Quality of life in chronic haemodialysis and peritoneal dialysis patients in Turkey and related factors

Understanding the Impact of Initial COVID-19 Restrictions on Physical Activity, Wellbeing and Quality of Life in Shielding Adults with End-Stage Renal Disease in the United Kingdom Dialysing at Home versus In-Centre and Their Experiences with Telemedicine

Early in the coronavirus-2019 (COVID-19) containment strategy, people with end-stage renal disease (ESRD) were identified as extremely clinically vulnerable and subsequently asked to 'shield' at home where possible. The aim of this study was to investigate how these restrictions and the transition to an increased reliance on telemedicine within clinical care of people living with kidney disease impacted the physical activity (PA), wellbeing and quality of life (QoL) of adults dialysing at home (HHD) or receiving in-centre haemodialysis (ICHD) in the UK. Individual semistructured telephone interviews were conducted with adults receiving HHD (n = 10) or ICHD (n = 10), were transcribed verbatim and, subsequently, thematically analysed. As result of the COVID-19 restrictions, PA, wellbeing and QoL of people with ESRD were found to have been hindered. However, widespread support for the continued use of telemedicine was strongly advocated and promoted independence and satisfaction in patient care. These findings highlight the need for more proactive care of people with ESRD if asked to shield again, as well as increased awareness of safe and appropriate PA resources to help with home-based PA and emotional wellbeing.

The effect of home care based on the Neuman systems model on symptomatic relief and quality of life in patients undergoing hemodialysis

Background

Chronic renal failure (CRF) is an important common health problem with high morbidity and mortality rate in the world and in Turkey.

Objectives

This study was conducted to determine the effect of home care based on the Neuman Systems Model on relief of physical and psychological symptoms and quality of life in patients undergoing hemodialysis.

Methods

This study was conducted as a pretest-posttest randomized controlled trial. The sample of the study was composed of 160 hemodialysis patients. The patients were randomly and sequentially assigned to experimental and control groups as 80 hemodialysis patients.

Results

After the intervention, it was determined that the symptoms levels of the patients in the experimental group reduced and their quality of life increased.

Conclusion

The care provided based on the Neuman Systems Model reduced the symptoms of the patients having hemodialysis treatment and enhanced their quality of life. Care given using a model is important in improving the quality of life of hemodialysis patients.

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

RATIONALE & OBJECTIVE

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

STUDY DESIGN

Systematic review and meta-analysis.

SETTING & STUDY POPULATIONS

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

SELECTION CRITERIA FOR STUDIES

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

DATA EXTRACTION

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

ANALYTICAL APPROACH

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

TRIAL REGISTRATION

PROSPERO 95985.

A comparison of quality of life between patients treated with different dialysis modalities in Taiwan

Purpose

This study compared the quality of life (QOL) of hemodialysis (HD) and peritoneal dialysis (PD) patients in Taiwan.

Methods

This cross-sectional study recruited end-stage renal disease patients from 34 Taiwanese hospitals or clinics. Patient characteristics, diagnoses, and laboratory data were extracted from charts. The Chinese version of the Quality of Life Index–Dialysis version (QLI-D) was used. Multiple linear regression analysis showed the effects of dialysis modality on QOL. P<0.05 indicated statistical significance.

Results

In total, 600 HD and 387 PD patients were included. The mean health and functioning, social and economic, psychological/spiritual, and family subscale scores and total QOL scores were significantly lower in HD patients than PD patients. After adjusting for region, hospital level, age, education level, marital status, and Karnofsky Performance Scale, the total QOL was 2.81 points higher for PD patients than for HD patients visiting medical centers (p<0.001). The total QOL was 2.53 points lower in PD patients than in HD patients for those visiting clinics.

Conclusion

Compared to HD patients, PD patients had better QOL in Taiwanese medical centers. The current survey improves our understanding of the QOL of patients undergoing different dialysis modalities in Taiwan.

Calidad de vida de los pacientes en diálisis. Revisión sistemática

calidad de vida relacionada con la salud en pacientes en diálisis, identificando los instrumentos de medida más utilizados. Material y Método: Se ha realizado una revisión sistemática en las bases de datos PubMed, Scopus, Google Académico y Scielo. Se han incluido artículos científicos en inglés y español. Se han analizado artículos que tratan la calidad de vida relacionada con la salud en pacientes en diálisis, excluyendo aquellos artículos que no aportaban resultados concluyentes, en población pediátrica y en los que se analizaba este parámetro exclusivamente en pacientes trasplantados. Resultados: Se han incluido 36 artículos publicados entre 2009-2019. La calidad de vida relacionada con la salud aparece disminuida en todos los pacientes en diálisis, más concretamente en hemodiálisis. Las variables más influyentes en la disminución de la calidad de vida relacionada con la salud del paciente en diálisis, son: sexo femenino, edad avanzada, no poseer un núcleo familiar, estudios primarios, y afectación de la situación laboral en pacientes en edad para trabajar; además de comorbilidad asociada a la patología renal, ansiedad y depresión, presencia de dolor y con grado de dependencia alto. Conclusiones: La disminución de la calidad de vida está presente en la mayoría de los pacientes de diálisis, con más frecuencia en hemodiálisis. Respecto a los instrumentos de evaluación empleados, el más utilizado es el KDQOL-SF. Esta pérdida de la calidad de vida se relaciona con ser mujer, edad avanzada, comorbilidad asociada, dolor con limitaciones, presencia de ansiedad y/o depresión y mayor dependencia.

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

Background

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

Methods

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

Discussion

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

Trial registration

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

Electronic supplementary material

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

Health related quality of life in 2002 and 2015 in patients undergoing hemodialysis: a single center study

Health related quality of life (HRQOL) has become a recognized outcome in studies of the treatment of patients undergoing hemodialysis (HD). The aim of this study was to assess changes in HRQOL reported by two different samples of patients undergoing HD in the same dialysis center in 2002 and 2015. Two samples of patients from the same Danish dialysis center completed the HRQOL questionnaire Kidney Disease Quality of Life version 1.3 in 2002 (n = 71) and 2015 (n = 81), respectively. The associations between KDQOL summery scores and the time frame were analyzed in multivariable regression analyses. The 2015 sample of patients were older compared to the 2002 sample (66 ± 13 vs. 59 ± 16 years, p = 0.003, respectively), they comprised more obese patients (20.6 vs. 3.2%, p = 0.002) and more patients with hypoalbuminemia (66.7 vs. 42.9%, p = 0.006). After confounder adjustment the time period 2015 versus 2002 was not associated with changes in the generic summery scales Physical Component Scale (β 3.9, 95% CI <-0.1; 7.9, p = 0.051) and Mental Component Scale (β -2.5, 95% CI -7.6; 2.5, p = 0.322) or the disease specific summery scale Kidney Disease Component Scale (β 1.0, 95% CI -5.1; 7.1, p = 0.746). This study indicated an unchanged HRQOL when recent data were compared with data collected 13 years earlier in patients undergoing HD from a Danish dialysis center. We suggest that the included dialysis center monitor HRQOL and pay attention on interventions that may be associated with improvements of HRQOL and reduce the elevated frequency of patients with obesity or hypoalbuminemia.

Oral yeast colonization in peritoneal dialysis and hemodialysis patients and renal transplant recipients

OBJECTIVE

We aimed to investigate the frequency of oral yeast colonization (OYC) and the risk factors for patients who received continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD) or were renal transplant recipients (RTRs). The patients admitted to the Nephrology Clinic at Ataturk University Medical School from January through April 2013 were included in the study. A questionnaire about risk factors was filled out, and swab cultures were taken from the tongue surface of each participant. OYC was detected in 32.1% of the RTRs, 40% of the HD patients, 20.9% of the CAPD patients, and 18% of the healthy control (HC) group. Of the 42 yeast strains isolated from the renal replacement therapy groups, 26 strains (61.9%) were Candida albicans, nine (21.4%) were Candida glabrata, two (4.7%) were Candida krusei, two (4.7%) were Candida kefyr, one (2.38%) was Candida parapsilosis, and two (4.7%) were Geotrichum candidum. Risk factors for OYC in the RTRs group included antibiotic use and the presence of dental prostheses; however, in patients with chronic renal failure undergoing CAPD, only the presence of dental prostheses was found to be a statistically significant risk factor. Although OYC was mostly detected in patients with chronic kidney disease (undergoing HD, a variety of isolated yeast strains in the RTRs was noted. The rates of OYC and isolated Candida species in CAPD were similar to those of the HC group.

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis

INTRODUCTION

Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients.

MATERIALS AND METHODS

45 patients (23 HD and 22 PD patients) were enrolled. BP measurements, echocardiography and chest X-ray were performed in each patient to determine the LVMI and to evaluate the CTR and AAC. Inflammatory indexes, intact parathyroid hormone (iPTH) and arterial blood gas analysis were also evaluated.

RESULTS

LVMI was higher in PD than HD patients (139 ŷ 19 vs. 104 ŷ 22; p = 0.04). In PD patients, a significant correlation between iPTH, C-reactive protein and the presence of LVH was observed (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively). The CTR was increased in PD patients as compared to HD patients, while no significant differences in cardiac calcifications were determined.

CONCLUSIONS

Our data indicate that HD patients present more effective BP control than PD patients. Adequate fluid and metabolic control are necessary to assess the adequacy of BP, which is strongly correlated with the increase in LVMI and with the increased CTR in dialysis patients. PD is a home therapy and allows a better quality of life, but PD patients may present a further increased cardiovascular risk if not adequately monitored.