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Elezi B, Rumano M, Abazaj E, Topi S. Health-related quality-of-life measures used in hemodialysis patients in Albania. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023. [DOI: 10.1186/s43162-022-00172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
Chronic kidney disease is a growing worldwide public health concern. On the other hand, patients’ perception of health is an important outcome measure in the assessment of the influence of chronic disease and received treatment. Interest in measuring health-related quality of life has increased together with an awareness that such humanistic outcomes require valid and reliable measures. The aimed study was to evaluate the health-related quality of life (QoL) and to investigate the relationship between selected demographic and clinical characteristics and Health-related Quality of Life (HRQoL) scores in hemodialysis patients.
Methods
This survey study was conducted on hemodialysis patients (209 patients) during the periods 2017–2018. The QoL includes 25 questions classified into five dimensions, which are mobility, personal care, common activities, discomfort and pain, anxiety, and depression. P value < .05 was considered statistically significant.
Results
Overall 209 hemodialysis patients, the mean of the five domains varies from a minimum value of 1.75 ± 1.06 for personal care to a maximum value of 2.65 ± 1.44 for anxiety and/or depression. In our study, among hemodialysis patients is seen a significant association scored between the quality of life and demographic variables like age groups (p = 0.034), and gender (p = 0.01) as in the previous studies. The presence of comorbidities was significantly associated with the QOL (p = 0.001). About the questionnaire, “How good or bad your health is today” the average score resulted to be 47.08 ± 4.5.
Conclusion
As we saw from the results of this study, a considerable number of the patients live with low income. Age, sex, and comorbidities are dependent factors of HRQoL. Therefore, we suggest that future studies include other factors that will evaluate hemodialysis efficiency and find the association between these and QoL.
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Gebrie MH, Asfaw HM, Bilchut WH, Lindgren H, Wettergren L. Psychometric properties of the kidney disease quality of life-36 (KDQOL-36) in Ethiopian patients undergoing hemodialysis. Health Qual Life Outcomes 2022; 20:24. [PMID: 35144625 PMCID: PMC8832803 DOI: 10.1186/s12955-022-01932-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Health-related quality of life (HRQOL) has a direct association with increased morbidity and mortality among end stage renal disease patients. Valid and reliable instruments to measure the HRQOL of patients with end stage renal disease are therefore required. This study aimed to translate, culturally adapt and evaluate the psychometric properties of the Amharic version of the Kidney Disease Quality of Life-36 (KDQOL-36) instrument in Ethiopian patients with end stage renal disease undergoing hemodialysis. Methods The KDQOL-36 instrument was developed for individuals with kidney disease who are being treated with dialysis and includes both generic and disease-specific components. The KDQOL-36 was translated to Amharic language and distributed to a cross-sectional sample of 292 hemodialysis patients. The psychometric evaluation included construct validity through corrected item-total correlation, confirmatory factor analysis and known group analysis. Convergent validity was evaluated by correlations between each of the three kidney disease targeted scales (symptoms/problems list, burden of kidney disease and effects of kidney diseases) and the European Quality of Life 5D-5L and Visual Analog Scales. Regarding reliability, internal consistency and test–retest reliability were assessed. Results Two hundred ninety-two patients with a mean age of 48 (SD ± 14.7) completed the questionnaire. Corrected item- total correlation scores were > 0.4 for all items. Confirmatory factor analysis revealed a two χ2 /df was 4.4, Root Mean Square Error of Approximation (RMSEA) = 0.108 (90% CI 0.064–0.095), Comparative Fit Index (CFI) = 0.922, Tucker Lewis Index (TLI) = 0.948 and Standardized Root mean-squared residual (SRMR) = 0.058) and three χ2 /df = 3.1, RMSEA = 0.085 (90% CI 0.064–0.095), CFI = 0.854, TLI = 0.838 and SRMR = 0.067) factor models for the generic and disease specific components respectively. The mean scores of the three kidney disease targeted domains were correlated to the EQ-5D-5L & VAS with correlation coefficients of large magnitude (0.55–0.81). The reliability of the instrument was satisfactory (Cronbach’s alpha = 0.81–0.91) and Intra-class correlation (ICC) = 0.90–0.96). Conclusion The Amharic version of the KDQOL-36 is a reliable and valid instrument recommended for assessment of HRQOL of Ethiopian patients on hemodialysis. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01932-y.
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Affiliation(s)
- Mignote Hailu Gebrie
- College of Medicine and Health Sciences, School of Nursing, University of Gondar, Gondar, Ethiopia.
| | - Hussen Mekonnen Asfaw
- College of Health Sciences, School of Nursing & Midwifery, Department of Nursing, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workagegnehu Hailu Bilchut
- College of Medicine and Health Sciences, School of Medicine, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Solna, Sweden
| | - Lena Wettergren
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Solna, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Hazara AM, Allgar V, Twiddy M, Bhandari S. A mixed-method feasibility study of a novel transitional regime of incremental haemodialysis: study design and protocol. Clin Exp Nephrol 2021; 25:1131-1141. [PMID: 34101030 PMCID: PMC8421284 DOI: 10.1007/s10157-021-02072-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022]
Abstract
Background Incremental haemodialysis/haemodiafiltration (HD) may help reduce early mortality rates in patients starting HD. This mixed-method feasibility study aims to test the acceptability, tolerance and safety of a novel incremental HD regime, and to study its impact on parameters of patient wellbeing.
Method We aim to enrol 20 patients who will commence HD twice-weekly with progressive increases in duration and frequency, achieving conventional treatment times over 15 weeks (incremental group). Participants will be followed-up for 6 months and will undergo regular tests including urine collections, bio-impedance analyses and quality-of-life questionnaires. Semi-structured interviews will be conducted to explore patients’ prior expectations from HD, their motivations for participation and experiences of receiving incremental HD. For comparison of safety and indicators of dialysis adequacy, a cohort of 40 matched patients who previously received conventional HD will be constructed from local dialysis records (historical controls).
Results Data will be recorded on the numbers screened and proportions consented and completing the study (primary outcome). Incremental and conventional groups will be compared in terms of differences in blood pressure control, interdialytic weight changes, indicators of dialysis adequacy and differences in adverse and serious adverse events. In analyses restricted to incremental group, measurements of RRF, fluid load and quality-of-life during follow-up will be compared with baseline values. From patient interviews, a narrative description of key themes along with anonymised quotes will be presented. Conclusion Results from this study will address a significant knowledge gap in the prescription HD therapy and inform the development novel future therapy regimens.
Supplementary Information The online version contains supplementary material available at 10.1007/s10157-021-02072-1.
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Affiliation(s)
- Adil M Hazara
- Hull York Medical School, Hull, UK. .,Hull University Teaching Hospitals NHS Trust, Anlaby Road, Hull, HU3 2JZ, UK.
| | - Victoria Allgar
- Peninsula Medical School, Faculty of Health, University of Plymouth, N15, ITTC Building 1, Plymouth Science Park, Plymouth, PL6 8BX, UK
| | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, University of Hull, Hull, HU6 7RX, UK
| | - Sunil Bhandari
- Hull York Medical School, Hull, UK.,Hull University Teaching Hospitals NHS Trust, Anlaby Road, Hull, HU3 2JZ, UK
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Ranabhat K, Khanal P, Mishra SR, Khanal A, Tripathi S, Sigdel MR. Health related quality of life among haemodialysis and kidney transplant recipients from Nepal: a cross sectional study using WHOQOL-BREF. BMC Nephrol 2020; 21:433. [PMID: 33046010 PMCID: PMC7552453 DOI: 10.1186/s12882-020-02085-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/02/2020] [Indexed: 12/05/2022] Open
Abstract
Background Very less is known about health-related quality of life (HRQOL) among patients with kidney diseases in Nepal. This study examined HRQOL among haemodialysis and kidney transplant recipients in Nepal. Methods The Nepali version of World Health Organization Quality of Life Instruments -(WHOQOL-BREF) questionnaire was administered using face to face interviews among end stage renal disease (ESRD) patients, from two large national referral centers in Nepal. The differences in socio-demographic characteristics among ESRD patients were examined using the Chi-square test. The group differences in quality of life (QOL) were examined using the Mann-Whitney U test and Kruskal-Wallis tests. Results Of the 161 participants, 92 (57.1%) were renal transplant recipients and 69 (42.9%) patients were on maintenance haemodialysis. Hypertension (70.9%) was the most common co-morbidity among ESRD patients. Haemodialysis patients scored significantly lower than the transplant recipients in all four domains as well as in overall perception of quality of life and general health. Ethnicity (p = 0.020), socio-economic status (p < 0.001), educational status (p < 0.001) and employment status (p = 0.009) were significantly associated with the overall QOL in ESRD patients. Across patient groups, educational status (p = 0.012) was positively associated with QOL in dialysis patients, while urban residence (p = 0.023), higher socio-economic status (p < 0.001), higher educational status (p = 0.004) and diabetes status (p = 0.010) were significantly associated with better QOL in transplant recipients. Conclusion The overall QOL of the renal transplant recipients was higher than that of the patients on maintenance haemodialysis; this was true in all four domains of the WHOQOL-BREF. ESRD patients with low HRQOL could benefit from targeted risk modification intervention.
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Affiliation(s)
- Kamal Ranabhat
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal.,Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Pratik Khanal
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | | | - Anu Khanal
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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5
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Visweswaran K, Shaffi M, Mathew P, Abraham M, Lordson J, Rajeev P, Thomas R, Aravindakshan R, G J, Nayar KR, Pillai M. Quality of Life of End Stage Renal Disease Patients Undergoing Dialysis in Southern Part of Kerala, India: Financial Stability and Inter-dialysis Weight Gain as Key Determinants. J Epidemiol Glob Health 2020; 10:344-350. [PMID: 32959612 PMCID: PMC7758848 DOI: 10.2991/jegh.k.200716.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/20/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Quality of Life (QoL) reflects the quality and outcome of healthcare along with key indicators of performance such as mortality and morbidity. Objective: The aim of the study was to measure the QoL among patients with End Stage Renal Disease (ESRD) on maintenance hemodialysis and to understand various correlates of QoL. Methods: A total of 95 ESRD patients from three dialysis centres in Southern districts of Kerala were interviewed. QoL was measured using vernacular version of World Health Organization Quality Of Life – Brief Version (WHOQOL-BREF) questionnaire. Results: The mean age of the patients was 56.2 ± 13 years and 73.7% were males. Mean converted scores for overall QoL was 42.37 ± 21.3 and Health-related QoL (HRQoL) was 43.3 ± 18.3, indicating poor QoL. Males had significantly higher physical domain scores (p < 0.03). Occupation, income and Socio-economic Status (SES) influenced overall HRQoL while better income and higher SES predicted better scores in psychological and environmental domains. Conclusion: Patients with better control over inter-dialysis weight gain (≤1600 g) had significantly higher scores. This study highlights the importance of using QoL tools in assessing the QoL of patients and the factors contributing to it.
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Affiliation(s)
- Kasi Visweswaran
- Department of Nephrology, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India
| | - Muhammed Shaffi
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India.,Directorate of Public Health, Ministry of Health, Al Taif, Makkah, Saudi Arabia
| | - Philip Mathew
- Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Minu Abraham
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India
| | - Jinbert Lordson
- Department of Nephrology, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India.,Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India
| | - Premini Rajeev
- College of Nursing, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India
| | - Reena Thomas
- Department of Nephrology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Rajeev Aravindakshan
- Department of Nephrology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Jayadevan G
- Department of Nephrology, Shankers Institute of Medical Sciences, Kollam, Kerala, India
| | - Kesavan Rajasekharan Nayar
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India
| | - Marthanda Pillai
- Department of Nephrology, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India.,Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India
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6
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Association between health related quality of life and progression of chronic kidney disease. Sci Rep 2019; 9:19595. [PMID: 31863079 PMCID: PMC6925203 DOI: 10.1038/s41598-019-56102-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 12/06/2019] [Indexed: 11/08/2022] Open
Abstract
The impact of health-related quality of life (HRQOL) on outcomes remains unclear in chronic kidney disease (CKD) patients despite its importance in socioeconomic aspects and individual health. We aim to identify the relationship between HRQOL and progression of CKD in pre-dialysis patients. A total 1622 patients with CKD were analyzed in the KoreaN cohort Study for Outcomes in patients With Chronic Kidney Disease, a prospective cohort study. CKD progression was defined as one or more of the following: initiation of dialysis or transplantation, a two-fold increase in baseline serum creatinine levels, or a 50% decline in the estimated glomerular filtration rate during the follow-up period. The group with CKD progression had lower scores of HRQOL than the group without CKD progression. A fully adjusted Cox proportional hazard ratio model showed that each low baseline physical and mental component summary score was associated with a higher risk of CKD progression. In Kaplan-Meier survival analysis using propensity score matched data, only low physical component summary scores showed statistical significance with CKD progression. Our study highlights low physical component summary score for an important prognostic factor of CKD progression. Risk-modification interventions for high-risk patients may provide benefits to individuals.
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7
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Dolgin NH, Movahedi B, Anderson FA, Brüggenwirth IMA, Martins PN, Bozorgzadeh A. Impact of recipient functional status on 1-year liver transplant outcomes. World J Transplant 2019; 9:145-157. [PMID: 31850158 PMCID: PMC6914386 DOI: 10.5500/wjt.v9.i7.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Karnofsky Performance Status (KPS) scale has been widely validated for clinical practice for over 60 years.
AIM To examine the extent to which poor pre-transplant functional status, assessed using the KPS scale, is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.
METHODS This study included 38278 United States adults who underwent first, non-urgent, liver-only transplantation from 2005 to 2014 (Scientific Registry of Transplant Recipients). Functional impairment/disability was categorized as severe, moderate, or none/normal. Analyses were conducted using multivariable-adjusted Cox survival regression models.
RESULTS The median age was 56 years, 31% were women, median pre-transplant Model for End-Stage for Liver Disease score was 18. Functional impairment was present in 70%; one-quarter of the sample was severely disabled. After controlling for key recipient and donor factors, moderately and severely disabled patients had a 1-year mortality rate of 1.32 [confidence interval (CI): 1.21-1.44] and 1.73 (95%CI: 1.56-1.91) compared to patients with no impairment, respectively. Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13 (CI: 1.02-1.24) and 1.16 (CI: 1.02-1.31), respectively.
CONCLUSION Pre-transplant functional status is a useful prognostic indicator for 1-year post-transplant patient and graft survival.
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Affiliation(s)
- Natasha H Dolgin
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
- Department of Quantitative Health Sciences, Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA 01605, United States
- Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA 01655, United States
| | - Babak Movahedi
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
| | - Frederick A Anderson
- Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA 01655, United States
| | - Isabel MA Brüggenwirth
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen 9713GZ, Netherlands
| | - Paulo N Martins
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
| | - Adel Bozorgzadeh
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
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8
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Shahabeddin Parizi A, Krabbe PFM, Buskens E, Bakker SJL, Vermeulen KM. A Scoping Review of Key Health Items in Self-Report Instruments Used Among Solid Organ Transplant Recipients. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:171-181. [PMID: 30324230 PMCID: PMC6397139 DOI: 10.1007/s40271-018-0335-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The overall aim of this scoping review of the literature is twofold: (1) to provide an overview of all instruments that have been used to assess health-related quality of life (HRQoL) after solid organ transplantation and (2) to provide a list of health items they include to support future studies on the development of a new-generation HRQoL instrument. All studies that administered any form of HRQoL instrument to post-transplant solid organ recipients were identified in a comprehensive search of PubMed (MEDLINE), Embase, and Web of Science, with a cut-off date of May 2018. The search used various combinations of the following keywords: lung, heart, liver, kidney, or pancreas transplantation; quality of life; well-being; patient-reported outcome; instrument; questionnaire; and health survey. In total, 8013 distinct publications were identified and 1218 of these were selected for review. Among the instruments applied, 53 measured generic, 51 organ-specific, 271 domain-specific, and 43 transplant-specific HRQoL. A total of 78 distinct health items grouped into 16 sub-domains were identified and depicted graphically. The majority of publications did not report a logical rationale for the choice of specific HRQoL instrument. The most commonly used types of instruments were generic health instruments, followed by domain-specific instruments. Despite the availability of transplant-specific instruments, few studies applied these types of instruments. Based on the 78 items, further research is planned to develop a patient-centered, transplant-specific HRQoL instrument that is concise, easy to apply (mobile application), and specifically related to the health issues of solid organ recipients.
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Affiliation(s)
- Ahmad Shahabeddin Parizi
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Paul F M Krabbe
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Buskens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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9
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Mingardi G, Mingardi G, Marchesi D, Perticucci E, Rota S, Tiraboschi G, Cornalba L, Brunzieri C, Foroni I, Lupi G, Cortinovis E, Ondei P, Alongi G, Lorenz M, Apolone G, Mosconi P, Ruggiata R. Quality of Life and End Stage Renal Disease Therapeutic Programs. Int J Artif Organs 2018. [DOI: 10.1177/039139889802101110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- G. Mingardi
- Nephrology and Dialysis Division, Ospedali Riuniti di Bergamo, Bergamo - Italy
| | | | | | | | - S. Rota
- Ospedali Riuniti di Bergamo, Bergamo
| | | | | | | | - I. Foroni
- Ospedale Predabissi di Melegnano, Milano
| | - G. Lupi
- Ospedale Predabissi di Melegnano, Milano
| | | | - P. Ondei
- Policlinico San Pietro di Ponte San Pietro, Bergamo
| | - G. Alongi
- Policlinico San Marco di Zingonia, Bergamo
| | - M. Lorenz
- Policlinico San Marco di Zingonia, Bergamo
| | - G. Apolone
- Istituto di Ricerche Farmacologiche Mario Negri, Milano
| | - P. Mosconi
- Istituto di Ricerche Farmacologiche Mario Negri, Milano
| | - R. Ruggiata
- Istituto di Ricerche Farmacologiche Mario Negri, Milano
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10
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Chong K, Unruh M. Why does quality of life remain an under-investigated issue in chronic kidney disease and why is it rarely set as an outcome measure in trials in this population? Nephrol Dial Transplant 2017; 32:ii47-ii52. [PMID: 28206614 DOI: 10.1093/ndt/gfw399] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022] Open
Abstract
The growing importance of quality of life (QoL) measures in health care is reflected by the increased volume and rigor of published research on this topic. The ability to measure and assess patients' experience of symptoms and functions has transformed the development of disease treatments and interventions. However, QoL remains an under-investigated issue in chronic kidney disease (CKD) and is seldom set as an outcome measure in trials in this population. In this article, we present various challenges in using patient-reported outcome (PRO) end points in CKD trials. We outline the need for additional research to examine more closely patient experiences with specific kidney disease symptoms and conditions, as well as caregiver perspectives of patients' symptom burden and end-of-life experiences. These efforts will better guide the development or enhancement of PRO instruments that can be used in clinical trials to more effectively assess treatment benefit, and improve therapy and care. Better understanding of health-related QoL issues would enable providers to deliver more patient-centered care and improve the overall well-being of patients. Even small improvements in QoL could have a large impact on the population's overall health and disease burden.
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Affiliation(s)
- Kelly Chong
- Renal Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Mark Unruh
- Renal Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.,Renal Section, New Mexico VA Health System, Albuquerque, NM, USA
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11
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Hogan AN, Fox WR, Roppolo LP, Suter RE. Emergent Dialysis and its Impact on Quality of Life in Undocumented Patients with End-Stage Renal Disease. Ethn Dis 2017; 27:39-44. [PMID: 28115820 DOI: 10.18865/ed.27.1.39] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to define the ethnographic composition and assess the health-related quality of life (HRQoL) of a large population of undocumented patients with end-stage renal disease (ESRD) seeking emergent dialysis in the emergency department (ED) of a large public hospital in the United States. DESIGN All ESRD patients presenting to the hospital's main ED were identified during a 4-week consecutive enrollment period. Consenting patients completed two surveys-an ethnographic questionnaire and the validated kidney disease quality of life-36 (KDQOL-36) instrument. SETTING The study was conducted at a large county hospital in Dallas, Texas. In 2013, the hospital recorded >50,000 ED visits and administered approximately 6,000 dialysis treatments to ED patients. PARTICIPANTS 88 of 101 unfunded patients presenting to the ED during the study period consented to participate, resulting in an 87.1% response rate. 65 of these patients were undocumented immigrants. MAIN OUTCOME MEASURES Quantitative scores for the 5 subscales of the KDQOL-36 were calculated for the study population. RESULTS Measures of physical and mental health in our study population were lower than those published for scheduled dialysis patients. 79.5% of our patients lost employment due to their dialysis requirements. At least 71.4% of the study patients were unaware that they required dialysis before immigrating to the United States. CONCLUSIONS Quality of life scores were found to be low among our population of undocumented emergent dialysis patients. Our data also provide some evidence that availability of dialysis at no cost is not a primary driver of illegal immigration of ESRD patients to the United States.
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Affiliation(s)
- Andrew N Hogan
- Division of Emergency Medicine, University of Chicago Medical Center
| | - William R Fox
- Department of Emergency Medicine, University of Texas Southwestern Medical Center
| | - Lynn P Roppolo
- Department of Emergency Medicine, University of Texas Southwestern Medical Center
| | - Robert E Suter
- Department of Emergency Medicine, University of Texas Southwestern Medical Center
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12
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Dolgin NH, Martins PNA, Movahedi B, Lapane KL, Anderson FA, Bozorgzadeh A. Functional status predicts postoperative mortality after liver transplantation. Clin Transplant 2016; 30:1403-1410. [PMID: 27439897 DOI: 10.1111/ctr.12808] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Frail patients are more vulnerable to perioperative stressors of liver transplantation (LT). Program Specific Reports, used in transplant center auditing, risk-adjust for frailty using the Karnofsky Performance Status (KPS) scale. We evaluate the extent to which functional impairment/disability is associated with increased risk of postoperative death. METHODS We included 24 505 first-time LT recipients from the Scientific Registry of Transplant Recipients (2006-2011). We categorized patients as Severe, Moderate, or Normal function/disability using the KPS scale and evaluated risk of 30- and 90-day mortality. Analyses took potential center-specific differences in KPS measurement protocols into account using hierarchal logistic modeling. RESULTS Over one-quarter of our population was Severely impaired/disabled, and 30.5% had no functional limitations. Severely and Moderately impaired/disabled patients had 2.56 (95% CI 1.91-3.44) and 1.40 (95% CI 1.10-1.78) times the odds of 30-day mortality, respectively, after adjusting for key recipient and donor factors. Estimates remained consistent regardless of Model for End-Stage Liver Disease score, medical condition, or clustering analyses by center. Technical/operative complications and multiorgan failure/hemorrhage were more common causes of death among more Severely disabled patients than in higher functioning groups. CONCLUSIONS Pre-transplant functional status, assessed using the KPS scale, is a reliable predictor of post-LT mortality in the United States.
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Affiliation(s)
- Natasha H Dolgin
- Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA. .,Department of Quantitative Health Sciences, Clinical & Population Health Research Program, University of Massachusetts Medical School, Worcester, MA, USA. .,Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Paulo N A Martins
- Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Babak Movahedi
- Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, Clinical & Population Health Research Program, University of Massachusetts Medical School, Worcester, MA, USA
| | - Fred A Anderson
- Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Adel Bozorgzadeh
- Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
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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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Porter AC, Lash JP, Xie D, Pan Q, DeLuca J, Kanthety R, Kusek JW, Lora CM, Nessel L, Ricardo AC, Wright Nunes J, Fischer MJ. Predictors and Outcomes of Health-Related Quality of Life in Adults with CKD. Clin J Am Soc Nephrol 2016; 11:1154-1162. [PMID: 27246012 PMCID: PMC4934840 DOI: 10.2215/cjn.09990915] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/14/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Low health-related quality of life is associated with increased mortality in patients with ESRD. However, little is known about demographic and clinical factors associated with health-related quality of life or its effect on outcomes in adults with CKD. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS Data from 3837 adult participants with mild to severe CKD enrolled in the prospective observational Chronic Renal Insufficiency Cohort and Hispanic Chronic Renal Insufficiency Cohort Studies were analyzed. Health-related quality of life was assessed at baseline with the Kidney Disease Quality of Life-36 and its five subscales: mental component summary, physical component summary, burden of kidney disease (burden), effects of kidney disease (effects), and symptoms and problems of kidney disease (symptoms). Low health-related quality of life was defined as baseline score >1 SD below the mean. Using Cox proportional hazards analysis, the relationships between low health-related quality of life and the following outcomes were examined: (1) CKD progression (50% eGFR loss or incident ESRD), (2) incident cardiovascular events, and (3) all-cause death. RESULTS Younger age, women, low education, diabetes, vascular disease, congestive heart failure, obesity, and lower eGFR were associated with low baseline health-related quality of life (P<0.05). During a median follow-up of 6.2 years, there were 1055 CKD progression events, 841 cardiovascular events, and 694 deaths. Significantly higher crude rates of CKD progression, incident cardiovascular events, and all-cause death were observed among participants with low health-related quality of life in all subscales (P<0.05). In fully adjusted models, low physical component summary, effects, and symptoms subscales were independently associated with a higher risk of incident cardiovascular events and death, whereas low mental component summary was independently associated with a higher risk of death (P<0.05). Low health-related quality of life was not associated with CKD progression. CONCLUSIONS Low health-related quality of life across several subscales was independently associated with a higher risk of incident cardiovascular events and death but not associated with CKD progression.
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Affiliation(s)
- Anna C Porter
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Flythe JE, Powell JD, Poulton CJ, Westreich KD, Handler L, Reeve BB, Carey TS. Patient-Reported Outcome Instruments for Physical Symptoms Among Patients Receiving Maintenance Dialysis: A Systematic Review. Am J Kidney Dis 2015. [PMID: 26210069 DOI: 10.1053/j.ajkd.2015.05.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) receiving dialysis have poor health-related quality of life. Physical symptoms are highly prevalent among dialysis-dependent patients and play important roles in health-related quality of life. A range of symptom assessment tools have been used in dialysis-dependent patients, but there has been no previous systematic assessment of the existing symptom measures' content, validity, and reliability. STUDY DESIGN Systematic review of the literature. SETTINGS & POPULATION Patients with ESRD on maintenance dialysis therapy. SELECTION CRITERIA FOR STUDIES Instruments with 3 or more physical symptoms previously used in dialysis-dependent patients and evidence of validity or reliability testing. INTERVENTION Patient-reported physical symptom assessment instrument. OUTCOMES Instrument symptom-related content, validity, and reliability. RESULTS From 3,148 screened abstracts, 89 full-text articles were eligible for review. After article exclusion and further article identification by reference reviews, 58 articles on 23 symptom assessment instruments with documented reliability or validity testing were identified. Of the assessment instruments, 43.5% were generic and 56.5% were ESRD specific. Symptoms most frequently assessed were fatigue, shortness of breath, insomnia, nausea and vomiting, and appetite. Instruments varied widely in respondent time burden, recall period, and symptom attributes. Few instruments considered recall periods less than 2 weeks and few assessed a range of symptom attributes. Psychometric testing was completed for congruent validity (70%), known-group validity (25%), responsiveness (30%), internal consistency (78%), and test-retest reliability (65%). Content validity was assessed in dialysis populations in 57% of the 23 instruments. LIMITATIONS Consideration of physical symptoms only and exclusion of single symptom-focused instruments. CONCLUSIONS The number of available instruments focused exclusively on physical symptoms in dialysis patients is limited. Few symptom-containing instruments have short recall periods, assess diverse symptom attributes, and have undergone comprehensive psychometric testing. Improved symptom-focused assessment tools are needed to improve symptom evaluation and symptom responsiveness to intervention among dialysis-dependent patients.
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Affiliation(s)
- Jennifer E Flythe
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; The Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC.
| | - Jill D Powell
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Caroline J Poulton
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Katherine D Westreich
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Lara Handler
- Health Sciences Library, University of North Carolina, Chapel Hill, NC
| | - Bryce B Reeve
- The Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC; Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Timothy S Carey
- The Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC; Division of General Internal Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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Twomey JC, Barrett BJ, Way CY, Churchill DN, Parfrey PS. Psychometric properties of the Patient's Perception of Life on Hemodialysis Scale. J Nurs Meas 2015; 23:72-81. [PMID: 25985496 DOI: 10.1891/1061-3749.23.1.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Hemodialysis (HD) is the main form of renal replacement therapy for many patients with end-stage renal disease. The purpose of this research is to assess reliability and validity of the Patient's Perception of Hemodialysis Scale. METHODS Using a cross-sectional design and a convenient sample (n = 236), psychometric properties of the PPHS were examined. Validity was assessed using factor analysis and Pearson's correlation. Reliability was determined using Cronbach's alpha and test-retest stability (n = 30). RESULTS Validity and reliability was supported. CONCLUSION Examination of the PPHS provides evidence that it is a valid and reliable instrument for measuring disease-specific concerns with the HD patients, assessing how people experience life, and identifying ways in which people interpret the meaning of their physical and psychosocial health and adaptation to life on HD.
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Jiang H, Wang L, Zhang Q, Liu DX, Ding J, Lei Z, Lu Q, Pan F. Family functioning, marital satisfaction and social support in hemodialysis patients and their spouses. Stress Health 2015; 31:166-74. [PMID: 24470353 DOI: 10.1002/smi.2541] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 08/12/2013] [Accepted: 09/12/2013] [Indexed: 11/11/2022]
Abstract
A growing number of studies have demonstrated the importance of marital quality among patients undergoing medical procedures. The aim of the study was to expand the literature by examining the relationships between stress, social support and family and marriage life among hemodialysis patients. A total of 114 participants, including 38 patients and their spouses and 38 healthy controls, completed a survey package assessing social support, stress, family functioning and marital satisfaction and quality. We found that hemodialysis patients and spouses were less flexible in family adaptability compared with the healthy controls. Patients and spouses had more stress and instrumental social support compared with healthy people. Stress was negatively associated with marital satisfaction. Instrumental support was not associated with family or marital outcomes. The association between marital quality and support outside of family was positive in healthy individuals but was negative in patients and their spouses. Family adaptability was positively associated with support within family as perceived by patients and positively associated with emotional support as perceived by spouses. In conclusion, findings suggest that social support may promote adjustment depending on the source and type. Future research should pay more attention to the types and sources of social support in studying married couples.
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Affiliation(s)
- Hong Jiang
- Department of Medical Psychology, Shandong University School of Medicine, Jinan, Shandong, China
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Joshi VD. Quality of life in end stage renal disease patients. World J Nephrol 2014; 3:308-316. [PMID: 25374827 PMCID: PMC4220366 DOI: 10.5527/wjn.v3.i4.308] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/24/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To understand factors associated with quality of life (QOL), examine types of QOL instruments, and determine need for further improvements in QOL assessment.
METHODS: The method used databases (Pubmed, Google scholar) and a bibliographic search using key words QOL, end stage renal disease, Hemodialysis, Peritoneal dialysis, instruments to measure QOL, patients and qualitative/quantitative analysis published during 1990 to June 2014. Each article was assessed for sample size, demographics of participants, study design and type of QOL instruments used. We used WHO definition of QOL.
RESULTS: For this review, 109 articles were screened, out of which 65 articles were selected. Out of 65 articles, there were 19 reports/reviews and 12 questionnaire manuals. Of the 34 studies, 82% were quantitative while only 18% were qualitative. QOL instruments measured several phenomenon such as physical/psychological health, effects and burdens of kidney disease, social support etc. those are associated with QOL. Few studies looked at spiritual beliefs, cultural beliefs, personal concerns, as per the WHO definition. Telemedicine and Palliative care have now been successfully used however QOL instruments seldom addressed those in the articles reviewed. Also noticed was that longitudinal studies were rarely conducted. Existing QOL instruments only partially measure QOL. This may limit validity of predictive power of QOL.
CONCLUSION: Culture and disease specific QOL instruments that assess patients’ objective and subjective experiences covering most aspects of QOL are urgently needed.
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Lubin M, Chen H, Elicker B, Jones KD, Collard HR, Lee JS. A comparison of health-related quality of life in idiopathic pulmonary fibrosis and chronic hypersensitivity pneumonitis. Chest 2014; 145:1333-1338. [PMID: 24458311 DOI: 10.1378/chest.13-1984] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patients with interstitial lung disease (ILD) have poor health-related quality of life (HRQL). However, whether HRQL differs among different subtypes of ILD is unclear. The aim of this study was to determine whether HRQL was different among patients with idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis (CHP). METHODS We identified patients from an ongoing longitudinal cohort of patients with ILD. HRQL was assessed using the Short Form (SF)-36 medical outcomes form (version 2.0). Regression analysis was used to determine the association between clinical covariates and HRQL, primarily the physical component summary (PCS) and mental component summary (MCS) score. A multivariate regression model was created to identify potential covariates that could help explain the association between the ILD subtype and HRQL. RESULTS Patients with IPF (n = 102) were older, more likely to be men, and more likely to have smoked. Pulmonary function was similar between the groups. The patients with CHP (n = 69) had worse HRQL across all eight domains of the SF-36, as well as the PCS and MCS, compared with patients with IPF (P < .01-.09). This pattern remained after controlling for age and pulmonary function (P < .01-.02). Covariates explaining part of the relationship between disease subtype and PCS score included severity of dyspnea (P < .01) and fatigue (P < .01). Covariates explaining part of the relationship between disease subtype and MCS score included severity of dyspnea (P < .01), female sex (P = .02), and fatigue (P = .02). CONCLUSIONS HRQL is worse in CHP compared with IPF. HRQL differences between ILD subtypes are explained in part by differences in sex, dyspnea, and fatigue.
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Affiliation(s)
- Molly Lubin
- Department of Medicine, Department of Radiology, Department of Pathology, University of California, San Francisco, CA
| | | | - Brett Elicker
- Department of Medicine, Department of Radiology, Department of Pathology, University of California, San Francisco, CA
| | - Kirk D Jones
- Department of Medicine, Department of Radiology, Department of Pathology, University of California, San Francisco, CA
| | - Harold R Collard
- Department of Medicine, Department of Radiology, Department of Pathology, University of California, San Francisco, CA
| | - Joyce S Lee
- Department of Medicine, Department of Radiology, Department of Pathology, University of California, San Francisco, CA.
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Anees M, Malik MR, Abbasi T, Nasir Z, Hussain Y, Ibrahim M. Demographic factors affecting quality of life of hemodialysis patients - Lahore, Pakistan. Pak J Med Sci 2014; 30:1123-7. [PMID: 25225539 PMCID: PMC4163245 DOI: 10.12669/pjms.305.5239] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/28/2014] [Accepted: 06/02/2014] [Indexed: 12/02/2022] Open
Abstract
Objective: The objective of the study was to determine the demographic factors affecting Quality Of Life (QOL) of hemodialysis (HD) patients. Methods: This observational study was conducted at Shalamar Hospital, Lahore. Patients of End Stage Renal Disease (ESRD) and on maintenance HD for more than three months were included during the period March to June 2012. Patient of ESRD not on dialysis and Acute Renal Failure were excluded. One hundred and twenty five patients who fulfilled the criteria were included. Demographic data containing age, sex, residence, socio economic status, education, mode of traveling for dialysis, total time consumed in dialysis were collected by the investigators. QOL index was measured using 26 items, WHO QOL BREF. Results: There were 89(71.2%) male and 36(28.8%) female patients. Environmental domain score was highest (p=0.000) than all other domains in HD Patients. In overall analysis age, marital status and total time consumed in getting HD effect QOL significantly (p=<0.05). In domain wise analysis, male has better QOL in social relationship domain than female. Age has negative relationship with physical health and psychological health domain. QOL of unmarried and literate patients is significantly better (p=<0.05) in physical health domain. Employed patients have better QOL in physical, psychological and social relationship domain (p=<0.05) than unemployed patients. Patients of residence of rural areas have better QOL in physical and environment domain. Financial status of HD patients affect QOL in social domain. Distance covered to reach hospital effect QOL in psychological domain (p=<0.05). Patients traveling in private transport have better QOL in environmental domain (p=<0.05). Total time consumed in getting HD effect social relation in QOL (p=<0.05). According to linear regression model, marital status is positive predictor and unemployment is negative predictor of QOL in physical health domain. Age is negative predictor of QOL in psychological domain, monthly income is positive predictor of QOL in domain. Unemployment is positive predictor of QOL in social relation domain. Monthly income and place of residence is positive predictor of QOL in environment domain. Conclusion: Gender, age, marital status, unemployment, residence of rural area, economical status, distance covered to reach hospital, mode of transport, total time consumed in getting HD, effect QOL in HD patient. Education level is a positive factor for improving QOL of HD patients.
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Affiliation(s)
- Muhammad Anees
- Dr. Muhammad Anees, MBBS, FCPS (Nephrology), Assistant Professor of Nephrology, Visiting Consultant Nephrologist, Shalamar Hospital Lahore, Pakistan. King Edward Medical University, Lahore, Pakistan
| | - Muzammil Riaz Malik
- Dr. Muzammil Riaz Malik, MBBS, Registrar Nephrology Department. King Edward Medical University, Lahore, Pakistan
| | - Tanzeel Abbasi
- Dr. Tanzeel Abbasi, MBBS, Postgraduate Trainee, Nephrology Department, King Edward Medical University, Lahore, Pakistan
| | - Zeeshan Nasir
- Dr. Zeeshan Nasir, MBBS, Postgraduate Trainee, Nephrology Department, King Edward Medical University, Lahore, Pakistan
| | - Yasir Hussain
- Dr. Yasir Hussain, MBBS, Postgraduate Trainee, Nephrology Department, King Edward Medical University, Lahore, Pakistan
| | - Muhamamd Ibrahim
- Muhamamd Ibrahim, Associate Professor of Statistics, Registrar, Govt. M.A.O College, Lahore, Pakistan
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Bergman J, Laviana A. Quality-of-life assessment tools for men with prostate cancer. Nat Rev Urol 2014; 11:352-9. [DOI: 10.1038/nrurol.2014.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Myint TM, O'Shaughnessy DV, Marshall S, Vucak-Dzumhur M, Elder GJ. Health-related quality of life of patients awaiting kidney and simultaneous pancreas-kidney transplants. Nephrology (Carlton) 2013; 18:827-32. [DOI: 10.1111/nep.12160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Thida M Myint
- Department of Renal Medicine; Westmead Hospital; Sydney New South Wales Australia
| | | | - Samual Marshall
- Postgraduate Medical School; University of Notre Dame; Sydney New South Wales Australia
| | - Mirna Vucak-Dzumhur
- Department of Renal Medicine; Westmead Hospital; Sydney New South Wales Australia
| | - Grahame J Elder
- Department of Renal Medicine; Westmead Hospital; Sydney New South Wales Australia
- Osteoporosis and Bone Biology Division; Garvan Institute of Medical Research; Sydney New South Wales Australia
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Bergman J, Litwin MS. Quality of life in men undergoing active surveillance for localized prostate cancer. J Natl Cancer Inst Monogr 2013; 2012:242-9. [PMID: 23271780 DOI: 10.1093/jncimonographs/lgs026] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Active surveillance is an important arrow in the quiver of physicians advising men with prostate cancer. Quality-of-life considerations are paramount for patient-centered decision making. Although the overall deleterious impact on health is less dramatic than for those who pursue curative treatment, men on active surveillance also suffer sexual dysfunction and distress. Five-year outcomes revealed more erectile dysfunction (80% vs 45%) and urinary leakage (49% vs 21%) but less urinary obstruction (28% vs 44%) in men undergoing prostatectomy. Bowel function, anxiety, depression, well-being, and overall health-related quality of life (HRQOL) were similar after 5 years, but at 6-8 years, other domains of HRQOL, such as anxiety and depression, deteriorated significantly for those who chose watchful waiting. Further research is needed to compare prospectively HRQOL outcomes in men choosing active surveillance and those never diagnosed with prostate cancer, in part to help weigh the potential benefits and harms of prostate cancer screening.
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Affiliation(s)
- Jonathan Bergman
- UCLA Department of Urology, University of California-Los Angeles, CA 90095-1738, USA.
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Health-related quality of life and long-term survival and graft failure in kidney transplantation: a 12-year follow-up study. Transplantation 2013; 95:740-9. [PMID: 23354297 DOI: 10.1097/tp.0b013e31827d9772] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although the prognosis of kidney transplantation is generally good, long-term survival varies substantially between patients. This study examined whether health-related quality of life (HRQOL) predicts long-term mortality in kidney transplantation after adjustment for known risk factors. METHODS A cohort of 347 (46.77 ± 13.96 years) kidney transplant recipients was followed up for 12 years after enrolment (1999-2001). Patients completed measures of HRQOL and medical records were reviewed to document clinical and cardiovascular risk factors and comorbidities at study entry (mean [SD], 8.57 [6.55] years after transplantation). The primary outcomes were ensuing all-cause mortality and all-cause graft failure (a composite endpoint consisting of return to dialysis therapy, preemptive retransplantation, or death with function). Cox proportional hazards multivariate models were developed to identify predictors of long-term patient and graft survival. RESULTS During the 12-year follow-up, 86 (24.8%) patients died, 64 (18.3%) died with a functioning graft, and 35 (11.1%) were placed back to dialysis. Physical QOL impairment increased the risk of mortality and graft failure during the follow-up period. The risk remained significant after adjusting for sociodemographic and clinical risk factors (adjusted hazard ratio, 1.89; 95% confidence interval, 1.09-2.95; P=0.022 and adjusted hazard ratio, 1.68; 95% confidence interval, 1.12-2.52; P=0.012 for patient and graft survival, respectively). Other significant risk factors were older age, time elapsed since transplantation, and Charlson comorbidity index. Risk of graft failure was also associated with glomerular filtration rate. CONCLUSIONS Physical HRQOL predicts long-term mortality and graft failure independently of sociodemographic and clinical risk factors in renal transplant patients. Future research should identify the determinants of HRQOL and refine interventions to improve it.
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Thomas CJ, Washington TA. Religiosity and social support: implications for the health-related quality of life of African American hemodialysis patients. JOURNAL OF RELIGION AND HEALTH 2012; 51:1375-85. [PMID: 21590493 DOI: 10.1007/s10943-011-9483-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The purpose of this study was to determine whether sociocultural differences have any effect on the health-related quality of life among African American hemodialysis patients. This study examined relationships between religiosity, social support, and the health-related quality of life of African American hemodialysis patients. Four hemodialysis units were selected for the study. The study population consisted of 176 African American hemodialysis patients who had been receiving hemodialysis treatments for at least 1 month. The religiosity variable was measured by the Measure of Religious Involvement. Social Support was measured by the Medical Outcomes Study Social Support Survey, and health-related quality of life was measured by the Medical Outcomes Study 36 Short Form Health Survey (SF-36v2). The investigators found that social support contributed to the emotional and physical health of African American hemodialysis patients in the sample, whereas religiosity was inversely related to the physical health of these patients.
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Naik N, Hess R, Unruh M. Measurement of Health-Related Quality of Life in the Care of Patients with ESRD: Isn’t This the Metric That Matters? Semin Dial 2012; 25:439-44. [DOI: 10.1111/j.1525-139x.2012.01110.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Griva K, Davenport A, Harrison M, Newman SP. The impact of treatment transitions between dialysis and transplantation on illness cognitions and quality of life - a prospective study. Br J Health Psychol 2012; 17:812-27. [PMID: 22536819 DOI: 10.1111/j.2044-8287.2012.02076.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Treatment transitions are frequent in end-stage renal disease (ESRD) but little is known about cognitive responses pre- to post-transplantation or after transplant failure. The purpose of this study was to examine changes in illness cognitions across treatment transitions between dialysis and transplantation and their impact on quality of life (QOL). METHODS In this longitudinal study, ESRD patients (N= 262) patients were followed up across treatment transitions over a 7-year observation window using the Illness Perceptions Questionnaire, the Illness Effects Questionnaire, and measures of QOL. Study sample comprised the patients from this cohort who switched treatment modality (N= 60 post-transplantation; N= 28 transplant failure). Data were collected while on dialysis or transplantation and at 6 months post-treatment change. RESULTS Significant changes in QOL and illness perceptions were found in treatment transitions with opposite patterns of either improvement or deterioration following transplantation or transplantation failure. Pre- to post-transplantation, QOL improves and patients report less symptoms, lower consequences, and illness intrusiveness, more acute timeline and stronger control beliefs (ps < .01). QOL is diminished following transplant failure and patients report more symptoms, consequences, illness disruptiveness, more chronic timeline, and lower control. Changes in cognitions are associated with changes in QOL (R(2) = .469-.789). CONCLUSIONS Treatment transitions marked significant changes in illness perceptions that were associated with changes in QOL. Interventions to prepare patients for treatment transitions and prevent increasingly negative patterns of illness perceptions with transplant failure may serve towards maintaining or improving adjustment outcomes.
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Affiliation(s)
- Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore
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Avramovic M, Stefanovic V. Health-Related Quality of Life in Different Stages of Renal Failure. Artif Organs 2012; 36:581-9. [DOI: 10.1111/j.1525-1594.2011.01429.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liu T, Liang KV, Rosenbaum A, Stephenson R, Pike F, Weissfeld L, Unruh ML. Peripheral vascular disease severity impacts health outcomes and health-related quality of life in maintenance hemodialysis patients in the HEMO Study. Nephrol Dial Transplant 2012; 27:2929-36. [DOI: 10.1093/ndt/gfr760] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chertow GM, Lu ZJ, Xu X, Knight TG, Goodman WG, Bushinsky DA, Block GA. Self-reported symptoms in patients on hemodialysis with moderate to severe secondary hyperparathyroidism receiving combined therapy with cinacalcet and low-dose vitamin D sterols. Hemodial Int 2011; 16:188-97. [DOI: 10.1111/j.1542-4758.2011.00642.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Glenn M. Chertow
- Division of Nephrology; Stanford University School of Medicine; Palo Alto; California; USA
| | - Z. John Lu
- Amgen, Inc.; Thousand Oaks; California; USA
| | - Xiao Xu
- Covance, Inc.; Madison; Wisconsin; USA
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The psychosocial correlates of quality of life in the dialysis population: a systematic review and meta-regression analysis. Qual Life Res 2011; 21:563-80. [PMID: 21805367 DOI: 10.1007/s11136-011-9973-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2011] [Indexed: 01/24/2023]
Abstract
PURPOSE The psychosocial correlates of quality-of-life (QoL) research in end-stage renal disease (ESRD) are important in identifying risk and protective factors that may account for the QoL variability. Thus, the present study provides a meta-analysis of these research results. METHODS Published studies reporting associations between any psychosocial factors and QoL were retrieved from Medline, Embase, and PsycINFO. Mean effect sizes were calculated for the associations across psychosocial constructs (affect, stress, cognitive appraisal, social support, personality attributes, and coping process). Multiple hierarchical meta-regressions were applied to moderator analyses. RESULTS Eighty-one studies covering a combined sample of 13,240 participants were identified resulting in 377 effect sizes of the association between psychosocial factors and QoL. The overall effect size of the association was medium (0.38). Stress, affect, and cognitive appraisal had the largest effect sizes. Location of study, dialysis type, gender, age and QoL domains measured (general well-being, subjective QoL, and health-related QoL) were significant substantive moderators for the associations. CONCLUSIONS The present study shows that there is a moderate association between psychosocial variables and QoL in patients with ESRD, consistent across different QoL domains. The psychosocial constructs that have the strongest association with QoL are stress, affect, and cognitive appraisal.
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Prospective Changes in Health-Related Quality of Life and Emotional Outcomes in Kidney Transplantation over 6 Years. J Transplant 2011; 2011:671571. [PMID: 21822474 PMCID: PMC3142681 DOI: 10.1155/2011/671571] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/30/2011] [Accepted: 05/03/2011] [Indexed: 01/22/2023] Open
Abstract
Little is known on long-term outcomes in kidney transplantation. This study evaluated changes and predictors of generic and transplantation-specific health-related quality of life (HQoL) over six years in N = 102 kidney transplant survivors using the Short-form Health Survey-36 and the Transplant Effects questionnaire. Mixed models analysis was used to determine long-term outcomes. Emotional HQoL improved over time: Mental Component score, Mental Health, Energy (Ps = .000). Physical HQoL deteriorated: Physical Component Score (P = .001), Pain (P = .002). LRD transplant recipients had greater decline in physical functioning (P = .003) and PCS (P = .000) compared to cadaver recipients. Worry about the transplant (P = .036) and feelings of responsibility (P = .008) increased significantly over time. Worry about the transplant and perceived ability to work predicted 12.7% and 31.1% in variance in MCS and PCS, respectively. Efforts should be made to maintain HQoL and emotional outcomes with ongoing monitoring and support programs throughout the course of posttransplant care.
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Ramer S, Germain A, Dohar S, Unruh M. Event-related distress in kidney disease patients. Nephrol Dial Transplant 2011; 27:299-303. [PMID: 21624943 DOI: 10.1093/ndt/gfr305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-dialysis-dependent chronic kidney disease (CKD) and dialysis-dependent Stage 5 CKD (CKD5) are associated with a significant physical and psychosocial burden. Little is known, however, about the impact of stressful life events on CKD and CKD5 patients. This study aimed to determine the prevalence of stressful life events in CKD and CKD5 patients and identify the factors correlated with high levels of event-related distress. METHODS This cross-sectional study's sample consisted of 181 patients (91 with non-dialysis-dependent CKD Stages 4 and 5, 90 with CKD5) who filled out the Impact of Event Scale (IES), which measures subjective distress related to stressful life events. Other measures included scores from the Medical Outcomes Study Short Form-36, Patient Health Questionnaire-9 (PHQ-9) and Dialysis Symptom Index (DSI). RESULTS One hundred and three subjects reported stressors on the IES. Almost half the stressors (49.5%) related to personal health; the rest fell into other categories. There were significant differences between the no stressor, low event-related distress and high event-related distress groups in age (P < 0.001), PHQ-9 score (P < 0.001) and DSI score (P = 0.002). After adjustment, PHQ-9 score was associated with high event-related distress [odds ratio (OR) 1.20, 95% confidence interval (CI) 1.10-1.32], as was DSI score (OR 1.04, 95% CI 1.02-1.07) in a separate model. CONCLUSIONS Event-related distress is common in CKD and CKD5 patients. High event-related distress is associated with worse depressive symptoms and greater somatic and emotional symptom burden, even with adjustments for age and gender. The renal practitioner may need to address patients' event-related distress in order to provide optimal care.
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Affiliation(s)
- Sarah Ramer
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Liang KV, Pike F, Argyropoulos C, Weissfeld L, Teuteberg J, Dew MA, Unruh ML. Heart failure severity scoring system and medical- and health-related quality-of-life outcomes: the HEMO study. Am J Kidney Dis 2011; 58:84-92. [PMID: 21549465 DOI: 10.1053/j.ajkd.2011.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 01/27/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cardiac disease is the leading cause of death in US prevalent hemodialysis (HD) patients. There is a lack of data about the impact of the severity of heart failure (HF) on outcomes and health-related quality of life (HRQoL) in HD patients. We aimed to determine the prognostic importance of the Index of Disease Severity (IDS) of the Index of Coexistent Disease (ICED) scoring system as an HF severity measure. STUDY DESIGN Subanalysis of the Hemodialysis (HEMO) Study, a randomized controlled trial. Relationships between HF severity and mortality and cardiac hospitalizations were determined using Cox proportional hazards models. The relationship between HF severity and HRQoL scores was modeled using linear regression and generalized estimating equations. SETTING & PARTICIPANTS 1,846 long-term HD patients at 15 clinical centers including 72 dialysis units. PREDICTOR OR FACTOR HF severity classified using the IDS of the ICED scoring system. OUTCOMES Mortality (all cause and cause specific), cardiac hospitalizations, and HRQoL. MEASUREMENTS All-cause, cardiac, and infectious deaths; cardiac hospitalizations; and HRQoL scores from the Kidney Disease Quality of Life-Long Form. RESULTS HF was present in 40% of HD patients. Increasing severity of HF was associated with older age, greater likelihood of diabetes, and lower serum albumin level (all P < 0.001). Adjusted HRs for all-cause mortality were 1.31 (95% CI, 1.12-1.53), 1.48 (95% CI, 1.19-1.85), and 2.11 (95% CI, 1.43-3.11) for mild, moderate, and severe HF, respectively (P < 0.001). All-cause, cardiac, and infectious mortality and cardiac hospitalizations increased with increasing severity of HF. Increasing HF severity was associated with decreases in HRQoL, particularly in physical functioning and sleep quality. LIMITATIONS This study is limited by the small sample size in the most severe HF group. CONCLUSIONS Increasing severity of HF is associated with increased mortality and cardiac hospitalizations and worse HRQoL, especially in perceived physical limitations. These findings emphasize the utility of the IDS of the ICED score as a valid prognostic tool for medical and HRQoL outcomes in the HD population with HF.
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Affiliation(s)
- Kelly V Liang
- Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Pakpour AH, Yekaninejad M, Molsted S, Harrison AP, Hashemi F, Saffari M. Translation, cultural adaptation assessment, and both validity and reliability testing of the Kidney Disease Quality of Life--Short Form version 1.3 for use with Iranian patients. Nephrology (Carlton) 2011; 16:106-12. [PMID: 21175986 DOI: 10.1111/j.1440-1797.2010.01389.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aims of the study were to translate the Kidney Disease Quality of Life--Short Form version 1.3 (KDQOL-SF ver. 1.3) questionnaire into Iranian (Farsi), and to then assess it in terms of validity and reliability on Iranian patients. METHODS The questionnaire was first translated into Farsi by two independent translators, and then subsequently translated back into English. After translation disparities had been reconciled, the final Iranian questionnaire was tested. An initial test-retest reliability evaluation was performed over a 10 day period on a sample of 20 patients recruited from a larger group (212 patients with end-stage renal disease on haemodialysis). Afterwards, reliability was estimated by internal consistency, and validity was assessed using known group comparisons and constructs for the patient group as a whole. Finally, the factor structure of the questionnaire was extracted by performing exploratory factor analysis. RESULTS All of the scales in the questionnaire showed good test-retest reliability (i.e. intraclass correlations between test and retest scores were >0.7). All of the scales met the minimal criteria (0.7) for internal consistency and Cronbach's-α ranged 0.71-0.93. Furthermore, results from a discriminate validity evaluation showed that the questionnaire could be used to discriminate between subgroups of the patients. Finally, a principal component analysis of the disease-specific scales indicated that this part of the questionnaire could be summarized into an 11 factor structure that jointly accounted for 79.81% of the variance. CONCLUSION The Iranian version of the KDQOL-SF questionnaire is both highly reliable and valid for use with Iranian patients on haemodialysis.
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Affiliation(s)
- Amir H Pakpour
- Department of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran.
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Griva K, Jayasena D, Davenport A, Harrison M, Newman SP. Illness and treatment cognitions and health related quality of life in end stage renal disease. Br J Health Psychol 2011; 14:17-34. [DOI: 10.1348/135910708x292355] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Jhamb M, Tamura MK, Gassman J, Garg AX, Lindsay RM, Suri RS, Ting G, Finkelstein FO, Beach S, Kimmel PL, Unruh M. Design and rationale of health-related quality of life and patient-reported outcomes assessment in the Frequent Hemodialysis Network trials. Blood Purif 2011; 31:151-8. [PMID: 21228584 DOI: 10.1159/000321855] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND End-stage renal disease patients experience significant impairments in health-related quality of life (HRQOL). Testing various strategies to improve patient HRQOL in multicenter clinical trials, such as the Frequent Hemodialysis Network (FHN) trials is vitally important. AIMS The aim of this paper is to describe the design and conduct of HRQOL and patient-reported outcomes (PRO) assessment in the FHN trials. METHODS In the FHN trials, HRQOL was examined as a multidimensional concept, and the SF-36 RAND Physical Health Composite score was one of the co-primary outcomes. The instruments completed to assess HRQOL included the Medical Outcomes Study Short Form SF-36, Health Utilities Index 3, Sleep Problems Index, Beck Depression Inventory and feeling thermometer. These instruments have been shown to have high reliability, validity and responsiveness to change in the end-stage renal disease population. Additional items evaluating PRO including sexual function, time to recovery after dialysis and patients' self-perceived burden to caregiver were also assessed. All questionnaires were administered by trained interviewers using computer-assisted telephone interviewing to ensure blinding and minimizing selection bias. Interim analysis reveals that these instruments can be used to collect a comprehensive set of HRQOL measures with minimal patient burden. CONCLUSIONS Accurate measurement of HRQOL and PRO can help us test whether hemodialysis interventions improve the health and well-being of this compromised patient population. We have shown that a comprehensive set of HRQOL measures can be centrally collected through telephone interviews in a blinded fashion, in a way that is well tolerated with minimum respondent burden.
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Affiliation(s)
- Manisha Jhamb
- Division of Nephrology, University of Western Ontario, London, Ontario, Canada
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Aguiar CCT, Vieira APGF, Carvalho AF, Montenegro-Junior RM. [Assessment instruments for a Health-Related Quality of Life in diabetes mellitus]. ACTA ACUST UNITED AC 2009; 52:931-9. [PMID: 18820804 DOI: 10.1590/s0004-27302008000600004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 05/18/2008] [Indexed: 12/14/2022]
Abstract
The assessment of Health-Related Quality of Life (HRQoL) has been increasingly used to measure the overall impact of diseases in people's life. Diabetes mellitus (DM) is a chronic disease associated with high morbidity, mortality, and HRQoL impairment in patients. In longitudinal studies, the psychosocial impact of DM predicts mortality. The objective of this review is to describe and to analyze the main instruments used for the HRQoL evaluation in patients with DM. Generic instruments such, as the Quality of Well-Being Scale (QWB), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), EuroQol (EQ-5D) and specific instruments as the Diabetes Care Profile (DCP), Diabetes Quality of Life Measure (DQOL), Diabetes Impact Measurement Scales (DIMS), Appraisal of Diabetes Scale (ADS), Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Health Profile (DHP-1 and DHP-18), Questionnaire on Stress in Patients with Diabetes-Revised (QSD-R), Well-Being Enquiry goes Diabetics (WED), Diabetes-Specific Quality-of-life Scale (DSQOLS), Diabetes 39 (D-39) Problems Areas in Diabetes (PAID) were analyzed. PAID is the only translated and validated instrument available in Brazil. The generic and specific instruments have their stregths and shortcomings for evaluation of HRQL in patients with DM. The combined use of both generic (such as the SF-36) and specific (such as the PAID) appears to be a consistent way to evaluate HRQoL as a construct in Brazilian patients with DM. The present article reviews a variety of instruments and emphasizes the urgent need for validation studies of such instruments to be used in Brazilian subjects with DM.
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Affiliation(s)
- Carlos Clayton Torres Aguiar
- Programa de Pós-graduação em Saúde Coletiva da Universidade de Fortaleza Serviço de Endocrinologia e Diabetes do Hospital Universitário Walter Cantídio da Faculdade de Medicina da Universidade Federal do Ceará, CE, Brasil
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Abdel-Kader K, Unruh ML, Weisbord SD. Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol 2009; 4:1057-64. [PMID: 19423570 DOI: 10.2215/cjn.00430109] [Citation(s) in RCA: 300] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES While many patients with end-stage renal disease (ESRD) have impaired physical and psychologic well-being, less is known about these health domains in patients with advanced chronic kidney disease (CKD). The authors sought to compare symptoms, depression, and quality of life in patients with ESRD and those with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients with ESRD and subjects with advanced CKD were enrolled. Patients' symptoms, depression, and quality of life were assessed using the Dialysis Symptom Index (DSI), Patient Health Questionnaire-9 (PHQ-9), and Short Form 36 (SF-36), respectively, and these health domains were compared between patient groups. RESULTS Ninety patients with ESRD and 87 with CKD were enrolled. There were no differences in the overall number of symptoms or in the total DSI symptom-severity score. Median scores on the PHQ-9 were similar, as was the proportion of patients with PHQ-9 scores >9. SF-36 Physical Component Summary scores were comparable, as were SF-36 Mental Component Summary scores. CONCLUSIONS The burden of symptoms, prevalence of depression, and low quality of life are comparable in patients with ESRD and advanced CKD. Given the widely recognized impairments in these domains in ESRD, findings of this study underscore the substantial decrements in the physical and psychologic well-being of patients with CKD.
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Affiliation(s)
- Khaled Abdel-Kader
- Renal Section and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, USA
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Mokkink LB, Terwee CB, Stratford PW, Alonso J, Patrick DL, Riphagen I, Knol DL, Bouter LM, de Vet HCW. Evaluation of the methodological quality of systematic reviews of health status measurement instruments. Qual Life Res 2009; 18:313-33. [PMID: 19238586 DOI: 10.1007/s11136-009-9451-9] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 01/29/2009] [Indexed: 12/13/2022]
Abstract
A systematic review of measurement properties of health-status instruments is a tool for evaluating the quality of instruments. Our aim was to appraise the quality of the review process, to describe how authors assess the methodological quality of primary studies of measurement properties, and to describe how authors evaluate results of the studies. Literature searches were performed in three databases. One hundred and forty-eight reviews were included. The purpose of included reviews was to identify health status instruments used in an evaluative application and to report on the measurement properties of these instruments. Two independent reviewers selected the articles and extracted the data. Reviews were often of low quality: 22% of the reviews used one database, the search strategy was often poorly described, and in many cases it was not reported whether article selection (75%) and data extraction (71%) was done by two independent reviewers. In 11 reviews the methodological quality of the primary studies was evaluated for all measurement properties, and of these 11 reviews only 7 evaluated the results. Methods to evaluate the quality of the primary studies and the results differed widely. The poor quality of reviews hampers evidence-based selection of instruments. Guidelines for conducting and reporting systematic reviews of measurement properties should be developed.
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Affiliation(s)
- Lidwine B Mokkink
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Arenas VG, Barros LFNM, Lemos FB, Martins MA, David-Neto E. Qualidade de Vida: comparação entre diálise peritoneal automatizada e hemodiálise. ACTA PAUL ENFERM 2009. [DOI: 10.1590/s0103-21002009000800017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a Qualidade de Vida relacionada à saúde em pacientes submetidos à Diálise Peritoneal Automatizada (DPA) e Hemodiálise em um centro de diálise satélite no Município de São Paulo. MÉTODOS: Este estudo observacional transversal, incluiu 101 pacientes com idade entre 18-75 anos, em terapia há mais de 90 dias e que compreenderam o questionário. RESULTADOS: O grupo em Hemodiálise (n=79) estava em terapia há mais tempo (p=0.001) e tinha albumina sérica maior (p<0.001) comparado ao grupo em DPA (n=22). Os escores do SF-36 foram semelhantes em várias dimensões, exceto pelo escore de Aspectos Físicos que foi maior nos pacientes em Hemodiálise (p=0.03). Não houveram interações significativas entre SF-36 e as demais variáveis que explicassem esta diferença. CONCLUSÃO: A Qualidade de Vida foi semelhante entre as modalidades, porém o escore de Aspectos Físicos foi menor para pacientes em Diálise Peritoneal Automatizada.
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Affiliation(s)
| | | | | | | | - Elias David-Neto
- Clínica de Nefrologia e Transplante Renal, Brasil; Universidade de São Paulo, Brasil
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Loss of Renal Function Is Associated With Deterioration of Health-Related Quality of Life in Kidney Transplant Patients. Transplant Proc 2008; 40:3460-5. [DOI: 10.1016/j.transproceed.2008.03.170] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 03/04/2008] [Accepted: 03/26/2008] [Indexed: 11/17/2022]
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Sathvik BS, Parthasarathi G, Narahari MG, Gurudev KC. An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire. Indian J Nephrol 2008; 18:141-9. [PMID: 20142925 PMCID: PMC2813538 DOI: 10.4103/0971-4065.45288] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A cross-sectional study was conducted to evaluate the quality of life (QOL) of hemodialysis patients. An attempt was made to compare the QOL of hemodialysis patients with the QOL of the general population, renal transplant patients, and patients with a chronic disease, in this case, asthma. The WHOQOL-BREF questionnaire was used to assess the quality of life. Hemodialysis patients who had completed three months of maintenance hemodialysis (n = 75) were enrolled into the study. The quality of life of hemodialysis patients was found to be significantly impaired (P < 0.05) in comparison to healthy individuals of the general population, particularly with respect to the physical, psychological, and social relationship domains. In comparison to the quality of life of renal transplant patients, the quality of life of hemodialysis patients was significantly (P < 0.05) lower in all the four WHOQOL-BREF domains. Only in the environmental dimension was the quality of life of hemodialysis patients found to be significantly lower than that of the asthma patients. Female hemodialysis patients showed significantly (P < 0.05) lower quality of life than did male patients in the psychological and environmental dimensions of WHOQOL-BREF. A positive association was seen between higher education and the psychological functioning and the environmental dimensions of WHOQOL-BREF. Thus, the quality of life of hemodialysis patients was found to be considerably impaired when compared to that of healthy individuals of the general population as well as of renal transplant patients.
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Affiliation(s)
- B. S. Sathvik
- Department of Pharmacy Practice, J.S.S. College of Pharmacy, Mysore - 570 015, India
| | - G. Parthasarathi
- Department of Pharmacy Practice, J.S.S. College of Pharmacy, Mysore - 570 015, India
| | - M. G. Narahari
- Department of Nephrology, J S S Medical College Hospital, Mysore - 570 004, India
| | - K. C. Gurudev
- Department of Nephrology, J S S Medical College Hospital, Mysore - 570 004, India
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Unruh ML, Newman AB, Larive B, Dew MA, Miskulin DC, Greene T, Beddhu S, Rocco MV, Kusek JW, Meyer KB. The influence of age on changes in health-related quality of life over three years in a cohort undergoing hemodialysis. J Am Geriatr Soc 2008; 56:1608-17. [PMID: 18721224 DOI: 10.1111/j.1532-5415.2008.01849.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the extent to which persons aged 70 and older undergoing hemodialysis (HD) had greater changes in health-related quality of life (HRQOL) over 3 years than younger patients undergoing HD. DESIGN Longitudinal. SETTING The Hemodialysis Study (HEMO Study) was a randomized, clinical trial of the effects of HD dose and membrane flux on mortality and morbidity in patients undergoing chronic dialysis. PARTICIPANTS Secondary analysis of the HEMO Study. MEASUREMENTS Participants completed the Index of Well-Being (IWB) and the Kidney Disease Quality of Life-Long Form (KDQOL-LF), which also includes the Medical Outcomes Study 36-item Short Form Questionnaire (SF-36) annually. Changes in subjects those aged 70 and older were compared with changes in subjects aged 55 to 69 and 18 to 54. RESULTS At baseline, 1,813 (98%) of HEMO participants completed HRQOL surveys. Their mean age was 58, 56% were female, 64% were black, and mean duration of dialysis was 3.8 years. In subjects with HRQOL data at the first three annual assessments, there were no substantial mean declines in the SF-36 Physical or Mental Component Summary scales over 3 years. In models incorporating effects of attrition, the differences in average change over 3 years between patients undergoing HD aged 70 and older and the younger cohorts were small in magnitude. There were high rates of adverse HRQOL events in all age groups and significantly higher composite event rates of death or clinically significant decline in HRQOL over 3 years was found in subjects aged 70 and older. CONCLUSION Although HRQOL was impaired in the population undergoing HD, HRQOL scores at baseline reflect a better-preserved multidimensional quality of life in respondents in the HEMO Study aged 70 and older than in younger patients undergoing HD. There was no substantial relationship between age and average decline in HRQOL score over 3 years in participants in the HEMO Study.
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Affiliation(s)
- Mark L Unruh
- Department of Medicine, University of Pittsburgh, Pennsylvania, USA.
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Abstract
Patients with end-stage renal disease treated with maintenance hemodialysis suffer substantial impairments in health-related quality of life (HRQOL). Despite widespread efforts, there are few interventions that improve the overall well-being and quality of life of this patient population. The current review provides a description of HRQOL as an essential, yet arguably overlooked health-related domain in hemodialysis patients, and discusses interventions that have been evaluated to improve the functional status and well-being of this population, with a particular focus on therapy with recombinant human erythropoietin. We review the controversy surrounding recombinant human erythropoietin as it relates to HRQOL, and describe the delicate balance faced by renal providers who seek to reduce hemodialysis patients' morbidity and mortality while simultaneously striving to improve patients' HRQOL.
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Affiliation(s)
- Steven D Weisbord
- Center for Health Equity Research and Promotion and Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, U.S.A
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Russ G, Jamieson N, Oberbauer R, Arias M, Murgia MG, Blancho G, Sato R, Stoeckl M, Revicki DA. Three-year health-related quality-of-life outcomes for sirolimus-treated kidney transplant patients after elimination of cyclosporine. Transpl Int 2007; 20:875-83. [PMID: 17854445 DOI: 10.1111/j.1432-2277.2007.00547.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study compared 3-year health-related quality-of-life (HRQL) outcomes of sirolimus (SRL)-treated kidney transplant patients after elimination of cyclosporine (CsA) with patients continuing on a combined CsA and SRL regimen. A randomized, multi-country, open-label, clinical trial was performed. 430 kidney transplant patients were randomly assigned to SRL+corticosteroids (ST) (n = 215) or SRL+CsA+ST (n = 215) therapy after an initial 3-month period of combined SRL+CsA+ST treatment. HRQL was measured using the Kidney Transplant Questionnaire (KTQ) and the SF-36 Health Survey at month 3 (time of randomization) and months 12, 24, and 36 post-transplantation. Mixed-model ancova was used to evaluate treatment differences in HRQL outcomes. HRQL scores were available for 361 (86.4%) eligible study patients. Significant treatment-by-assessment time interactions, favoring SRL+ST, were found on KTQ fatigue (P = 0.0005), emotions (P = 0.028), and appearance scores (P = 0.006). Statistically significant treatment-by-assessment time interactions were observed for SF-36 vitality (P = 0.0001), general health (P = 0.011), social function (P = 0.020), and role-physical scores (P = 0.049). Vitality scores improved in the SRL+ST group (mean 3.5-point change) over 36 months, compared with decreases in the SRL+CsA+ST group (mean -3.2-point change). SRL-based therapy with early CsA-elimination results in fewer appearance-related problems, less fatigue, greater vitality, and improved general health status and social functioning compared with continuous SRL+CsA+ST treatment.
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Affiliation(s)
- Graeme Russ
- The Queen Elizabeth Hospital, Woodville, Woodville South, SA, Australia
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Tavallaii SA, Fathi-Ashtiani A, Nasiri M, Assari S, Maleki P, Einollahi B. ORIGINAL RESEARCH—PSYCHOLOGY: Correlation Between Sexual Function and Postrenal Transplant Quality of Life: Does Gender Matter? J Sex Med 2007; 4:1610-8. [PMID: 17672846 DOI: 10.1111/j.1743-6109.2007.00565.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Subjective health perceptions affect sexual function differently in males and females; such differences, however, have not hitherto been studied comprehensively in kidney-transplant recipients. AIM This study sought to investigate gender effect on the correlation between sexual function and quality-of-life (QOL) subdomains in kidney-transplant recipients by evaluating intercourse frequency (IF) and intercourse satisfaction (IS). METHODS In a cross-sectional study, 124 married kidney-transplant recipients, who were randomly selected, were interviewed. The bivariate correlations between QOL subdomains, and IF and IS were analyzed with the Pearson test in the males and females, separately. MAIN OUTCOME MEASURE The IF and IS using the relationship and sexuality scale, and also the QOL using Short Form 36 (SF-36) were assessed. RESULTS Sixty-seven subjects (54%) reported having no intercourse within the preceding months. Fifty subjects (40%) reported having no intercourse satisfaction. While IF and IS correlated with the total SF-36 score in the males (r = 0.252 and 0.263, P < 0.05), there was no such correlation in the females. In the males, IS correlated with physical health (r = 0.281, P < 0.05) and physical function (r = 0.274, P < 0.05), and there was a correlation between IF and role limitation due to emotional problems (r = 0.250, P < 0.05). In the females, whereas IF correlated with general health (r = 0.372, P < 0.05) and mental health (r = 0.305, P < 0.05), there was no correlation between IS and QOL subdomains (P > 0.05). CONCLUSION Sexual function and satisfaction seem to be correlated with mental and physical health in female and male kidney-transplant recipients, respectively. Although in the two genders, both physical and mental health should be equally evaluated; improving of the sexual function may be better achieved through different approaches.
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Affiliation(s)
- Seyed Abbas Tavallaii
- Behavioral Sciences Research Center, Baqiyatallah Medical Sciences University, Tehran, Iran.
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Noohi S, Karami GR, Lorgard-Dezfuli-Nejad M, Najafi M, Saadat SH. Are all domains of quality of life poor among elderly kidney recipients? Transplant Proc 2007; 39:1079-81. [PMID: 17524896 DOI: 10.1016/j.transproceed.2007.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study sought to answer whether all domains of HRQoL are low among elderly kidney recipients. METHODS A cross-sectional study of 162 renal transplanted subjects included group I (age<40 years, n=85), group II (age between 40 and 55 years, n=55), and group III (age >55 years, n=22). We compared the total score of the Short Form health survey (SF-36) and its eight subscales, including physical functioning (PF), social functioning (SF), role limitations due to physical health problems (RPh), role limitations due to emotional problems (REm), mental health (MH), vitality (VT), bodily pain (BP), and general health perceptions (GH) between the study groups. RESULTS As compared to groups II and I, group III, showed significantly lower scores of REm (49.12 +/- 23.22, 63.03 +/- 26.33, 64.36 +/- 26.54, P=.08), PF (48.94 +/- 27.41, 72.69 +/- 25.54, 72.14 +/- 22.79, P=.001) and SF-36 total score (46.79 +/- 10.52, 54.77 +/- 10.66, 54.09 +/- 9.35, P=.01). There were no significant differences among SF, RPh, MH, VT, and BP. Group III reported better GH than groups II and I (52.36 +/- 9.18, 48.71 +/- 12.01, 43.50 +/- 14.81, P=.020). CONCLUSIONS Increasing age did not result in poor health-related quality of life in all domains. The general health perception was better in the elderly, which might be due to their better coping ability.
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Affiliation(s)
- S Noohi
- Nephrology/Urology Research Center (NURC), Baqiyatallah Medical Sciences University, Tehran, Iran.
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Steinman TI. HCFA Capitation Payments and Nephrology Manpower Projections. Semin Dial 2007. [DOI: 10.1111/j.1525-139x.1997.tb00528.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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