, Jose M. Validation of the IPOS-Renal Symptom Survey in Advanced Kidney Disease: A Cross-sectional Study. J Pain Symptom Manage 2018; 56:281-287. [PMID: 29729346 DOI: 10.1016/j.jpainsymman.2018.04.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
CONTEXT The significant symptom burden in advanced renal disease is often poorly recognized by clinicians. Recently, the Integrated Palliative Outcome Score (IPOS)-renal survey was developed from pre-existing tools to capture these symptoms and other common concerns. OBJECTIVES We studied the validity and reliability of the IPOS-renal survey (patient and staff versions) in an Australian population. METHODS Adult patients with advanced renal disease and nurses caring for them were participated. We initially administered the IPOS-renal survey simultaneously with other validated surveys and then retested the IPOS-renal after seven to 14 days. We tested the construct validity of 1) IPOS-renal patient version in relation to the Edmonton Symptom Assessment Survey-revised and the Kidney Diseases quality of life-short form version 1.3 questionnaire and 2) IPOS-renal staff version in relation to the Support Team Assessment Schedule survey. RESULTS Eighty-one patients (65 hemodialysis, 10 peritoneal dialysis, and six on supportive care; average age 64.9 years) and 53 nurses (average renal nursing experience 10.9 years) were participated. Intraclass coefficients for test-retest reliability were >0.7 for most queries; Cronbach's alphas for internal consistency were 0.84 (patient version) and 0.91 (staff version). In tests of construct validity, Spearman's coefficient of correlation between surveys and their comparators for similar questions was significant, at 0.61 to 0.77 (patients) and 0.24 to 0.76 (staff). As expected, symptom scores and total symptom burden were negatively correlated with summary scores of quality of life. CONCLUSION The IPOS-renal surveys, patient and staff versions, have good test-retest reliability, internal consistency, and construct validity in patients with advanced kidney disease and their nurses. We recommend their use in symptom assessment.
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Affiliation(s)
- Rajesh Raj
- School of Medicine, University of Tasmania, Hobart, Australia.
| | - Kiran Ahuja
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Mai Frandsen
- Faculty of Health, University of Tasmania, Launceston, Australia
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Matthew Jose
- School of Medicine, University of Tasmania, Hobart, Australia
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36
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Health-related quality of life in end-stage renal disease patients: the effects of starting dialysis in the first year after the transition period. Int Urol Nephrol 2018; 50:1131-1142. [PMID: 29582338 PMCID: PMC5986848 DOI: 10.1007/s11255-018-1845-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS Prevalent dialysis patients have low scores of health-related quality of life (HRQOL) which are associated with increased risk of hospitalization and mortality. Also in CKD-5 non-dialysis patients, HRQOL scores seem to be lower as compared with the general population. This study firstly aimed to compare HRQOL between CKD-5 non-dialysis and prevalent dialysis patients in a cross-sectional analysis and to assess longitudinal changes over 1 year after the dialysis initiation. Secondly, the correlation between HRQOL and physical activity (PA) was explored. METHODS Cross-sectional 44 CKD-5 non-dialysis, 29 prevalent dialysis, and 20 healthy controls were included. HRQOL was measured by Short Form-36 questionnaires to measure physical and mental domains of health expressed by the physical component summary (PCS) and mental component summary (MCS) scores. PA was measured by a SenseWear™ pro3. Longitudinally, HRQOL was assessed in 38 CKD-5 non-dialysis patients (who were also part of the cross-sectional analysis), before dialysis initiation until 1 year after dialysis initiation. RESULTS PCS scores were significantly lower both in CKD-5 non-dialysis patients and in prevalent dialysis patients as compared with healthy controls (p < 0.001). MCS scores were significantly lower in both CKD-5 non-dialysis patients (p = 0.003), and in dialysis patients (p = 0.022), as compared with healthy controls. HRQOL scores did not change significantly from the CKD-5 non-dialysis phase into the first year after dialysis initiation. PA was significantly related to PCS in both CKD-5 non-dialysis patients (r = 0.580; p < 0.001), and dialysis patients (r = 0.476; p = 0.009). CONCLUSIONS HRQOL is already low in the CKD-5 non-dialysis phase. In the first year after dialysis initiation, HRQOL did not change significantly. Given the correlation between PCS score and PA, physical activity programs may be potential tools to improve HRQOL in both CKD-5 non-dialysis as well as in prevalent dialysis patients.
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37
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Stojanovic M, Ilic S, Stefanovic V. Influence of Co-Morbidity on Health-Related Quality of Life in Patients Treated with Hemodialysis. Int J Artif Organs 2018; 29:1053-61. [PMID: 17160962 DOI: 10.1177/039139880602901105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Studies on the outcome of hemodialysis (HD) patients over time have mainly focused on morbidity and mortality, but currently, the importance of measuring the patient's health-related quality of life (HRQoL) is being increasingly recognized. On the other hand, comorbidity is the single most important determinant of outcome in patients on HD. The aims of this study were to evaluate HRQoL in patients at the initiation of HD therapy (incident cohort), and in patients on long-term HD treatment (prevalent cohort), and to establish the relationship between the presence of comorbidity and patient's HRQoL. The study enrolled 229 patients on HD, divided into two groups: prevalent cohort comprised 192 patients on chronic HD more than 3 months, and incident cohort with 37 patients who started their dialysis during the study. Comorbidity was assessed using the Index of Coexistent Diseases (ICED), including two sub-indexes: Index of Disease Severity (IDS), a medical record review of 16 medical conditions, and Index of Physical Impairment (IPI), an observer-based assessment of 11 physical functions. ICED scores range from 0 to 3, with higher levels reflecting more severe comorbidity. Patient's self-assessment of HRQoL was measured by the 36-item Short Form Health Survey Questionnaire (SF-36), encompassing 8 summary scales and 2 summary dimensions. Based on the ICED index level, in both groups of patients (prevalent and incident group), a high presence of associated diseases was observed, i.e. 56.8 % and 67.6 % respectively. Indicators of comorbidities have negative and statistically significant correlation, so that any increase of IDS and IPI indexes produces significant decrease of HRQoL parameters. HRQoL summary scales in both groups of patients were similar, but generally with lower values in incident subjects and with statistical significance only in social functioning (SF) scale (40.5 ± 24.9 vs 51.0 ± 27.2). In the incident group of patients, one year of HD treatment was associated with a slight improvement in all HRQoL parameters, but statistical significance (p < 0.05) was observed only in the role-physical limitation (RP) scale and SF scale. Conclusions In the patients on HD treatment, comorbid conditions have negative and statistically significant correlation with parameters of HRQoL, and could explain poor HRQoL to a remarkable extent. One year after starting HD, patients reported better scores in some domains, especially in the RP and SF scale. From a clinical perspective, parameters of HRQoL and comorbidities should be considered in the follow up of patients treated with HD. (Int J Artif Organs 2006; 29: 1053–61)
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Affiliation(s)
- M Stojanovic
- Institute of Nephrology and Hemodialysis, Faculty of Medicine, Nis, Serbia.
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38
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Chen JB, Lee WC, Cheng BC, Moi SH, Yang CH, Lin YD. Impact of risk factors on functional status in maintenance hemodialysis patients. Eur J Med Res 2017; 22:54. [PMID: 29282123 PMCID: PMC5745856 DOI: 10.1186/s40001-017-0298-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/15/2017] [Indexed: 12/29/2022] Open
Abstract
Objectives To survey by measuring patient’s functional status which is crucial when end-stage renal disease patients begin a dialysis program. The influence of the disease on patients can be examined by the measurement of Karnofsky Performance Status (KPS) scores, together with a quality of life survey, and clinical variables. Methods The details for the dataset in the study were collected from patients receiving regular hemodialysis (HD) in one hospital, which were available retrospectively for 1166 patients during the 5-year study period. KPS scores were applied for quantifying functional status. To identify risk factors for functional status, clinical factors including demographics, laboratory data, and HD vintage were selected. This study applied a classification and regression tree approach (CART) and logistic regression to determine risk factors on functional impairment among HD patients. Results Ten risk factors were identified by CART and regression model (age, primary kidney disease subclass, treatment years, hemoglobin, albumin, creatinine, phosphorus, intact parathyroid hormone, ferritin, and cardiothoracic ratio). The results of logistic regression with selected interaction models showed older age or higher hematocrit, blood urea nitrogen, and glucose levels could significantly increase the log-odds of obtaining low KPS scores at in-person visits. Conclusions In interaction results, the combination of older age with higher albumin level and higher creatinine level with longer HD treatment years could significantly decrease the log-odds of a low KPS score assessment during in-person visits. Age, hemoglobin, albumin, urea, creatinine levels, primary kidney disease subclass, and HD duration are the major determinants for functional status in HD patients. Electronic supplementary material The online version of this article (10.1186/s40001-017-0298-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Ben-Chung Cheng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Sin-Hua Moi
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan
| | - Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan. .,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan.
| | - Yu-Da Lin
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan.
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Low back pain in hemodialysis patients: Risk factors and its impact on health-related quality of life. Turk J Phys Med Rehabil 2017; 64:66-71. [PMID: 31453491 DOI: 10.5606/tftrd.2018.1016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/14/2017] [Indexed: 12/19/2022] Open
Abstract
Objectives The aim of this study was to evaluate frequency and characteristics of low back pain and to identify possible risk factors of low back pain and its impact on health-related quality of life in hemodialysis patients. Patients and methods A total of 87 hemodialysis patients (41 males, 46 females; mean age: 53.3±15.8 years; range, 21 to 80 years) were included in the study between January 2015 and July 2015. Medical charts and face-to-face interviews were used to collect clinical and demographic data. A comprehensive clinical evaluation of low back pain was implemented. The patients were divided into two groups: those with (n=32) and without (n=55) low back pain. Demographic data, quality of life, pain, and disability were compared between the groups. Pain severity was assessed using the Visual Analog Scale (VAS). Low back pain-associated disability was measured using the Oswestry Disability Index (ODI). Risk factors of low back pain were identified using multiple logistic regression analysis. The impact of low back pain on health-related quality of life was measured using the Nottingham Health Profile (NHP). Results Advanced age, increased body mass index, and smoking were found to be significant independent risk factors of low back pain (p=0.048; p=0.037; p=0.020, respectively). Energy, pain, and physical mobility subscale scores of the NHP were also higher in the hemodialysis patients with low back pain (p=0.008; p<0.001; p<0.001, respectively). Energy, pain, sleep, and physical mobility subscale scores of the NHP showed a significant positive correlation with the ODI scores (r=0.424, p=0.016; r=0.803, p<0.001; r=0.493, p=0.004; r=0.862, p<0.001, respectively). The etiology of low back pain was non-specific in the majority of the patients (71.9%). There were spondylodiscitis in two patients (6.2%), compression fractures in two patients (6.2%), spinal stenosis in one patient (3.1%), and discopathy in four patients (12.5%). Conclusion Low back pain is a common condition in hemodialysis patients. Advanced age, increased body mass index, and smoking are the main risk factors of low back pain. The presence of low back pain is also related to poor health-related quality of life in hemodialysis patients.
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van Loon I, Hamaker ME, Boereboom FTJ, Grooteman MPC, Blankestijn PJ, van den Dorpel RMA, Nubé MJ, Ter Wee PM, Verhaar MC, Bots ML. A closer look at the trajectory of physical functioning in chronic hemodialysis. Age Ageing 2017; 46:594-599. [PMID: 28164208 DOI: 10.1093/ageing/afx006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/07/2017] [Indexed: 11/12/2022] Open
Abstract
Background in chronic hemodialysis, physical functioning (PF) is known to be poor. We set out to assess to what extent chronic dialysis patients are able to maintain a good physical condition over time and what the influence of age is on the trajectory of PF. Methods we used data form 714 prevalent hemodialysis patients, enrolled in the CONvective TRAnsport STudy (CONTRAST). The PF subscale of the KDQOL SF-36 was assessed at baseline (n = 679) and during 2 years of follow-up (n = 298). Baseline PF score (0-100) was categorized into tertiles (good, intermediate and low). Change of PF of ≥ 5 points was considered clinically relevant. A regression model was applied to assess factors related to 'decline of PF (≥5 points)/low PF (0-33) at follow-up'. Results during follow-up, only 15.3 % (1 out of 6) of patients succeeded in maintaining a good physical condition, the remainder deteriorated or died. Of the older patients (≥75) only 3.6% remained in a good physical condition. Factors related to decline/low PF were increasing age (odds ratio [OR] = 1.96 [95% CI: 1.03-3.72] for 65-74 years and OR = 2.38 [95%CI: 1.17-4.84] for ≥75 years compared to <65 years) and albumin (OR = 1.10 [95%CI: 1.01-1.18] per g/L decrease). Conclusion very few hemodialysis patients maintain a good physical condition over a 2-year time span. Especially in older patients, physical performance is poor and decline is faster than in the healthy population. These findings should be taken into account when considering dialysis in older patients and more emphasis should be placed to attempts for improving physical condition.
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Affiliation(s)
- Ismay van Loon
- Dianet Dialysis Center, Brennerbaan 100, Utrecht 3524 BN, Netherlands
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Zeist, Utrecht, Netherlands
| | - Franciscus T J Boereboom
- Dianet Dialysis Center, Brennerbaan 100, Utrecht 3524 BN, Netherlands
- Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, Netherlands
| | | | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | | | - Menso J Nubé
- Department of Internal Medicine, VU Medical Center, Utrecht, Netherlands
| | - Piet M Ter Wee
- Department of Internal Medicine, VU Medical Center, Utrecht, Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Liaveri PG, Dikeos D, Ilias I, Lygkoni EP, Boletis IN, Skalioti C, Paparrigopoulos T. Quality of sleep in renal transplant recipients and patients on hemodialysis. J Psychosom Res 2017; 93:96-101. [PMID: 28107900 DOI: 10.1016/j.jpsychores.2016.12.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/22/2016] [Accepted: 12/23/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sleep disorders are very common in patients with chronic kidney disease and they may not always subside after kidney transplantation. AIM AND METHODS The aim of this cross-sectional study was to evaluate the self-reported quality of sleep, insomnia problems in particular, and examine the factors that disturb sleep of kidney transplant recipients (KTx: n=152) in comparison to age- and sex-matched patients on dialysis (HD: n=67) and participants with normal renal function (NOR: n=49), through the administration of the Athens Insomnia Scale (AIS) at least six months after transplantation. Clinical and laboratory data, as well as health-related quality of life, depression, anxiety, post-traumatic stress symptoms, and the presence of restless legs syndrome (RLS) and pruritus were investigated in relation to sleep problems. RESULTS The highest mean AIS score was observed in the transplant patients (KTx: 4.6±13.3 vs. HD: 3.8±8.1 vs. NOR: 2.4±10.2); both KTx and HD patients had a lower quality of sleep compared to participants with normal renal function. Multiple linear regression analysis showed that the determinants of the total AIS score were the frequency of post-traumatic stress symptoms, depression, RLS, diastolic blood pressure, and pain (all p<0.0001). CONCLUSION Although amelioration of renal function post-transplantation improves several aspects of quality of life, it does not seem to have a beneficial effect on self-reported sleep.
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Affiliation(s)
| | - Dimitris Dikeos
- Sleep Research Unit, First Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, "Eginition" Hospital, Athens, Greece
| | - Ioannis Ilias
- Endocrine Unit, "Elena Venizelou" Hospital, Athens, Greece
| | - Eirini P Lygkoni
- School of Applied Mathematics and Physical Science, National Technical University of Athens, Athens, Greece
| | - Ioannis N Boletis
- Nephrology Department, Renal Transplantation Unit, "Laikon" Hospital, Athens, Greece
| | - Chryssanthi Skalioti
- Nephrology Department, Renal Transplantation Unit, "Laikon" Hospital, Athens, Greece
| | - Thomas Paparrigopoulos
- Sleep Research Unit, First Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, "Eginition" Hospital, Athens, Greece
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Taber DJ, DuBay D, McGillicuddy JW, Nadig S, Bratton CF, Chavin KD, Baliga PK. Impact of the New Kidney Allocation System on Perioperative Outcomes and Costs in Kidney Transplantation. J Am Coll Surg 2017; 224:585-592. [PMID: 28159650 DOI: 10.1016/j.jamcollsurg.2016.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND In December 2014, a new kidney allocation system (KAS) was implemented nationwide with the goal of improving longevity matching, increasing access to sensitized patients, and improving racial/ethnic disparities. STUDY DESIGN National cohort study of US kidney transplantation programs, analyzing hospital-level outcomes (October 2012 to June 2016) using University HealthSystem Consortium data. In-hospital outcomes and costs were analyzed for trends over time using interrupted time series analysis with segmented regression. RESULTS There were 38,016 kidney transplantation procedures analyzed during the 3.8-year period. Over time, there was a mean increase of 2.7 cases/month (95% CI -0.02 to 5.4; p = 0.059), unaffected by KAS (18.9 case increase; p = 0.5601). Implementation of KAS led to significant changes in patient demographics, including a decrease in age (-2.8 years; p < 0.001), increase in number of African Americans (3.8%; p < 0.001), decrease in number of Caucasians (6.0%; p < 0.001), increase in number of Hispanics (2.9%; p < 0.001), increase in congestive heart failure (1.3%; p < 0.001), and decrease in diabetes with complications (4.0%; p < 0.001). The KAS had no impact on length of stay (0.12 days; 95% CI -0.11 to 0.35), length of stay index (0.01; 95% CI -0.03 to 0.05), ICU cases, ICU length of stay, patient safety indicators, or in-hospital mortality. The KAS led to a significant increase in delayed graft function rates (5.4%; 95% CI 23.3% to 7.4%); total in-hospital costs ($2,429; 95% CI $594 to $4.263); and 7-day (2.2%), 14-day (2.6%), and 30-day (2.7%) readmission rates. CONCLUSIONS Policy changes in organ allocation can have a significant impact on perioperative costs and outcomes, which can have a downstream influence on transplantation center perisurgical care processes.
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Affiliation(s)
- David J Taber
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC.
| | - Derek DuBay
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - John W McGillicuddy
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - Satish Nadig
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - Charles F Bratton
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - Kenneth D Chavin
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - Prabhakar K Baliga
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
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Poulsen CG, Kjaergaard KD, Peters CD, Jespersen B, Jensen JD. Quality of life development during initial hemodialysis therapy and association with loss of residual renal function. Hemodial Int 2016; 21:409-421. [PMID: 27804233 DOI: 10.1111/hdi.12505] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/08/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Health related quality of life (HRQOL) is markedly reduced in hemodialysis patients compared to the general population. We investigated the course of self-reported HRQOL over time and the association with selected factors, focusing on changes in glomerular filtration rate (GFR). METHODS Eighty-two newly started hemodialysis patients from the SAFIR cohort filled out the Kidney Disease Quality of Life Short Form Version 1.3 (KDQOL-SFTM ) questionnaire at baseline, 6 and 12 months. The SAFIR study was a randomized, placebo-controlled, double-blind intervention study, examining the effects of the angiotensin II receptor blocker irbesartan. HRQOL was a secondary outcome measure. Main inclusion criteria: Dialysis vintage <1 year, left ventricular ejection fraction >30% and urinary output >300 mL/day. GFR was measured with mean creatinine and urea clearance from 24-hour urine collections at baseline, 6 and 12 months. FINDINGS Irbesartan treatment did not affect HRQOL. Patients were pooled into one group for further analyses. Decline in GFR correlated significantly with decreasing HRQOL over time. HRQOL was stable over time, with a slight nonsignificant tendency toward improved HRQOL. The largest HRQOL-differences (positive values equal improved HRQOL) observed during the 12 month study period were (mean[95% confidence interval]): Burden of kidney disease:6.4[-2.2;15.0], Role limitations-physical:12.7[-2.1;27.5], and Role limitations-emotional:9.7[-5.2;24.6]. Comorbidity, especially diabetes, hospital admissions, female gender, and age were strongly associated with lower HRQOL in cross sectional analysis. DISCUSSION Preservation of residual renal function seems to be important for HRQOL. In newly started HD patients, HRQOL showed little change after 12 months. HRQOL was negatively affected by comorbidity, especially diabetes, hospital admissions, female gender, and age.
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Affiliation(s)
| | | | | | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Denmark.,Institute of Clinical Medicine, Aarhus University, Denmark
| | - Jens D Jensen
- Department of Renal Medicine, Aarhus University Hospital, Denmark.,Institute of Clinical Medicine, Aarhus University, Denmark
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Ho YF, Li IC. The influence of different dialysis modalities on the quality of life of patients with end-stage renal disease: A systematic literature review. Psychol Health 2016; 31:1435-1465. [PMID: 27604248 DOI: 10.1080/08870446.2016.1226307] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study aims to generate evidence regarding the relationships of different dialysis modalities with HR-QOL. DESIGN A systematic review was conducted to investigate the HR-QOL of patients treated with different dialysis modalities. METHODS A literature search was conducted for English language articles in the CINAHL, Medline and PubMed databases published from January 1990 through May 2016. Specifically, we sought articles that would compare the HR-QOL of hemodialysis (HD) and peritoneal dialysis (PD) patients in terms of physiological, psychological and social functioning, as well as disease symptoms. Thirty-four articles met the study inclusion criteria and were included into the analysis. RESULTS The research results indicated no significant differences in HR-QOL between HD and PD treatment. However, a higher percentage of patients who received PD had a better HR-QOL in terms of physiological, psychological, social and disease symptoms. CONCLUSIONS Despite the fact that the results of this study showed no difference in HR-QOL between HD and PD treatment, its review of relevant references can serve as a reference for health professionals. However, patients' conditions must still be taken into account when making suggestions about which dialysis modality a patient should use.
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Affiliation(s)
- Ya-Fang Ho
- a Department of Nephrology , Wei Gong Memorial Hospital, School of Nursing, National Yang Ming University , Taipei , Taiwan
| | - I-Chuan Li
- b Institute of Community Health Care , National Yang Ming University , Taipei , Taiwan
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Piillips L, Davies SJ, White E. Health-related quality of life assessment in end-stage renal failure. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/136140960100600304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
End-stage renal failure (ESRF) is a life-threatening condition and survival can be maintained only with renal replacement therapy. Furthermore, the complications of ESRF, its treatment and co-existing diseases have been found to have a significant impact on the physical health of patients. It is well documented that the health status of the renal patient population is worse than that of the general healthy population; for this reason the assessment of quality of life of ESRF patients has received considerable attention.During the 1990s, the focus of health assessment moved away from the disease itself towards health status and wellbeing. The widespread use of the 36-item short-form (SF-36) questionnaire has promoted this. In ESRF studies from data using the SF-36 questionnaire it has been shown that it is the physical functional component of health that is most affected by the patient's condition, with co-morbidity having a significant impact.There is growing consensus that health-related quality of life is more than just an assessment of health status. Rather, it is the relative importance given by the individuals themselves to the impact of the disease on their life. While this approach is emerging, some of the tools which have been developed to measure individualised quality of life require further scientific validation for use with the ESRF population.
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Affiliation(s)
| | - Simon J. Davies
- Department of Nephrology, North Staffordshire Hospitals, Stoke-on-Trent; Postgraduate Department of Medicine, Keele University, Staffordshire
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Measuring health-related quality of life in patients with conservatively managed stage 5 chronic kidney disease: limitations of the Medical Outcomes Study Short Form 36: SF-36. Qual Life Res 2016; 25:2799-2809. [PMID: 27522214 PMCID: PMC5065617 DOI: 10.1007/s11136-016-1313-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Chronic kidney disease (CKD) negatively affects health-related quality of life (HRQoL), which is often measured using the Medical Outcomes Study Short Form 36 (SF-36) questionnaire. However, the adequacy of SF-36 in this population has not been reported. We aimed to determine floor and ceiling effects and responsiveness to change of SF-36 in patients with conservatively managed stage 5 CKD. METHODS SF-36 data were collected prospectively. Floor and ceiling effects were estimated for each SF-36 scale and summary measure based on raw scores. The minimal clinically important difference (MCID) was estimated using a combination of anchor-based and distribution-based methods. Responsiveness to change was assessed by comparing MCID for each scale and summary measure to its smallest detectable change. RESULTS SF-36 data were available for 73 of the 74 study participants. Using baseline data, floor and/or ceiling effects were detected for 3 of the 8 SF-36 scales. The anchor-based estimation of MCID based on differences in baseline functional status yielded the most reliable results. For the physical component summary, MCID was estimated at 5.7 points. Whilst the two SF-36 summary measures were responsive to change and free of floor and/or ceiling effects, six of the eight scales were not. CONCLUSIONS This small study of patients with conservatively managed stage 5 CKD found that only the summary measures of SF-36 and 2 of its 8 scales can be used to assess changes in HRQoL over time. These findings suggest that in this population, alternative HRQoL assessment tools should be considered for future studies.
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Chang YT, Hwang JS, Hung SY, Tsai MS, Wu JL, Sung JM, Wang JD. Cost-effectiveness of hemodialysis and peritoneal dialysis: A national cohort study with 14 years follow-up and matched for comorbidities and propensity score. Sci Rep 2016; 6:30266. [PMID: 27461186 PMCID: PMC4962092 DOI: 10.1038/srep30266] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/04/2016] [Indexed: 12/15/2022] Open
Abstract
Although treatment for the dialysis population is resource intensive, a cost-effectiveness analysis comparing hemodialysis (HD) and peritoneal dialysis (PD) by matched pairs is still lacking. After matching for clinical characteristics and propensity scores, we identified 4,285 pairs of incident HD and PD patients from a Taiwanese national cohort during 1998-2010. Survival and healthcare expenditure were calculated by data of 14-year follow-up and subsequently extrapolated to lifetime estimates under the assumption of constant excess hazard. We performed a cross-sectional EQ-5D survey on 179 matched pairs of prevalent HD and PD patients of varying dialysis vintages from 12 dialysis units. The product of survival probability and the mean utility value at each time point (dialysis vintage) were summed up throughout lifetime to obtain the quality-adjusted life expectancy (QALE). The results revealed the estimated life expectancy between HD and PD were nearly equal (19.11 versus 19.08 years). The QALE's were also similar, whereas average lifetime healthcare costs were higher in HD than PD (237,795 versus 204,442 USD) and the cost-effectiveness ratios for PD and HD were 13,681 and 16,643 USD per quality-adjusted life year, respectively. In conclusion, PD is more cost-effective than HD, of which the major determinants were the costs for the dialysis modality and its associated complications.
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Affiliation(s)
- Yu-Tzu Chang
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Shih-Yuan Hung
- Division of Nephrology, Department of Internal Medicine, E-DA Hospital, and School of Medicine for International Students, I-Shou University, Kaohsiung
| | - Min-Sung Tsai
- Division of Nephrology, Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan
| | - Jia-Ling Wu
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Junne-Ming Sung
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Environmental and Occupational Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Chen JY, Wan EY, Choi EP, Wong CK, Chan AK, Chan KH, Li PK, Lam CL. Clinical and patient-reported outcomes of Chinese patients undergoing haemodialysis in hospital or in the community: A 1-year longitudinal study. Nephrology (Carlton) 2016; 21:617-23. [PMID: 26616825 PMCID: PMC5129586 DOI: 10.1111/nep.12686] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 12/16/2022]
Abstract
AIM Little is known about the effect of haemodialysis (HD) setting on outcomes of patients with end stage renal disease (ESRD). The study aimed at comparing clinical outcomes and patient-reported outcomes (PRO) of patients on community-based (CBHD) and hospital-based haemodialysis (HBHD). METHODS A prospective cohort of Chinese ESRD patients receiving HBHD (n = 89) or CBHD (n = 117) in Hong Kong were followed up for 12 months. Subjects were assessed on clinical outcomes of dialysis adequacy (Kt/V) and blood haemoglobin and PRO of health-related quality of life (SF-12v2), general health condition (Global Rating Scale (GRS)) and confidence to cope with their illness (Patient Enablement Instrument (PEI)). Differences between groups were analyzed by independent t-tests for the SF-12v2, GRS and PEI scores. χ(2) tests were used to analyze the difference in proportion of patients reaching the targets of Kt/V and blood haemoglobin and with GRS > 0 and PEI > 0. Multiple linear and logistic regressions were performed to assess the adjusted difference-in-difference estimation. RESULTS The mean PEI and GRS scores of CBHD patients at 12 months were significantly higher than those of HBHD patients. CBHD patients had significantly greater improvement in self-efficacy and were more likely to be enabled after 12 months than the HBHD patients. CONCLUSION The study showed similar clinical outcomes and PRO between CBHD and HBHD but CBHD was more effective than HBHD in promoting patient enablement over a 12-month period. The results suggest added value for patients receiving CBHD and support the transfer of HD care from the hospital to the community.
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Affiliation(s)
- Julie Y Chen
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Eric Yf Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Edmond Ph Choi
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
| | - Carlos Kh Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Anca Kc Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Karina Hy Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Philip Kt Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Cindy Lk Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
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Abstract
In light of the recent emphasis on patient-centered outcomes and quality of life for patients with kidney disease, we contend that the nephrology community should no longer fund, perform, or publish studies that compare survival by dialysis modality. These studies have become redundant; they are methodologically limited, unhelpful in practice, and therefore a waste of resources. More than two decades of these publications show similar survival between patients undergoing peritoneal dialysis and those receiving thrice-weekly conventional hemodialysis, with differences only for specific subgroups. In clinical practice, modality choice should be individualized with the aim of maximizing quality of life, patient-reported outcomes, and achieving patient-centered goals. Expected survival is often irrelevant to modality choice. Even for the younger and fitter home hemodialysis population, quality of life, not just duration of survival, is a major priority. On the other hand, increasing evidence suggests that patients with ESRD continue to experience poor quality of life because of high symptom burden, unsolved clinical problems, and unmet needs. Patients care more about how they will live instead of how long. It is our responsibility to align our research with their needs. Only by doing so can we meet the challenges of ESRD patient care in the coming decades.
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Affiliation(s)
- Martin B. Lee
- Division of Nephrology, University Medicine Cluster, National University Health System, Singapore; and
| | - Joanne M. Bargman
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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Gura V, Rivara MB, Bieber S, Munshi R, Smith NC, Linke L, Kundzins J, Beizai M, Ezon C, Kessler L, Himmelfarb J. A wearable artificial kidney for patients with end-stage renal disease. JCI Insight 2016; 1:86397. [PMID: 27398407 DOI: 10.1172/jci.insight.86397] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Stationary hemodialysis machines hinder mobility and limit activities of daily life during dialysis treatments. New hemodialysis technologies are needed to improve patient autonomy and enhance quality of life. METHODS We conducted a FDA-approved human trial of a wearable artificial kidney, a miniaturized, wearable hemodialysis machine, based on dialysate-regenerating sorbent technology. We aimed to determine the efficacy of the wearable artificial kidney in achieving solute, electrolyte, and volume homeostasis in up to 10 subjects over 24 hours. RESULTS During the study, all subjects remained hemodynamically stable, and there were no serious adverse events. Serum electrolytes and hemoglobin remained stable over the treatment period for all subjects. Fluid removal was consistent with prescribed ultrafiltration rates. Mean blood flow was 42 ± 24 ml/min, and mean dialysate flow was 43 ± 20 ml/min. Mean urea, creatinine, and phosphorus clearances over 24 hours were 17 ± 10, 16 ± 8, and 15 ± 9 ml/min, respectively. Mean β2-microglobulin clearance was 5 ± 4 ml/min. Of 7 enrolled subjects, 5 completed the planned 24 hours of study treatment. The trial was stopped after the seventh subject due to device-related technical problems, including excessive carbon dioxide bubbles in the dialysate circuit and variable blood and dialysate flows. CONCLUSION Treatment with the wearable artificial kidney was well tolerated and resulted in effective uremic solute clearance and maintenance of electrolyte and fluid homeostasis. These results serve as proof of concept that, after redesign to overcome observed technical problems, a wearable artificial kidney can be developed as a viable novel alternative dialysis technology. TRIAL REGISTRATION ClinicalTrials.gov NCT02280005. FUNDING The Wearable Artificial Kidney Foundation and Blood Purification Technologies Inc.
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Affiliation(s)
- Victor Gura
- Cedars-Sinai Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine at UCLA, UCLA, Los Angeles, California, USA
| | - Matthew B Rivara
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Scott Bieber
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Raj Munshi
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington, USA.,Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, Washington, USA
| | - Nancy Colobong Smith
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington, USA.,University of Washington Medical Center, Seattle, Washington, USA
| | - Lori Linke
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - John Kundzins
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Masoud Beizai
- Blood Purification Technologies Inc., Beverly Hills, California, USA
| | - Carlos Ezon
- Blood Purification Technologies Inc., Beverly Hills, California, USA
| | - Larry Kessler
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Jonathan Himmelfarb
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington, USA
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