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Luo G, Li W, Wu D, Wei X, Zang Y, Liu JD. Quality of life profiles and their associations with depressive symptoms and cognitive impairment of community-dwelling older adults in Hong Kong. Front Public Health 2023; 11:1165934. [PMID: 37275496 PMCID: PMC10233146 DOI: 10.3389/fpubh.2023.1165934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/17/2023] [Indexed: 06/07/2023] Open
Abstract
Background This study aimed to (1) explore the quality of life (QoL) profiles of older adults in Hong Kong and (2) examine their association with predictors (age, sex, body mass index, and depressive symptoms) and distal outcome (cognitive impairment) using a person-centered approach. Methods A total number of 328 community-dwelling older adults in Hong Kong were invited to participate in this study. Data from 259 older adults were identified as valid for the primary analysis. Latent profile analysis was used to explore QoL profiles. Multinomial logistic regression using the R3STEP function in Mplus was used to explore the predictive role of age, sex, body mass index, and depressive symptoms in profile membership. The Bolck-Croon-Hagenaars approach was used to examine how the distal outcome of cognitive impairment differs as a function of QoL profiles. Results Three QoL profiles emerged from the latent profile analysis (Low, Moderate and High QoL). It was found that depression, but not age, sex, or body mass index, significantly predicted QoL profile membership. The results of the Bolck-Croon-Hagenaars analysis revealed no significant differences in cognitive impairment across the three QoL profiles. Conclusion This is the first study that examined the relationship between QoL, depressive symptoms and cognitive impairment of older adults using a person-centered approach. The findings provide additional information for the evidence obtained from variable-centered approach on the associations among variables abovementioned. Our additional focus on the antecedents of emergent QoL profiles also provide practical knowledge regarding timely treatment for or prevention of depressive symptoms, which we submit will be crucial for enhancing the QoL of older adults.
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Affiliation(s)
- Guozhi Luo
- Department of Geriatric Psychiatry, Shenzhen Kangning Hospital, Shenzhen, China
| | - Weiping Li
- Weighting and Combat Sports Administrative Center of Guangdong, Guangzhou, China
| | - Donghai Wu
- Department of Physical Education, Sun Yat-Sen University, Guangzhou, China
| | - Xinyue Wei
- Department of Physical Education, Sun Yat-Sen University, Guangzhou, China
| | - Yanpeng Zang
- Department of Physiotherapy, School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, Hong Kong SAR, China
| | - Jing-Dong Liu
- Department of Physical Education, Sun Yat-Sen University, Guangzhou, China
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Butcher E, Walker R, Wyeth E, Samaranayaka A, Schollum J, Derrett S. Health-Related Quality of Life and Disability Among Older New Zealanders With Kidney Failure: A Prospective Study. Can J Kidney Health Dis 2022; 9:20543581221094712. [PMID: 35493402 PMCID: PMC9052826 DOI: 10.1177/20543581221094712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Disability is prevalent in individuals with kidney failure and can contribute
to significantly reduced quality of life and survival. In older individuals
with kidney failure, disability can be caused by a combination of factors,
including issues directly related to their kidney disease and/or treatment,
including weakness, low energy, and low activity. Few studies have
investigated health-related quality of life (HRQoL) as a possible predictor
of disability among older individuals experiencing kidney failure. Objective: This study aimed to determine if patient-reported HRQoL, and/or other factors
at baseline, predicts disability in people with kidney failure, aged ≥65
years, after 12 months of follow-up. Design: The DOS65+ study was an accelerated longitudinal cohort design comprising of
both cross-sectional and longitudinal components. Participants were eligible
if they were aged ≥65 years, had chronic kidney disease stage 5G (CKD 5G)
(estimated glomerular filtration rate (eGFR) <15 ml/min/1.73
m2), and had: commenced kidney replacement education, or were
on an active conservative pathway, or were newly incident dialysis patients
commencing dialysis therapy or prevalent on dialysis. Setting: Three New Zealand District Health Board (DHB) nephrology units (Counties
Manukau, Hawke’s Bay, and Southern DHB) were involved in the study. Participants: Participants were eligible if they were aged ≥65 years, had CKD 5G (eGFR
<15 ml/min/1.73 m2), and had: commenced kidney replacement
education, or were on an active conservative pathway, or were newly incident
dialysis patients commencing dialysis therapy or prevalent on dialysis. Measurements: Disability and HRQoL were measured by EQ-5D-3L, a WHO Disability Assessment
Schedule (WHODAS) 2.0. Methods: Baseline and 12-month data from our longitudinal dialysis outcomes in older
New Zealanders’ study were analyzed to determine if HRQoL at baseline
predicted disability outcomes 12 months later. Results: Of the 223 participants at baseline, 157 participants completed a follow-up
interview 12 months later. Individuals with “considerable disability” at
baseline had a significantly (86%) higher risk of experiencing “considerable
disability” at 12 months compared with those with “lesser/no disability” at
baseline. Two thirds of those with ≥3 comorbidities were experiencing
“considerable disability.” In addition, those with problems with EQ-5D-3L
self-care, EQ-5D-3L usual activities, and EQ-5D-3L anxiety/depression
reported higher rates of disability. Limitations: Selection bias is likely to have been an issue in this study as participants
were excluded from the follow-up interview if they had an intercurrent
illness requiring hospitalization within 2 weeks of the survey interview or
if the treating nephrologist judged that the individual’s ability to take
part was significantly impaired. Sample size meant there were a limited
number of explanatory/confounding variables that could be investigated in
the multivariable model. Conclusions: EQ-5D-3L mobility and self-care may be useful in predicting subsequent
disability for individuals with CKD 5G. Although individuals with kidney
failure often experience disability, previous studies have not clearly
identified HRQoL or disability as predictors of later disability for
individuals with kidney failure. Therefore, we would recommend the
assessment of mobility and self-care, in conjunction with existing
disabilities in the clinical review and pre-dialysis education of
individuals with kidney failure as they approach the need for kidney
replacement therapy. Trial registration: the Australian and New Zealand clinical trials registry:
ACTRN12611000024943.
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Affiliation(s)
- Elizabeth Butcher
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Robert Walker
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ari Samaranayaka
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - John Schollum
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Gamberini L, Mazzoli CA, Prediletto I, Sintonen H, Scaramuzzo G, Allegri D, Colombo D, Tonetti T, Zani G, Capozzi C, Dalpiaz G, Agnoletti V, Cappellini I, Melegari G, Damiani F, Fusari M, Gordini G, Laici C, Lanza MC, Leo M, Marudi A, Papa R, Potalivo A, Montomoli J, Taddei S, Mazzolini M, Ferravante AF, Nicali R, Ranieri VM, Russo E, Volta CA, Spadaro S. Health-related quality of life profiles, trajectories, persistent symptoms and pulmonary function one year after ICU discharge in invasively ventilated COVID-19 patients, a prospective follow-up study. Respir Med 2021; 189:106665. [PMID: 34717097 PMCID: PMC8531241 DOI: 10.1016/j.rmed.2021.106665] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) impairment is often reported among COVID-19 ICU survivors, and little is known about their long-term outcomes. We evaluated the HRQoL trajectories between 3 months and 1 year after ICU discharge, the factors influencing these trajectories and the presence of clusters of HRQoL profiles in a population of COVID-19 patients who underwent invasive mechanical ventilation (IMV). Moreover, pathophysiological correlations of residual dyspnea were tested. METHODS We followed up 178 survivors from 16 Italian ICUs up to one year after ICU discharge. HRQoL was investigated through the 15D instrument. Available pulmonary function tests (PFTs) and chest CT scans at 1 year were also collected. A linear mixed-effects model was adopted to identify factors associated with different HRQoL trajectories and a two-step cluster analysis was performed to identify HRQoL clusters. RESULTS We found that HRQoL increased during the study period, especially for the significant increase of the physical dimensions, while the mental dimensions and dyspnea remained substantially unchanged. Four main 15D profiles were identified: full recovery (47.2%), bad recovery (5.1%) and two partial recovery clusters with mostly physical (9.6%) or mental (38.2%) dimensions affected. Gender, duration of IMV and number of comorbidities significantly influenced HRQoL trajectories. Persistent dyspnea was reported in 58.4% of patients, and weakly, but significantly, correlated with both DLCO and length of IMV. CONCLUSIONS HRQoL impairment is frequent 1 year after ICU discharge, and the lowest recovery is found in the mental dimensions. Persistent dyspnea is often reported and weakly correlated with PFTs alterations. TRIAL REGISTRATION NCT04411459.
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Affiliation(s)
- Lorenzo Gamberini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Carlo Alberto Mazzoli
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Irene Prediletto
- Alma Mater Studiorum University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit, Bologna, Italy.
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Gaetano Scaramuzzo
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Davide Colombo
- Anaesthesia and Intensive Care Department - SS. Trinità Hospital, ASL Novara, Italy; Health Science Department - Eastern Piedmont University, Italy
| | - Tommaso Tonetti
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Chiara Capozzi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Vanni Agnoletti
- Anaesthesia and Intensive Care Unit - M.Bufalini Hospital, Cesena, Italy
| | - Iacopo Cappellini
- Department of Critical Care Section of Anesthesiology and Intensive Care, Azienda USL Toscana Centro, Prato, Italy
| | - Gabriele Melegari
- Department of Anaesthesiology, University Hospital of Modena, Via Del Pozzo 71, 41100, Modena, Italy
| | - Federica Damiani
- Department of Anaesthesia, Intensive Care and Pain Therapy - Imola Hospital, Imola, Italy
| | - Maurizio Fusari
- Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Giovanni Gordini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Cristiana Laici
- Postoperative Intensive Care Unit. Medical and Surgical Department of Digestive, Liver and Endocrine-Metabolic Diseases. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Concetta Lanza
- Department of Anesthesia and Intensive Care, G.B. Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Mirco Leo
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Marudi
- Department of Anaesthesiology, University Hospital of Modena, Via Del Pozzo 71, 41100, Modena, Italy
| | - Raffaella Papa
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Antonella Potalivo
- Department of Anaesthesia and Intensive Care - Infermi Hospital, Rimini, Italy
| | - Jonathan Montomoli
- Department of Anaesthesia and Intensive Care - Infermi Hospital, Rimini, Italy
| | - Stefania Taddei
- Anaesthesia and Intensive Care Unit, Bentivoglio Hospital, Bentivoglio, Italy
| | | | | | - Roberta Nicali
- Outpatient Pneumology Department. - SS. Trinità Hospital Borgomanero, ASL NO, Novara, Italy
| | - Vito Marco Ranieri
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Emanuele Russo
- Anaesthesia and Intensive Care Unit - M.Bufalini Hospital, Cesena, Italy
| | - Carlo Alberto Volta
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Savino Spadaro
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
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Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Segev DL, Shafi T, Monroy-Trujillo JM, Parekh RS, McAdams-DeMarco MA. Frailty, Age, and Postdialysis Recovery Time in a Population New to Hemodialysis. KIDNEY360 2021; 2:1455-1462. [PMID: 35373112 PMCID: PMC8786133 DOI: 10.34067/kid.0001052021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
Background Frailty, a phenotype characterized by decreased physiologic reserve and the inability to recover following confrontation with a stressor like hemodialysis, may help identify which patients on incident hemodialysis will experience longer postdialysis recovery times. Recovery time is associated with downstream outcomes, including quality of life and mortality. We characterized postdialysis recovery times among patients new to hemodialysis and quantified the association between frailty and hemodialysis recovery time. Methods Among 285 patients on hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, frailty was measured using the Fried phenotype. Self-reported recovery time was obtained by telephone interview. We estimated the association of frailty (intermediately frail and frail versus nonfrail) and postdialysis recovery time using adjusted negative binomial regression. Results Median time between dialysis initiation and study enrollment was 3.4 months (IQR, 2.7-4.9), and that between initiation and recovery time assessment was 11 months (IQR, 9.3-15). Mean age was 55 years, 24% were >65 years, and 73% were Black; 72% of individuals recovered in ≤1 hour, 20% recovered in 1-6 hours, 5% required 6-12 hours to recover, and <5% required >12 hours to recover. Those with intermediate frailty, frailty, and age ≤65 years had 2.56-fold (95% CI, 1.45 to 4.52), 1.72-fold (95% CI, 1.03 to 2.89), and 2.35-fold (95% CI, 1.44 to 3.85) risks, respectively, of longer recovery time independent of demographic characteristics, comorbidity, and dialysis-related factors. Conclusions In adults new to hemodialysis, frailty was independently associated with prolonged postdialysis recovery. Future studies should assess the effect of frailty-targeted interventions on recovery time to improve clinical outcomes.
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Affiliation(s)
- Jessica Fitzpatrick
- Department of Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen M. Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland
| | - Bernard G. Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Nephrology Center of Maryland, Baltimore, Maryland
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California,Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Dorry L. Segev
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Tariq Shafi
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi,Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Rulan S. Parekh
- Department of Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada
| | - Mara A. McAdams-DeMarco
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Surgery, Johns Hopkins University, Baltimore, Maryland
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5
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de Alencar SBV, Dias LDA, Dias VDA, de Lima FM, Montarroyos UR, de Petribú KCL. Quality of life may be a more valuable prognostic factor than depression in older hemodialysis patients. Qual Life Res 2020; 29:1829-1838. [PMID: 32062755 DOI: 10.1007/s11136-020-02445-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE Depression and impairment of quality of life (QoL) reduce the survival of individual on hemodialysis (HD). However, few studies evaluated the impact of these conditions on the survival of older patients undergoing HD. METHODS A retrospective cohort study was performed including patients aged ≥ 60 years on HD in Recife, Brazil, assessed in 2013 and monitored until 2017. Depression was evaluated with the Mini-International Neuropsychiatric Interview and QoL with the Control, Autonomy, Self-realization, and Pleasure Questionnaire (CASP-16). Survival differences according to the depression and QoL status were measured by Kaplan-Meier analysis and Cox regression. Death Certificates were analyzed to assess the cause of death. RESULTS A total of 171 patients were included (mean age 68.7 ± 6.9 years). The mean follow-up time was 3 years (maximum 4.5 years) and there were 98 deaths (57.3% of the sample). In a multivariate model that included depression and QoL, only QoL impairment was associated with a higher risk of death (HR 1.62, p = 0.035). Among CASP domains, only "Control" was associated with survival (HR 0.90, p = 0.014). Depression was unrelated to the cause of death, but there was a trend for death by endocrine diseases if QoL was impaired (p = 0.057). CONCLUSION QoL impairment is a key predictor of prognosis in older patients on HD and may be more important than depression. It is important that teams dealing with this population include in protocols an assessment of QoL, in order to offer a range of care according to the needs of these patients.
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Affiliation(s)
- Saulo Barbosa Vasconcelos de Alencar
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil.
| | - Luana do Amaral Dias
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil
| | - Victor do Amaral Dias
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil
| | - Fábia Maria de Lima
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil
| | - Ulisses Ramos Montarroyos
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil
| | - Kátia Cristina Lima de Petribú
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil
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Raj R, Thiruvengadam S, Ahuja KDK, Frandsen M, Jose M. Discussions during shared decision-making in older adults with advanced renal disease: a scoping review. BMJ Open 2019; 9:e031427. [PMID: 31767590 PMCID: PMC6887047 DOI: 10.1136/bmjopen-2019-031427] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES This review summarises the information available for clinicians counselling older patients with kidney failure about treatment options, focusing on prognosis, quality of life, the lived experiences of treatment and the information needs of older adults. DESIGN We followed the Joanna Briggs Institute Methodology for Scoping Reviews. The final report conforms to the PRISMA-ScR guidelines. DATA SOURCES PubMed, PsycINFO, CINAHL, Embase, Scopus, Web of Science, TRIP and online repositories (for dissertations, guidelines and recommendations from national renal associations). ELIGIBILITY CRITERIA FOR INCLUSION Articles in English studying older adults with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2); published between January 2000 and August 2018. Articles not addressing older patients separately or those comparing between dialysis modalities were excluded. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened articles for inclusion and grouped them by topic as per the objectives above. Quantitative data were presented as tables and charts; qualitative themes were identified and described. RESULTS 248 articles were included after screening 15 445 initial results. We summarised prognostic scores and compared dialysis and non-dialytic care. We highlighted potentially modifiable factors affecting quality of life. From reports of the lived experiences, we documented the effects of symptoms, of ageing, the feelings of disempowerment and the need for adaptation. Exploration of information needs suggested that patients want to participate in decision-making and need information, in simple terms, about survival and non-survival outcomes. CONCLUSION When discussing treatment options, validated prognostic scores are useful. Older patients with multiple comorbidities do not do well with dialysis. The modifiable factors contributing to the low quality of life in this cohort deserve attention. Older patients suffer a high symptom burden and functional deterioration; they have to cope with significant life changes and feelings of disempowerment. They desire greater involvement and more information about illness, symptoms and what to expect with treatment.
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Affiliation(s)
- Rajesh Raj
- Department of Nephrology, Launceston General Hospital, Launceston, Tasmania, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | | | | | - Mai Frandsen
- Faculty of Health, University of Tasmania, Launceston, Tasmania, Australia
| | - Matthew Jose
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Department of Nephrology, Royal Hobart Hospital, Hobart, Tasmania, Australia
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7
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Bossola M, Pepe G, Picca A, Calvani R, Marzetti E. Treating symptoms to improve the quality of life in patients on chronic hemodialysis. Int Urol Nephrol 2019; 51:885-887. [PMID: 30888603 DOI: 10.1007/s11255-019-02121-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/04/2019] [Indexed: 12/18/2022]
Abstract
Health-related quality of life (HRQOL) in patients on chronic hemodialysis has not improved significantly in the last 20 years. This is largely due to their substantial symptom burden which is rarely assessed and treated in routine clinical practice. This is also consequence of the lack of an appropriate armamentarium for the treatments of such symptoms. Adequate studies on the causes and pathogenesis of the symptoms of hemodialysis patients are needed followed by high-quality studies on possible therapeutic pharmacological and non-pharmacological interventions. Patients on chronic hemodialysis deserve a better quality of life.
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Affiliation(s)
- Maurizio Bossola
- Hemodialysis Unit, Institute of Clinical Surgery, Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Gilda Pepe
- Department of Surgery, Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Picca
- Department of Gerontology, Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Calvani
- Department of Gerontology, Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Marzetti
- Department of Gerontology, Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Triantafylidis LK, Hawley CE, Perry LP, Paik JM. The Role of Deprescribing in Older Adults with Chronic Kidney Disease. Drugs Aging 2019; 35:973-984. [PMID: 30284120 DOI: 10.1007/s40266-018-0593-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Older adults with chronic kidney disease (CKD) often experience polypharmacy, a recognized predictor of prescribing problems including inappropriately dosed medications, drug-drug and drug-disease interactions, morbidity and mortality. Polypharmacy is also associated with nonadherence, which leads to recurrent hospitalizations and poorer hemodialysis outcomes in CKD patients. Further complicating medication management in this vulnerable population are the physiologic changes that occur with both age and CKD. This guide for pharmacists and prescribers offers considerations in medication evaluation and management among older adults with CKD. Careful prescribing with the aid of tools such as the American Geriatrics Society Beers Criteria can support safe medication use and appropriate prescribing. Polypharmacy may be systematically addressed through 'deprescribing,' an evidence-based process that enables identification and elimination of unnecessary or inappropriate medications. Detailed guidance for deprescribing in older adults with CKD has not been published previously. We highlight three specific targets for medication optimization and deprescribing in older adults with CKD: (1) proton pump inhibitors, (2) oral hypoglycemic agents, including newer classes of agents, and (3) statins. These medication classes have been chosen as they represent three of the most commonly prescribed classes of medications in the United States. For each area, we review considerations for medication use in older adults with CKD and provide strategies to avoid, modify, or discontinue these medications when clinically indicated. By utilizing deprescribing techniques, pharmacists are well positioned to help decrease the medication burden in older adults with CKD, thereby potentially reducing the risk of morbidity and mortality associated with polypharmacy.
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Affiliation(s)
| | - Chelsea E Hawley
- Pharmacy Department, VA Boston Healthcare System, Boston, MA, USA.,New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
| | - Laura P Perry
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Primary Care and Geriatrics, Highland Hospital, Oakland, CA, USA
| | - Julie M Paik
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Renal Section, VA Boston Healthcare System, Boston, MA, USA.,Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Trajceska L, Mladenovska D, Dzekova-Vidimliski P, Sikole A. Quality of Life-Repeated Measurements Are Needed In Dialysis Patients. Open Access Maced J Med Sci 2018; 6:1410-1412. [PMID: 30159066 PMCID: PMC6108791 DOI: 10.3889/oamjms.2018.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND: There is a general agreement that, besides survival, the quality of life is a highly relevant outcome in the evaluation of treatment in patients with the end-stage renal disease. Moreover, it is very important to determine whether the quality of life impacts survival. AIM: This study aims to assess whether changes or absolute scores of the quality of life (QOL) measurements better predict mortality in dialysis patients. MATERIAL AND METHODS: In a longitudinal study comprising 162 prevalent hemodialysis patients QOL was assessed with the 36-item - Short Form Health Survey Questionnaire (SF-36) at baseline and after 12 months. Patients were followed for 60 months. Mortality risk was assessed using Cox proportional hazards analysis for patients with below and above median levels of both physical and mental QOL component scores (PCS and MCS, respectively). RESULTS: At the beginning of the study the mean Physical Component score was 47.43 ± 26.94 and mean Mental Component Score was slightly higher 50.57 ± 24.39. Comparative analysis of the changes during the first year showed a marked deterioration of all quality of life scores in surviving patients. The 5-point decline for PCS was noted in 39 (24%) patients and 42 (26%) for MCS. In the follow-up period of 60 months, 69 (43%) patients died. In the Cox analysis, mortality was significantly associated with lower PCS: HR = 2.554 [95% confidence interval (CI): 1.533-4.258], (P < 0.000) and lower MCS: 2.452 (95% CI: 1.478-4.065), P < 0.001. The patients who had lower levels of PCS and MCS in the second QOL survey 1 year later, had similarly high mortality risk: 3.570 (95% CI: 1.896-6.727, P < 0.000); 2.972 (95% CI: 1.622-5.490, P < 0.000), respectively. The hazard ratios for mortality across categories for the change of PCS and MCS were not significant. In the multivariate model categorising the first and second scores as predictors and adjusted for age, only the second PCS and MCS score were associated with mortality. CONCLUSION: Low QOL scores are associated with mortality in repeated measurements, but only the more recent overwhelmed the power of the decline.
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Affiliation(s)
- Lada Trajceska
- University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Daniela Mladenovska
- University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Pavlina Dzekova-Vidimliski
- University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Aleksandar Sikole
- University Clinic of Nephrology, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Kurella Tamura M, Desai M, Kapphahn KI, Thomas IC, Asch SM, Chertow GM. Dialysis versus Medical Management at Different Ages and Levels of Kidney Function in Veterans with Advanced CKD. J Am Soc Nephrol 2018; 29:2169-2177. [PMID: 29789430 DOI: 10.1681/asn.2017121273] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/27/2018] [Indexed: 11/03/2022] Open
Abstract
Background Appropriate patient selection and optimal timing of dialysis initiation among older adults with advanced CKD are uncertain. We determined the association between dialysis versus medical management and survival at different ages and levels of kidney function.Methods We assembled a nationally representative 20% sample of United States veterans with eGFR<30 ml/min per 1.73 m2 between 2005 and 2010 (n=73,349), with follow-up through 2012. We used an extended Cox model to determine associations among the time-varying exposures, age (<65, 65-74, 75-84, and ≥85 years), eGFR (<6, 6-<9, 9-<12, 12-<15, and 15-<29 ml/min per 1.73 m2), and provision of dialysis, and survival.Result Over the mean±SEM follow-up of 3.4±2.2 years, 15% of patients started dialysis and 52% died. The eGFR at which dialysis, compared with medical management, associated with lower mortality varied by age (P<0.001). For patients aged <65, 65-74, 75-84, and ≥85 years, dialysis associated with lower mortality for those with eGFR not exceeding 6-<9, <6, 9-<12, and 9-<12 ml/min per 1.73 m2, respectively. Dialysis initiation at eGFR<6 ml/min per 1.73 m2 associated with a higher median life expectancy of 26, 25, and 19 months for patients aged 65, 75, and 85 years, respectively. When dialysis was initiated at eGFR 9-<12 ml/min per 1.73 m2, the estimated difference in median life expectancy was <1 year for these patients.Conclusions Provision of dialysis at higher levels of kidney function may extend survival for some older patients.
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Affiliation(s)
| | - Manisha Desai
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Kristopher I Kapphahn
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - I-Chun Thomas
- Geriatric Research and Education Clinical Center and.,Division of Nephrology and
| | - Steven M Asch
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
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11
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Tattersall J, Farrington K, Gentile G, Kooman J, Macias Núñez JF, Nistor I, Van Biesen W, Covic A. Is Kt/V useful in elderly dialysis patients? Pro and Con arguments. Nephrol Dial Transplant 2018; 33:742-750. [DOI: 10.1093/ndt/gfy042] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/04/2018] [Indexed: 01/06/2023] Open
Affiliation(s)
- James Tattersall
- Renal Unit, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ken Farrington
- Renal Unit, Lister Hospital, Stevenage, Hertfordshire, UK
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
| | - Giorgio Gentile
- Department of Renal Medicine, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Jeroen Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Ionut Nistor
- Department of Nephrology “Dr CI Parhon” Hospital, Iasi, Romania
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Adrian Covic
- Department of Nephrology “Dr CI Parhon” Hospital, Iasi, Romania
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12
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Debnath S, O'Connor J, Hura C, Kasinath B, Lorenzo C. Quality of Life and Depression Among Mexican Americans on Hemodialysis: A Preliminary Report. Ther Apher Dial 2017; 22:166-170. [PMID: 29193825 DOI: 10.1111/1744-9987.12642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/07/2017] [Accepted: 09/21/2017] [Indexed: 11/29/2022]
Abstract
Health-related quality of life (QOL) and depression burden of Mexican Americans with end-stage renal disease (ESRD) are not known. This observational cross-sectional study assessed QOL and depression and examined their inter-relatedness in Mexican Americans with type 2 diabetes and ESRD on maintenance hemodialysis (HD) treatment. Prevalent Mexican Americans on HD (N = 40) completed the Kidney Disease Quality of Life-Short Form (KDQOL-SF) and the Beck Depression Inventory II. The overall median scores for the mental component summary and the physical component summary scales in the KDQOL-SF were 40.9 and 34.0, respectively. The prevalence of severe depression was 40%. The most significant differences between depressed and non-depressed groups were symptom/problem list, cognitive function, and emotional well- being (P < 0.0001 for all). Mexican Americans with depression endure a more dismal QOL compared to non-depressed peers. Significant negative correlations between depression and several QOL scales underscore plausible interactions between the two conditions which warrants further evaluation.
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Affiliation(s)
- Subrata Debnath
- Department of Medicine, Division of Nephrology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jason O'Connor
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Claudia Hura
- Department of Medicine, Division of Nephrology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Balakuntalam Kasinath
- Department of Medicine, Division of Nephrology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Carlos Lorenzo
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Barbosa JBN, Moura ECSCD, Lira CLOBD, Marinho PÉDM. Quality of life and duration of hemodialysis in patients with chronic kidney disease (CKD): a cross-sectional study. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.004.ao13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Quality of life (QoL) of hemodialysis patients is a major evaluative marker currently measured, while treatment time is a clinical determinant associated with impaired QOL. Objective: To evaluate QOL in individuals undergoing hemodialysis (HD) considering treatment time and the presence of comorbidities. Methods: A cross-sectional study conducted in the hemodialysis unit of the Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE). We studied patients with Chronic Kidney Disease (CKD) of both genders over the age of 18 years, at any level of education and undergoing HD for at least 6 months. We evaluated the demographic/socioeconomic and clinical data, followed by application of the quality of life questionnaire (KDQOL-SF). Results: Participants were 47 patients with a mean age of 50.94 ± 13.33 years, 55.3% were male and average treatment time of 57.35 ± 61.46 months. Hypertension (59.6%) was the most frequent underlying disease. According to the responses obtained through the KDQOL-SF, the situation at work and physical limitation scored worse. Sexual function (85.83) and encouragement by the team had the best performance. There were no differences in dimensions of questionnaire and treatment time. Conclusion: The presence of comorbidities and HD duration were not found to be possible factors for changing QoL in this study. However, we suggest that future studies evaluate other factors such as laboratory, emotional and functional data to check for changes in QoL in these patients related to HD duration.
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14
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Lee PH, Wong FKY, Wang SL, Chow SKY. Substitution of SF-36 by SF-12 Among Hong Kong Chinese Older Adults: Secondary Analysis of Randomized Controlled Trials. Int J Behav Med 2017; 23:635-44. [PMID: 26843380 DOI: 10.1007/s12529-016-9542-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aims to examine the appropriateness of substituting the Short-Form 36 (SF-36) by its shortened version (SF-12) in measuring health-related quality of life (HRQoL) in older Chinese population. METHODS Secondary analysis of two transitional care management programs, conducted from 2009 to 2012, were analyzed (n = 1188, aged 60-97). Participants were discharged patients with respiratory disease, type 2 diabetes, cardiac disease, and renal disease, and were classified according to number of chronic diseases. SF-36 was administered at baseline and 4-week follow-up. RESULTS Both overestimations and underestimations of HRQoL by SF-12 were found. Most domain scores of SF-36 and SF-12 were highly correlated (Spearman correlation (ρ) > 0.85), with the exception of General Health (ρ = 0.64) and Vitality subscales (ρ = 0.82). Multiple linear regression adjusted for demographic characteristics showed that the four out of eight domains of SF-36 and SF-12 were equivalent in measuring the difference across numbers of chronic diseases (all p < 0.05). Paired sample t tests in 989 (83.2 %) who completed the SF-36 survey 4 weeks after baseline showed that SF-12 overestimated the 4-week changes in most of the domains. CONCLUSIONS The use of the Chinese version of SF-12v2 for reporting the change over time in quality of life among medical patients after hospital discharge may need to be interpreted with caution. The SF-12 tends to underestimate the difference when compared with the SF-36.
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Affiliation(s)
- Paul H Lee
- School of Nursing, The Hong Kong Polytechnic University, GH519, Hung Hom, Kowloon, Hong Kong
| | - Frances K Y Wong
- School of Nursing, The Hong Kong Polytechnic University, GH519, Hung Hom, Kowloon, Hong Kong.
| | - Shao Ling Wang
- School of Nursing, The Hong Kong Polytechnic University, GH519, Hung Hom, Kowloon, Hong Kong
| | - Susan K Y Chow
- School of Nursing, The Hong Kong Polytechnic University, GH519, Hung Hom, Kowloon, Hong Kong
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Romano-Zelekha O, Golan E, Ifrah A, Weinstein T, Shohat T. Differences in quality of life between Jewish and Arab patients on hemodialysis. Qual Life Res 2017; 26:3343-3352. [PMID: 28791563 DOI: 10.1007/s11136-017-1661-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Higher health-related quality of life (HRQOL) in dialysis patients has been associated with fewer hospitalizations and lower mortality. Since Arab patients on dialysis have better survival rates than Jewish patients, we hypothesized that they would have higher HRQOL. We also studied the impact of several risk factors on HRQOL in each population. METHODS Based on a national dialysis registry, patients from 64 hemodialysis units were recruited to participate. Patients who consented were interviewed face-to-face, using the Kidney Disease Quality of Life Short Form (KDQOL-SF36) questionnaire. RESULTS Five hundred and fifty-eight (50.6%) Jewish and 544 (49.4%) Arab patients participated in the study. For Arab patients mean crude scores for the "mental component summary" and KDQOL scores were significantly lower than for Jewish patients [31.6 (95% Cl 30.0-33.3) vs. 38.0 (95% Cl 36.1-39.9), p < 0.0001 and 55.6 (95% Cl 54.5-56.7) vs. 59.8 (95% Cl 58.6-60.9), p < 0.0001, respectively]. Much lower scores were observed for Arabs in the "emotional role" and "work status" subscales. The two populations had similar general health assessments and albumin level. For both, HRQOL was positively associated with higher educational level, higher albumin level, and dialysis connection by fistula or graft; and negatively associated with low income and diabetes. HRQOL was negatively associated with previous cerebrovascular accident among Arabs and with female gender among Jews. CONCLUSIONS Differences between Jews and Arabs in subscales related to psychosocial factors suggest that cultural differences in the perceptions of sickness and health may be relevant here. Future studies should explore such possibility and focus on the large gap in the "work status" subscale.
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Affiliation(s)
- Orly Romano-Zelekha
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, 52621, Israel.
| | - Eliezer Golan
- Hemodialysis Unit, Meir Medical Center, Kfar Saba, Israel
- Israel Renal Registry, ISNH, Tel Hashomer, Israel
- Sourasky Medical Center Tel-Aviv, Tel-Aviv, Israel
| | - Anneke Ifrah
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, 52621, Israel
| | - Talia Weinstein
- Sourasky Medical Center Tel-Aviv, Tel-Aviv, Israel
- The Israeli Society of Nephrology and Hypertension, Tel-Aviv, Israel
| | - Tamy Shohat
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, 52621, Israel
- Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Hanafusa N, Nitta K, Tsuchiya K. The characteristics of the older dialysis population—heterogeneity and another type of altered risk factor patterns. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0110-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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17
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van Loon I, Hamaker ME, Boereboom FTJ, Grooteman MPC, Blankestijn PJ, van den Dorpel RMA, Nubé MJ, Ter Wee PM, Verhaar MC, Bots ML. A closer look at the trajectory of physical functioning in chronic hemodialysis. Age Ageing 2017; 46:594-599. [PMID: 28164208 DOI: 10.1093/ageing/afx006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/07/2017] [Indexed: 11/12/2022] Open
Abstract
Background in chronic hemodialysis, physical functioning (PF) is known to be poor. We set out to assess to what extent chronic dialysis patients are able to maintain a good physical condition over time and what the influence of age is on the trajectory of PF. Methods we used data form 714 prevalent hemodialysis patients, enrolled in the CONvective TRAnsport STudy (CONTRAST). The PF subscale of the KDQOL SF-36 was assessed at baseline (n = 679) and during 2 years of follow-up (n = 298). Baseline PF score (0-100) was categorized into tertiles (good, intermediate and low). Change of PF of ≥ 5 points was considered clinically relevant. A regression model was applied to assess factors related to 'decline of PF (≥5 points)/low PF (0-33) at follow-up'. Results during follow-up, only 15.3 % (1 out of 6) of patients succeeded in maintaining a good physical condition, the remainder deteriorated or died. Of the older patients (≥75) only 3.6% remained in a good physical condition. Factors related to decline/low PF were increasing age (odds ratio [OR] = 1.96 [95% CI: 1.03-3.72] for 65-74 years and OR = 2.38 [95%CI: 1.17-4.84] for ≥75 years compared to <65 years) and albumin (OR = 1.10 [95%CI: 1.01-1.18] per g/L decrease). Conclusion very few hemodialysis patients maintain a good physical condition over a 2-year time span. Especially in older patients, physical performance is poor and decline is faster than in the healthy population. These findings should be taken into account when considering dialysis in older patients and more emphasis should be placed to attempts for improving physical condition.
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Affiliation(s)
- Ismay van Loon
- Dianet Dialysis Center, Brennerbaan 100, Utrecht 3524 BN, Netherlands
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Zeist, Utrecht, Netherlands
| | - Franciscus T J Boereboom
- Dianet Dialysis Center, Brennerbaan 100, Utrecht 3524 BN, Netherlands
- Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, Netherlands
| | | | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | | | - Menso J Nubé
- Department of Internal Medicine, VU Medical Center, Utrecht, Netherlands
| | - Piet M Ter Wee
- Department of Internal Medicine, VU Medical Center, Utrecht, Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Bossola M, Pepe G, Marzetti E. Health-related quality of life of patients on chronic dialysis: The need for a focused effort. Semin Dial 2017; 30:413-416. [DOI: 10.1111/sdi.12620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Maurizio Bossola
- Hemodialysis Unit; Institute of Clinical Surgery; Catholic University of the Sacred Heart; Rome Italy
| | - Gilda Pepe
- Department of Surgery; Catholic University of the Sacred Heart; Rome Italy
| | - Emanuele Marzetti
- Department of Gerontology; Catholic University of the Sacred Heart; Rome Italy
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Palmer SC, Natale P, Ruospo M, Saglimbene VM, Rabindranath KS, Craig JC, Strippoli GFM. Antidepressants for treating depression in adults with end-stage kidney disease treated with dialysis. Cochrane Database Syst Rev 2016; 2016:CD004541. [PMID: 27210414 PMCID: PMC8520741 DOI: 10.1002/14651858.cd004541.pub3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Depression affects approximately one-quarter of people treated with dialysis and is considered an important research uncertainty by patients and health professionals. Treatment for depression in dialysis patients may have different benefits and harms compared to the general population due to different clearances of antidepressant medication and the severity of somatic symptoms associated with end-stage kidney disease (ESKD). Guidelines suggest treatment of depression in dialysis patients with pharmacological therapy, preferably a selective serotonin reuptake inhibitor. This is an update of a review first published in 2005. OBJECTIVES To evaluate the benefit and harms of antidepressants for treating depression in adults with ESKD treated with dialysis. SEARCH METHODS We searched Cochrane Kidney and Transplant's Specialised Register to 20 January 2016 through contact with the Information Specialist using search terms relevant to this review. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing antidepressant treatment with placebo or no treatment, or compared to another antidepressant medication or psychological intervention in adults with ESKD (estimated glomerular filtration rate < 15 mL/min/1.73 m(2)). DATA COLLECTION AND ANALYSIS Data were abstracted by two authors independently onto a standard form and subsequently entered into Review Manager. Risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data were calculated with 95% confidence intervals (95% CI). MAIN RESULTS Four studies in 170 participants compared antidepressant therapy (fluoxetine, sertraline, citalopram or escitalopram) versus placebo or psychological training for 8 to 12 weeks. In generally very low or ungradeable evidence, compared to placebo, antidepressant therapy had no evidence of benefit on quality of life, had uncertain effects on increasing the risk of hypotension (3 studies, 144 participants: RR 1.72, 95% CI 0.75 to 3.92), headache (2 studies 56 participants: RR 2.91, 95% CI 0.73 to 11.57), and sexual dysfunction (2 studies, 101 participants: RR 3.83, 95% CI 0.63 to 23.34), and increased nausea (3 studies, 114 participants: RR 2.67, 95% CI 1.26 to 5.68). There were few or no data for hospitalisation, suicide or all-cause mortality resulting in inconclusive evidence. Antidepressant therapy may reduce depression scores during treatment compared to placebo (1 study, 43 participants: MD -7.50, 95% CI -11.94 to -3.06). Antidepressant therapy was not statistically different from group psychological therapy for effects on depression scores or withdrawal from treatment and a range of other outcomes were not measured. AUTHORS' CONCLUSIONS Despite the high prevalence of depression in dialysis patients and the relative priority that patients place on effective treatments, evidence for antidepressant medication in the dialysis setting is sparse and data are generally inconclusive. The relative benefits and harms of antidepressant therapy in dialysis patients are poorly known and large randomised studies of antidepressants versus placebo are required.
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Affiliation(s)
- Suetonia C Palmer
- University of Otago ChristchurchDepartment of Medicine2 Riccarton AvePO Box 4345ChristchurchNew Zealand8140
| | | | - Marinella Ruospo
- DiaverumMedical Scientific OfficeLundSweden
- Amedeo Avogadro University of Eastern PiedmontDivision of Nephrology and Transplantation, Department of Translational MedicineVia Solaroli 17NovaraItaly28100
| | | | | | - Jonathan C Craig
- The University of SydneySydney School of Public HealthEdward Ford Building A27SydneyNSWAustralia2006
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | - Giovanni FM Strippoli
- DiaverumMedical Scientific OfficeLundSweden
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- Diaverum AcademyBariItaly
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Liebman S, Li NC, Lacson E. Change in quality of life and one-year mortality risk in maintenance dialysis patients. Qual Life Res 2016; 25:2295-306. [PMID: 26941217 DOI: 10.1007/s11136-016-1257-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Quality of life (QOL) is an important metric of high-quality dialysis care. QOL is commonly measured by the Short Form 36 Questionnaire (SF-36), which provides two summary scores: a mental component score (MCS) and a physical component score (PCS). Poor QOL is associated with mortality in dialysis patients. Small studies show that changes in QOL also predicts mortality. We investigated whether changes in QOL over time are associated with mortality in a large cohort of maintenance hemodialysis patients. METHODS This retrospective study was conducted in 1017 outpatient dialysis facilities. Over 10,000 hemodialysis patients completed two SF-36 surveys. We compared 1-year morality rates in those whose MCS or PCS increased or decreased ±5 vs. those whose did not. RESULTS For those who completed two surveys, mean score for PCS was unchanged, whereas MCS increased slightly (48.6 vs. 48.9, p = 0.05). Individual patients, however, showed marked variation. On the second survey, more than half of patients demonstrated a ± 5 point change in the PCS and/or MCS. After multivariate adjustment, a ≥ 5 decrease in MCS was associated with an increase in mortality (HR = 1.33, 95 % CI 1.18, 1.50). CONCLUSIONS Clinicians should be aware that many patients experience a significant change in both the MCS and PCS on dialysis. A MCS decrease of ≥5 was associated with increased mortality. More study is needed to determine whether this is a causal relationship. Physicians should evaluate root causes and seek to mitigate declines in QOL whenever possible.
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Affiliation(s)
- Scott Liebman
- University of Rochester Medical Center, 601 Elmwood Ave, Box 675, Rochester, NY, 14642, USA.
| | - Nien-Chen Li
- Fresenius Medical Care North America, Waltham, MA, USA
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Einollahi B, Motalebi M, Rostami Z, Nemati E, Salesi M. Sleep quality among Iranian hemodialysis patients: a multicenter study. Nephrourol Mon 2014; 7:e23849. [PMID: 25738125 PMCID: PMC4330687 DOI: 10.5812/numonthly.23849] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/12/2014] [Indexed: 12/20/2022] Open
Abstract
Background: Sleep disorders are prevalent complication in patients with end-stage renal disease undergoing hemodialysis (HD). The factors affecting sleep quality (SQ) of patients on HD have not been completely recognized yet. In addition, some studies have shown that poor SQ increases the risk of mortality in patients on HD. Objectives: This study aimed to identify the prevalence of poor SQ and its associated risk factors in Iranian patients on HD. Patients and Methods: This cross-sectional and multicenter study was conducted on 6878 patients on HD from 132 dialysis centers in Iran. Sleep domain of disease specific core of KDCS-SF questionnaire and generic core of this questionnaire (SF-36) were used to assess patients’ SQ and quality of life (QoL), respectively. A poor SQ was defined as a score of ≤ 61.2. Logistic and linear regression analyses were applied to assess predictors of SQ and their associations. Results: The mean age of patients was 54.4 ± 17.1 years and 39.7% of patients were > 60 years old. The majority of our patients had poor SQ (60.6%). Patients with diabetes mellitus were significantly more likely to have poor quality of sleep (63.4%). In logistic regression analysis, there were significant correlation between good SQ and younger age, shorter dialysis vintage, less muscle cramp, high QoL, high cognitive function score, and high sexual function. In addition, linear regression showed a significant association among SQ, QoL, and hospital stay as an outcome. Conclusions: With improving some factors and QoL of patients on HD, we can promote SQ in these patients that it might lead to reduction in length of hospital stay.
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Affiliation(s)
- Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Motalebi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohsen Motalebi, Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2181262073, Fax: +98-2181262073, E-mail:
| | - Zohreh Rostami
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Eghlim Nemati
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mahmood Salesi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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Tonelli M, Riella M. Chronic Kidney Disease and the Ageing Population. ACTA ACUST UNITED AC 2014; 128:319-22. [DOI: 10.1159/000362458] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/24/2014] [Indexed: 11/19/2022]
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Tonelli M, Riella M. Chronic kidney disease and the ageing population. Intern Med J 2014; 44:213-7. [PMID: 24621282 DOI: 10.1111/imj.12367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/07/2014] [Indexed: 11/30/2022]
Affiliation(s)
- M Tonelli
- University of Alberta, Alberta, Canada
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Tonelli M, Riella M. Chronic kidney disease and the aging population. Nephrol Dial Transplant 2014; 29:221-4. [PMID: 24493860 DOI: 10.1093/ndt/gft519] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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Tonelli M, Riella MC. World Kidney Day 2014: CKD and the aging population. Am J Kidney Dis 2014; 63:349-53. [PMID: 24560153 DOI: 10.1053/j.ajkd.2014.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 01/22/2023]
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Affiliation(s)
- M Tonelli
- University of Alberta, Alberta, Canada
| | - M Riella
- Catholic University of Parana, Curitiba, Brazil
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Tonelli M, Riella M. Chronic kidney disease and the aging population. Int J Organ Transplant Med 2014. [DOI: 10.1016/j.hkjn.2014.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Tonelli M, Riella M. Chronic kidney disease and the aging population. Nephrol Ther 2014; 10:74-7. [PMID: 24662271 DOI: 10.1016/j.nephro.2013.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
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Tonelli M, Riella M. Editorial: chronic kidney disease and the ageing population. Int J Older People Nurs 2014; 9:3-7. [PMID: 24588903 DOI: 10.1111/opn.12046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tonelli M, Riella M. Chronic Kidney Disease and the Aging Population. J Clin Hypertens (Greenwich) 2014. [DOI: 10.1111/jch.12292] [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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Tonelli M, Riella M. Chronic kidney disease and the aging population. Am J Physiol Renal Physiol 2014; 306:F469-72. [PMID: 24500692 DOI: 10.1152/ajprenal.00063.2014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Griva K, Yu Z, Chan S, Krisnasamy T, Yamin RBA, Zakaria FB, Wu SY, Oei E, Foo M. Age is not a contraindication to home-based dialysis - Quality-of-Life outcomes favour older patients on peritoneal dialysis regimes relative to younger patients. J Adv Nurs 2014; 70:1902-14. [PMID: 24495288 DOI: 10.1111/jan.12355] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
Abstract
AIM To compare Quality of Life, anxiety and depression between older (≥65 years) and younger (<65 years) patients across automated peritoneal dialysis and continuous ambulatory peritoneal dialysis. BACKGROUND There is a lack of studies as to whether the different peritoneal dialysis modalities confer similar outcomes in older and younger patients. DESIGN Cross-sectional. METHODS A total of 201 patients completed the Kidney Disease Quality of Life Short-Form, World Health Organization Quality of Life Instrument, Short Form and Hospital Anxiety and Depression Scale. Comorbidity and biochemical values were abstracted from medical records. RESULTS Older patients reported significantly better quality of life than younger patients in the Kidney Disease Quality of Life Short-Form effects of kidney disease and patient satisfaction and the World Health Organization Quality of Life Instrument overall Quality-of-Life/health despite worse clinical profile. Quality of life outcomes were comparable between automated peritoneal dialysis and continuous ambulatory peritoneal dialysis with the exception of the Kidney Disease Quality of Life Short-Form symptoms in favour of automated peritoneal dialysis. Levels of anxiety and depression were equivalent for older and younger patients across peritoneal dialysis modalities. The observed quality-of-life advantages for older patients persisted after case-mix adjustments and extended to more quality-of-life domains and depression and anxiety. CONCLUSION Our findings of superior quality of life in patients aged ≥ 65 support the expansion of peritoneal dialysis use in older patients. Patients across different age groups should be given non-biased information about both peritoneal dialysis modalities and individual preferences should be elicited and carefully considered by healthcare providers.
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Affiliation(s)
- Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore
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Tonelli M, Riella M. Chronic kidney disease and the aging population. Nephrology (Carlton) 2014; 19:65-8. [PMID: 24428214 DOI: 10.1111/nep.12185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tonelli M, Riella M. Chronic kidney disease and the aging population. Int J Organ Transplant Med 2014; 5:1-6. [PMID: 25013672 PMCID: PMC4089330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - M. Riella
- Catholic University of Parana, Curitiba, Brazil
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Maditinos DI, Papadopoulos D, Prats L. The Free Time Allocation and its Relationship with the Perceived Quality of Life (QoL) and Satisfaction with Life (SwL). ACTA ACUST UNITED AC 2014. [DOI: 10.1016/s2212-5671(14)00053-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ying I, Levitt Z, Jassal SV. Should an elderly patient with stage V CKD and dementia be started on dialysis? Clin J Am Soc Nephrol 2013; 9:971-7. [PMID: 24235287 DOI: 10.2215/cjn.05870513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The burden of cognitive impairment appears to increase with progressive renal disease, such that the prevalence of dementia among those starting dialysis, or those already established on dialysis, is high. The appropriateness of dialysis initiation in this population has been questioned, and current Renal Physician Association guidelines suggest forgoing dialysis in individuals who have dementia and lack awareness of self and environment. Patients are, however, also entitled to equal rights and respect, equal access to health care services, and an opportunity to engage in shared decision-making processes, particularly if there is concern over reversibility of disease. This article discusses, on the basis of principles of beneficence and nonmaleficence, the arguments in favor of and against dialysis use, and the process of determining an appropriate care plan. Factors discussed include the current societal trend toward a technological imperative, premature fatalism, survival benefits, and the implications of providing care to patients who are unable to express their tolerance for symptoms associated with the treatment or lack of treatment.
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Affiliation(s)
- Irene Ying
- Division of Palliative Care, University of Toronto, Toronto, Ontario, Canada, †Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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Alshraifeen A, McCreaddie M, Evans JMM. Quality of life and well-being of people receiving haemodialysis treatment in Scotland: A cross-sectional survey. Int J Nurs Pract 2013; 20:518-23. [DOI: 10.1111/ijn.12194] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Ali Alshraifeen
- School of Nursing, Midwifery and Health; University of Stirling; Stirling UK
| | - May McCreaddie
- School of Nursing, Midwifery and Health; University of Stirling; Stirling UK
| | - Josie MM Evans
- School of Nursing, Midwifery and Health; University of Stirling; Stirling UK
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Lægreid IK, Aasarød K, Bye A, Leivestad T, Jordhøy M. The impact of nutritional status, physical function, comorbidity and early versus late start in dialysis on quality of life in older dialysis patients. Ren Fail 2013; 36:9-16. [PMID: 24028283 DOI: 10.3109/0886022x.2013.830206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For the majority of the older patients in dialysis, the treatment will be lifelong. Thus, quality of life (QoL) is a crucial outcome. Our aim was to assess the QoL of older Norwegian dialysis patients and to investigate the impact of early (estimated glomerular filtration rate, eGFR ≥10 mL/min) versus late (eGFR <10 mL/min) start in dialysis, comorbidity, nutritional status and physical capacity. METHODS A self-report questionnaire including SF-36 (QoL) and the Subjective Global Assessment (SGA; nutritional status) was mailed to all patients (n = 320) ≥75 years registered in the Norwegian Renal Registry (NRR) as being in dialysis by September 2009. Reply was received from 233 patients (73%). Medical data including comorbidities and eGFR at dialysis start (obtained for 194 patients) were retrieved from the NRR. Functional capacity was determined from the SGA. RESULTS Compared to reports from younger dialysis patients, our patients scored poorer on all SF-36 subscales. Early start in dialysis was registered for 52 patients, 142 patients started late, 51.4% were well nourished (SGA A), 32.3% moderately malnourished (SGA B) and 16.4% were severely malnourished (SGA C). No significant association between any SF-36 scores and early versus late start, nutritional status or comorbidity was found. Better physical function was significantly associated with better scores on all SF-36 scales. CONCLUSIONS Our results indicate that physical function is important to all QoL aspects. Increased focus on physical rehabilitation seems pertinent. Early start of dialysis treatment was not associated with better long term QoL scores.
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Affiliation(s)
- Inger Karin Lægreid
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU , Trondheim , Norway
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Rostami Z, Einollahi B, Lessan-Pezeshki M, Soleimani Najaf Abadi A, Mohammadi Kebar S, Shahbazian H, Makhlough A, Makhdoomi K, Salesi M, Jalalzadeh M. Health-related quality of life in hemodialysis patients: an Iranian multi-center study. Nephrourol Mon 2013; 5:901-12. [PMID: 24350090 PMCID: PMC3842562 DOI: 10.5812/numonthly.12485] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/28/2013] [Indexed: 01/09/2023] Open
Abstract
Background The effectiveness of health care and health policy developments are often determined by health-related quality of life (HRQOL) assessment. Objectives The objective of this study was to explore the potential corresponding factors and traditional biomarkers of HRQOL in a large number of Iranian hemodialysis patients. Patients and Methods A total of 6,930 chronic hemodialysis (HD) patients enrolled. KDCS-SF version 1.3 questionnaire was used to assess the health related quality of life (HRQOL). We pooled PCS, MCS and KDCS scores with random effect model from 19 similar studies performed between 1996 and 2010 Results The mean age was 54.4 ± 17.1 years. Mean PCS, MCS and KDCS scores obtained for the study cohort were 40.79 ± 20.10, 47.79 ± 18.31 and 57.97 ± 11.70, respectively; the total score of SF-36 plus KDCS was 51.12 ± 13.41 as well. The most common primary known disease was hypertension (31.9%) and the second etiology was diabetes (25.5%). In multilevel logistic regression, Kt/V between 1 and 1.2 and PCS, KDCS more than 50 were considered as a significant reduction in the risk of hospitalization. Conclusions This study showed that PCS and MCS score were slightly more than overall results while KDCS was slightly less than overall results. In addition, dialysis adequacy with Kt/V between 1 and 1.2 is associated with lower rate of hospitalization.
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Affiliation(s)
- Zohreh Rostami
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Zohreh Rostami, Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-9121544897, Fax: +98-2188934125, E-mail:
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | | | | | | | | | - Atieh Makhlough
- Department of Nephrology, Sari University of Medical Sciences, Sari, IR Iran
| | - Khadijeh Makhdoomi
- Department of Nephrology, Urmia University of Medical Sciences, Urmia, IR Iran
| | - Mahmood Salesi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mojgan Jalalzadeh
- Department of Nephrology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Williams ME, Sandeep J, Catic A. Aging and ESRD demographics: consequences for the practice of dialysis. Semin Dial 2012; 25:617-22. [PMID: 23067122 DOI: 10.1111/sdi.12029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The disproportionate increase in the prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the elderly is now recognized as a national and global reality. Among the major contributing factors are the aging of the population, a growing prevalence of CKD, greater access to care, and increased comorbidities. The utilization of renal replacement therapy in the geriatric population has concomitantly increased. It is imposing enormous challenges to the practice of ESRD care, the largest of which may be to determine the best application of clinical performance targets to a population with limitations in life expectancy. Concurrently, increased focus on quality of life will be required. The effective dialysis practitioner will need to adapt to the aging ESRD demographics with an increased focus on physical and mental well-being of the geriatric patient.
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Affiliation(s)
- Mark E Williams
- Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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