Quality of life in peritoneal and hemodialysis patients in China

Health-related quality of life and associated factors in HIV-positive transplant candidates and recipients from a HIV-positive donor

INTRODUCTION

HRQOL in transplant candidates and recipients who are also infected with HIV and are awaiting a kidney, or have received one from a HIV-positive donor, has not been previously investigated.

METHODS

The HRQOL of 47 HIV-positive kidney transplant candidates and 21 recipients from HIV-positive donors was evaluated using the Short Form-36 (SF-36) and face to face interviews at baseline and at 6 months. The correlation between SF-36 scores and sociodemographic, clinical and nutritional factors was determined.

RESULTS

68 patients completed the SF-36 at baseline and 6 months. Transplant candidates: transplant candidates had lower HRQOL than recipients. The main mental stressors were income, employment and waiting for a donor. Physical health complaints were body pain (BP) and fatigue. Pre-albumin and BMI was positively correlated with general health at baseline (r = 0.401, p = 0.031 and r = 0.338, p = 0.025). Besides a positive association with role physical (RP) and BP, albumin was associated with overall physical composite score (PCS) (r = 0.329, p = 0.024) at 6 months. Transplant recipients: Transplant recipients had high HRQOL scores in all domains. PCS was 53.8 ± 10.0 and 56.6 ± 6.5 at baseline and 6 months respectively. MCS was 51.3 ± 11.5 and 54.2 ± 8.5 at baseline and 6 months respectively. Albumin correlated positively with PCS (r = 0.464, p = 0.034) at 6 months and role emotional (RE) (r = 0.492, p = 0.024). Higher pre-albumin was associated with better RE and RP abilities and MCS (r = 0.495, p = 0.034). MAMC was associated with four domains of physical health and strongly correlated with PCS (r = 0.821, p = 0.000).

CONCLUSION

Strategies to improve HRQOL include ongoing social support, assistance with employment issues and optimising nutritional status.

Health-related quality of life and long-term mortality in young and middle-aged hemodialysis patients

PURPOSE

The relationship of health-related quality of life (HRQoL) with mortality in young and middle-aged hemodialysis (HD) patients has scarcely been studied and remains unclear. The aim of the study was to examine whether physical and mental components of HRQoL are related to long-term risks of all-cause and cardiovascular (CV) death in this particular HD population.

METHODS

A long-term observational prospective study included 238 prevalent HD patients aged 18-64 years. The median follow-up was 50 (22, 96) months (maximum 13.9 years). HRQoL variables of the Short Form 36 Health Survey (SF-36), clinical, and demographic data were assessed at the time of inclusion. Associations of baseline HRQoL scores with all-cause and CV mortality were assessed using Kaplan-Meier survival plots and Cox regression analysis adjusted for clinical and demographic confounders.

RESULTS

The majority of HRQoL parameters were associated with outcomes in univariable analyses. In multivariable regression models adjusted for clinical and demographic confounders, Physical Functioning (PF) and Physical Component Summary Score (PCS) remained independently related to all-cause mortality [hazard ratio (HR) for a 1-point increase in PF and PCS were 0.981, 95% confidence interval (CI) 0.972-0.989 and 0.954, CI 0.929-0.980, respectively] and CV death (HR for a 1-point increase in PF and PCS were 0.975, CI 0.962-0.988 and 0.950, CI 0.915-0.985, respectively).

CONCLUSION

PF and PCS assessment seems to be relevant for refining the prognosis and clinical decision-making in young and middle-aged HD patients.

The cross-lagged association between depressive symptoms and health-related quality of life in patients receiving maintenance hemodialysis: a three-wave longitudinal study

PURPOSE

To examine the cross-lagged relationship between depressive symptoms and health-related quality of life (HRQoL) in patients receiving maintenance hemodialysis.

METHODS

A longitudinal, observational study was conducted in two public hospitals in Shanghai, China. The sample consisted of 204 patients at baseline (T1). Of these, 144 completed the 12-month follow-up survey (T2), and 135 completed the 24-month follow-up survey (T3). Depressive symptoms were assessed using the depression subscale of the Hospital Anxiety and Depression Scale, and HRQoL was assessed using the Kidney Disease Quality of Life 36 short form. Cross-lagged path analysis was used to examine the temporal relationship between depressive symptoms and domains of health-related quality of life.

RESULTS

Lower levels of three out of five domains of HRQoL (physical functioning, burden of kidney disease, and symptoms of kidney disease) at T1 were associated with increases in depressive symptoms at T2. Moreover, higher depressive symptoms at T2 were associated with decreases in four domains of HRQoL (mental functioning, burden of kidney disease, symptoms of kidney disease, and effects of kidney disease) at T3.

CONCLUSIONS

Patients who had poor HRQoL were more likely to report more subsequent depressive symptoms, which in turn predict lower HRQoL over time. It indicates a need to break this cycle in patients receiving maintenance hemodialysis.

The Effect of Positive Thinking Training on Different Dimensions of Quality of Life of Hemodialysis Patients: A Randomized Controlled Clinical Trial

Background: Nowadays, the quality of life of hemodialysis patients has decreased, which doubled the need for educational interventions. Objectives: The current study investigated the effect of positive thinking training on different dimensions of quality of life of hemodialysis patients. Methods: This is a controlled clinical trial study conducted on 70 hemodialysis patients in Fasa, Fars province, in 2019. The patients were selected using the simple sampling method. Then, they were divided into two groups of intervention (n = 35) and control (n = 35). After obtaining informed consent, the researchers asked the participants to complete the SF-36 Quality of Life Questionnaire. The intervention group was trained positive thinking skills in 8 workshop sessions; each lasted for 90 minutes. Data were analyzed using SPSS version 20. To analyze the data, statistical tests such as chi-square, Kolmogorov-Smirnov, independent, and t-test were used. Results: The mean and standard deviation of the patients’ quality of life in the intervention group increased from 35.95 ± 10.07 to 55.98 ± 11.71 (P < 0.001). The changes in patients’ quality of life before and after the intervention were also assessed in 8 dimensions, which showed that the quality of life of the patients did not change significantly in terms of physical function (P = 0.42) and physical pain (P = 0.62), but for other dimensions, it was significantly increased (P < 0.001). Conclusions: Positive thinking training improved the quality of life of hemodialysis patients, particularly in the dimensions of the emotional role, emotional health, energy and vitality, social performance, and general health is recommended.

Health-Related Quality of Life in Home Dialysis Patients Compared to In-Center Hemodialysis Patients: A Systematic Review and Meta-analysis

RATIONALE & OBJECTIVE

Dialysis patients judge health-related quality of life (HRQoL) as an essential outcome. Remarkably, little is known about HRQoL differences between home dialysis and in-center hemodialysis (HD) patients worldwide.

STUDY DESIGN

Systematic review and meta-analysis.

SETTING & STUDY POPULATIONS

Search strategies were performed on the Cochrane Library, Pubmed, and EMBASE databases between 2007 and 2019. Home dialysis was defined as both peritoneal dialysis and home HD.

SELECTION CRITERIA FOR STUDIES

Randomized controlled trials and observational studies that compared HRQoL in home dialysis patients versus in-center HD patients.

DATA EXTRACTION

The data extracted by 2 authors included HRQoL scores of different questionnaires, dialysis modality, and subcontinent.

ANALYTICAL APPROACH

Data were pooled using a random-effects model and results were expressed as standardized mean difference (SMD) with 95% CIs. Heterogeneity was explored using subgroup analyses.

RESULTS

Forty-six articles reporting on 41 study populations were identified. Most studies were cross-sectional in design (90%), conducted on peritoneal dialysis patients (95%), and used the 12-item or 36-item Short-Form Health Survey questionnaires (83%). More than half the studies showed moderate or high risk of bias. Pooled analysis of 4,158 home dialysis patients and 7,854 in-center HD patients showed marginally better physical HRQoL scores in home dialysis patients compared with in-center HD patients (SMD, 0.14; 95% CI, 0.04 to 0.24), although heterogeneity was high (I 2>80%). In a subgroup analysis, Western European home dialysis patients had higher physical HRQoL scores (SMD, 0.39; 95% CI, 0.17 to 0.61), while home dialysis patients from Latin America had lower physical scores (SMD, -0.20; 95% CI, -0.28 to -0.12). Mental HRQoL showed no difference in all analyses.

LIMITATIONS

No randomized controlled trials were found and high heterogeneity among studies existed.

CONCLUSIONS

Although pooled data showed marginally better physical HRQoL for home dialysis patients, the quality of design of the included studies was poor. Large prospective studies with adequate adjustments for confounders are necessary to establish whether home dialysis results in better HRQoL.

TRIAL REGISTRATION

PROSPERO 95985.

Health-related quality of life in end-stage renal disease patients, using the Missoula-Vitas quality of life index: a multicenter study

Background and aims

Assessment of Health-related Quality of Life in chronic hemodialysis patients (CHD) is a predictive indicator of the outcome of the disease, including mortality and hospitalization. Regular surveys of the quality of life (QoL) in CHD patients have been conducted worldwide, using various, internationally validated and standardized tools, including the Missoula-VITAS Quality of Life Index scale (MVQOLI). The aim of this study was to examine the reliability and validity of the Bulgarian version of the Missoula-VITAS Quality of Life Index-15 (B-MVQOLI-15) and QoL in CHD patients using this instrument.

Methods

Our study was designed as multi-center cross-sectional. It incorporated 263 end-stage renal disease (ESRD) patients on CHD from across the country and applied the B-MVQOLI-15. Internal consistency and convergent validity of the index were assessed. Non-parametric methods were used to evaluate the impact of demographic factors on the different dimensions scores and on the total score. The relationship between the total QoL score, the total MVQOLI-15 score and dimensions scores were measured based on Spearman's rho Correlation Coefficient.

Results

The total MVQOLI-15 score in the study was 16.44, which is slightly above the middle of the index scale. The patients with higher education were less satisfied with the level of their symptom control compared to patients with lower education. However, high education patients seem to manage better with everyday life compared to those with low education. Men seem to feel more satisfied than women when fulfilling their daily activities (P=0.026). Retired patients and unemployed expressed more satisfaction, compared to the employed (P=0.021). Also, patients on dialysis for over 5 years had lower QoL scores (P=0.043).

Conclusions

B-MVQOLI-15 is a reliable instrument to measure QoL in Bulgarian patients with CHD. The majority of CHD patients rate their QoL as "Fair". Four of all five dimensions positively affect the QoL of CHD patients. The most important dimensions positively affecting the QoL of CHD patients were: interpersonal relationships and transcendent factors. Future studies are necessary to assess the adequacy of the delivered dialysis, the level of medico-social care and the needs of ESRD patients treated with CHD in order to improve their QoL.

Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO): rationale and design

Background

More than 6200 End Stage Renal Disease patients in the Netherlands are dependent on dialysis, either performed at home or in a dialysis centre. Visiting a dialysis centre three times a week is considered a large burden by many patients. However, recent data regarding the effects of dialysis at home on quality of life, clinical outcomes, and costs compared with in-centre haemodialysis are lacking.

Methods

The Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO) is a nationwide, prospective, observational cohort study that will include adult patients starting with a form of dialysis. Health-related quality of life, as the primary outcome, clinical outcomes and costs, as secondary outcomes, will be measured every 3–6 months in patients on home dialysis, and compared with a control group consisting of in-centre haemodialysis patients. During a 3-year period 800 home dialysis patients (600 peritoneal dialysis and 200 home haemodialysis patients) and a comparison group of 800 in-centre haemodialysis patients will be included from 53 Dutch dialysis centres (covering 96% of Dutch centres) and 1 Belgian dialysis centre (covering 4% of Flemish centres).

Discussion

DOMESTICO will prospectively investigate the effect of home dialysis therapies on health-related quality of life, clinical outcomes and costs, in comparison with in-centre haemodialysis. The findings of this study are expected to ameliorate the shared decision-making process and give more guidance to healthcare professionals, in particular to assess which type of patients may benefit most from home dialysis.

Trial registration

The DOMESTICO study is registered with the National Trial Register on (number: NL6519, date of registration: 22 August 2017) and the Central Committee on Research Involving Human Subjects (CCMO) (number: NL63277.029.17).

Electronic supplementary material

The online version of this article (10.1186/s12882-019-1526-4) contains supplementary material, which is available to authorized users.

Quality of life in patients on chronic dialysis in South Africa: a comparative mixed methods study

Background

The increasing prevalence of treated end-stage renal disease and low transplant rates in Africa leads to longer durations on dialysis. Dialysis should not only be aimed at prolonging lives but also improve quality of life (QOL). Using mixed methods, we investigated the QOL of patients on chronic haemodialysis (HD) and peritoneal dialysis (PD).

Methods

We conducted a cross-sectional study at Tygerberg Hospital in Cape Town, South Africa. All the PD patients were being treated with continuous ambulatory peritoneal dialysis. The KDQOL-SF 1.3 questionnaire was used for the quantitative phase of the study. Thereafter, focus-group interviews were conducted by an experienced facilitator in groups of HD and PD patients. Electronic recordings were transcribed verbatim and analysed manually to identify emerging themes.

Results

A total of 106 patients completed questionnaires and 36 of them participated in the focus group interviews. There was no difference between PD and HD patients in the overall KDQOL-SF scores. PD patients scored lower with regard to symptoms (P = 0.005), energy/fatigue (P = 0.025) and sleep (P = 0.023) but scored higher for work status (P = 0.005) and dialysis staff encouragement (P = 0.019) than those on HD. Symptoms and complications were verbalised more in the PD patients, with fear of peritonitis keeping some housebound. PD patients were more limited by their treatment modality which impacted on body image, sexual function and social interaction but there were less dietary and occupational limitations. Patients on each modality acknowledged the support received from family and dialysis staff but highlighted the lack of support from government. PD patients had little opportunity for interaction with one another and therefore enjoyed less support from fellow patients.

Conclusions

PD patients experienced a heavier symptom burden and greater limitations related to their dialysis modality, especially with regards to social functioning. The mixed-methods approach helped to identify several issues affecting quality of life which are amenable to intervention.

Electronic supplementary material

The online version of this article (doi:10.1186/s12882-016-0425-1) contains supplementary material, which is available to authorized users.

The influence of different dialysis modalities on the quality of life of patients with end-stage renal disease: A systematic literature review

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.

THE IMPACT OF SOCIOECONOMIC FACTORS ON QUALITY OF LIFE OF PATIENTS WITH CHRONIC KIDNEY DISEASE IN GREECE

BACKGROUND

Quality of Life (QoL) is often poor in people undergoing dialysis and this sometimes contributes to the high rate of morbidity and mortality. The aim of our study is to assess the QoL of patients on haemodialysis in Greece and discuss the socio-demographic factors that affect QoL in this period of financial crisis.

DESIGN/PATIENTS

Patients with CKD not on dialysis, plus those undergoing Haemodialysis (HD) and Peritoneal Dialysis (PD) were invited to complete the SF-36 questionnaire electronically, supervised by a trained nurse. Patients were asked about their marital status, education level and monthly household income. Additionally, patients were requested to comment on their subjective financial difficulties.

RESULTS

A total of 172 patients were enrolled in the study, 39 of them were undergoing PD, 90 on HD and 43 had CKD. Among those with CKD, on HD and PD, 9.3%, 17.8% and 23.1%, respectively, had 'some/a lot' difficulties in copying with financial problems. The physical component summary score was significant lower in HD, while the summary score of the mental component showed no differences between the groups. In multiple linear regression analysis, age and dialysis had significantly negative correlations with physical functioning scores. Those who were divorced or widowed tended to perform worse in physical scores compared with those who were married. Mental scores were affected only by coping with financial difficulties.

CONCLUSIONS

In general terms, people with CKD patients present with a poor QoL. Apart from the burden of the renal disease per se, social and economic factors (divorce, financial difficulties) seem to aggravate their status, especially in this period of financial crisis.