Quality of Life of Patients With Chronic Kidney Disease Under Maintenance Hemodialysis and Their Caregivers: A Cross-Sectional Study

BACKGROUND

Maintenance hemodialysis (MHD) prolongs the life of patients with end-stage chronic kidney disease (CKD), but this process can change their lifestyle, affecting their quality of life (QoL). Patients with MHD require their caregivers' assistance in daily management and repeated hospital visitation. This places a burden on caregivers affecting their QoL. Both patient and caregiver form a unit during the caregiving process. This study aims to compare and correlate the QoL of patients with CKD under MHD with their caregivers, considering their common familial and socioeconomic backgrounds.

METHODOLOGY

This is a cross-sectional, comparative study in the Hemodialysis Unit of Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Patients aged >14 years with CKD under MHD and caregivers staying with the patient at their resident place for a minimum of two months were included in the study. QoL of patients with CKD under MHD was compared with caregivers under different domains of the physical component summary (PCS) and mental component summary (MCS) scores using an SF-36 (Short form-36) health survey questionnaire. Data was collected and entered in Microsoft Excel 2010/Epi info version 7.2 and analyzed.

RESULTS

The overall QoL of caregivers was better than CKD patients under MHD in terms of both PCS score (48.13 vs. 35.36) and MCS score (48.11 vs. 43.25) and was statistically significant (p-value: <0.001) in both scores. The patient's QoL was not significantly correlated with the caregiver's PCS score (p-value: 0.635). Still, there was a significant correlation between QoL and MCS scores (p-value: 0.006). Similarly, caregivers had better QoL than CKD patients under MHD under all eight domains, which was statistically significant. No significant correlation was found between the frequency and duration of MHD with PCS and MCS scores of both patient and caregiver.

CONCLUSION

Overall, the physical and mental QoL of the caregiver was better than CKD patients under MHD. Further studies need to be conducted to assess the QoL of both groups compared to the healthy population to address the issue of hemodialysis patients and their caregivers.

Limb Salvage Strategy Amendment for a Better Future in the Era of Bone Cancer Therapy: A Cross-Sectional Study in North India

BACKGROUND

 Bone tumors remain a formidable challenge for orthopedic surgeons. In developing countries, the challenge is exacerbated by limited diagnostic, therapeutic, and management facilities and ignorance. Patients with upper and lower-extremity muscle and skeletal tumors are candidates for amputation or surgical rescue of the limbs. Traditionally, limb rescue surgery by neo-adjuvant chemotherapy is the preferred surgery method for localized carcinoma. Amputations are usually reserved for patients with increased tumor size. The purpose of this study is to investigate health-related quality of life (HRQOL) and physical disability, focusing on surgical care, gender, and age, in adolescent and young adult survivors of malignant bone tumors treated surgically.

METHODS

 This cross-sectional study consists of 38 long-term survivors who underwent amputation or limb-salvage surgery at King George's Medical University, Lucknow, from 2019 to 2022. After obtaining ethical clearance and informed consent, 38 patients which included 26 patients treated with limb salvage in Group A and 12 patients treated with amputation in Group B were included in the study. The SF-36 and HUI3 scores were used to assess the functional outcome and health-related QoL of these patients.

RESULTS

 After minimal six months of interventions, we have found a significant improvement in all the following factors: physical functioning (P=0.000), role limitations due to physical health (P=0.000) and emotional problems (P=0.001), energy/fatigue (P=0.000), emotional well-being (P=0.000), social functioning (P=0.000), pain (P=0.000), and general health (P=0.000). Group A showed a higher degree of significance than Group B through SF-36 (Short Form-36, patient-reported outcome), whereas HUI-3 did not show any significant outcomes (P=0.347).

CONCLUSION

 The overall quality of life of patients with salvaged limbs appears to be higher than that of the quality of life of amputee patients in tumor survivor patients. Further analyses must be carried out to verify the results and focus on areas that have a major impact on the overall quality of life using other assessment tools. The impact of therapy on the quality of life depends on maintaining the necessary structures for functional functions, adjusting patient expectations to cancer treatments, and designing long-term rehabilitation programs to support functional functions.

Benefits in quality of life following an obstructive sleep apnea screening and treatment program in patients with acute ischemic stroke

INTRODUCTION

Obstructive sleep apnea (OSA) has been proposed as a factor that worsens stroke prognosis. Our aim was to determine if an OSA intervention could improve quality of life (QOL, first objective) and modified Rankin score (mRS, second objective).

PATIENTS AND METHODS

The intervention group of this quasi-experimental study included patients with acute ischemic stroke <72 hours who underwent polygraphy and Continuous Positive Airway Pressure (CPAP) and hygienic-dietary measures if required. The control group followed routine clinical practice. The Short Form 36 Health Survey (SF-36) and mRS were applied at the sixth month after stroke in both groups.

RESULTS

Fifty-five vs. sixty-two patients were included in the intervention and control group respectively. In the intervention group, 64.71% of patients accepted the proposed CPAP (16 cases with a good adherence). An improvement in SF-36 items was detected in the intervention group: physical functioning (p = 0.008), role physical (p = 0.002), bodily pain (p = 0.008), general health (p <0.001), vitality (p = 0.001) and role emotional (p = 0.015). In a per-protocol analysis, all these improvements were verified in the group of patients treated with good CPAP adherence (p < 0.05 in all the same SF-36 items). The percentage of patients with physical component summatory = 50 was higher in the intervention group (p = 0.003). There were no differences in the median of mRS (p = 0.262).

CONCLUSIONS

Although more evidence is needed, a significant improvement in QOL was suggested after our OSA intervention, particularly in patients with good CPAP adherence.