Quality of life of chronic dialysis patients

Abstract

Objectives: Survival with end stage kidney disease (ESKD) is made possible by dialysis but is in turn associated with increased morbidity, mortality, and decreased quality of life (QOL). Quality of life is a frequently overlooked, yet a critical consideration in evaluating the overall medical care of ESKD patients. This study aimed to evaluate the QOL of chronic haemodialysis (HD) and peritoneal dialysis (PD) patients in multiple dialysis units in South Africa. Methods: A comparative descriptive study carried out on 100 haemodialysis (HD) (n=100) and 100 peritoneal dialysis patients (PD) (n=100) patients, evaluating factors such as demographics, duration on dialysis, medical history, clinical indicators and the patient’s understanding thereof, was performed. Quality of life was measured using the medical outcomes study 36 (SF-36). These factors, clinical scores and QOL measures were compared amongst HD and PD patients and thereafter correlated to nephrology professionals’ perspective on QOL. Results: A total of 200 (n=200) patients from 11 dialysis units were evaluated. Mean age for the HD group was 49±15 years compared to 53±14 years for the PD group (p=0.043). The HD patient group had an improved physical composite (PCS) score adjusted for age, urea, creatinine and albumin (p<0.001). The mental composite score (MCS) was improved in the PD group although not significant (p>0.05). A positive correlation was found, as PD patients had an improved symptom control score, adjusted for age (p=0.04), an improved effect of kidney disease score adjusted for albumin (p=0.000), and an improved burden QOL score adjusted for urea, creatinine and albumin (p=0.019). Age was shown to be associated to the physical functioning (p=0.01) and PCS (p=0.040), and diabetes to the emotional role (p=0.04), in QOL. An increase in the years on dialysis showed a reduced emotional well-being (p=0.028) and being on the transplant list an improved MCS (p=0.003). Participation in a pre-end stage kidney disease (PESKD) management programme showed improvement in the general health component (p=0.032), the effect (p=0.01), and the burden of kidney disease (p=0.02). Assessing patients’ knowledge on ESKD revealed the relationship of the PCS to the understanding of managing the complications associated with CKD (p=0.01) and access management (p=0.01). The understanding of diet was found to be significant to the burden of CKD (p=0.01) and the complications associated with CKD was found to be further significant to the effect and symptom QOL (p=0.01). Nephrology professionals rated the difficulty of living with kidney disease a 7.49 out of 10 score and 71% felt QOL is taken into consideration with managing ESKD patients. Conclusion: The study demonstrated differences in the adjusted QOL scores amongst HD and PD dialysis patients in the dialysis units studied. The importance of PESKD was emphasized in relation to improved QOL. Quality of life is a valid marker and important for the ongoing audit of renal services.