Quality of life of end-stage renal disease patients and study on the implementation of nocturnal home hemodialysis in Greece

The Association between Psychosocial and Age-Related Factors with Adherence to Immunosuppressive Therapies after Renal Transplantation

Renal transplantation (RT) is the optimal renal replacement treatment approach in terms of patient survival and high quality of life. Proper adherence to medication is essential in order to prolong graft life and patient survival. This study aimed to investigate the effects of psychosocial factors and age-related declines on adherence in kidney transplant recipients. Methods: This was a cross-sectional study of kidney transplant recipients, based on regression analysis. Patient adherence was assessed with the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS). Psychosocial and age-related variables were measured with the World Health Organization’s quality of life questionnaire (WHOQoL-BREF), the Mini-Mental State Examination (MMSE), the Hospital Anxiety and Depression Scale (HADS), the Acceptance of Illness Scale (AIS), and the Tilburg Frailty Indicator (TFI). Results: A simple linear regression model indicated that the significant predictors of self-reported adherence (p < 0.05) were age, time since transplant, and anxiety and cognitive functions. For problems with implementing immunosuppressive medication, logistic regression models showed that gender, age, retirement status, hypercholesterolemia, and cognitive impairment were the most significant predictors (p < 0.05). However, after controlling for other predictors in the multiple regression models, anxiety and cognitive ability no longer predicted treatment adherence to immunosuppressive medication. Conclusions: Renal transplantation is the most effective therapy in chronic renal failure patients. Proper adherence to immunosuppressive therapy is critical to prolonging graft and person survival. Our study shows that occupational status more significantly influences adherence to the implementation of treatment in kidney transplant recipients.

Quality of life and duration of hemodialysis in patients with chronic kidney disease (CKD): a cross-sectional study

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.

Health-related quality of life after kidney transplantation: who benefits the most?

The influence of dialysis modalities on HRQoL before and after kidney transplantation (KT) and the role of adherence to medication on HRQoL have not been fully studied. Sixty four dialysis patients who answered the 15D HRQoL survey during dialysis were surveyed again after KT. Adherence and employment were also investigated. The mean 15D score was highest among home hemodialysis patients (HHD) and lowest among in-center hemodialysis patients (icHD). After KT, the mean 15D score improved significantly in 78.6% of peritoneal dialysis patients (PD), 47.6% of HHD, and 53.8% of icHD. Then, mean 15D score remained unchanged in 28.6% of HHD and in 23.1% of icHD patients. A deterioration in the 15D score occurred in 14.3% of PD, 23.1% of icHD, and 23.8% of HHD patients, and this was influenced by the number of pills (P = 0.04). Adherence to medication was the lowest in PD, timing being the most challenging task showing a connection to higher creatinine concentration (never forgot 1.41 mg/dl vs. forgot 2.08 mg/dl P = 0.05). Employed patients had a higher mean 15D score. The icHD and PD patients benefited the most from KT and HHD the least. Low pill burden and employment were linked to a better HRQoL.

Measuring health related quality of life (hrqol) in renal transplant patients: psychometric properties and cross-cultural adaptation of kidney transplant questionnaire (ktq-25) in persian

BACKGROUND

Different measuring tools have been used to understand the outcomes of renal replacement therapies. The goal of renal transplantation is both to ensure survival, and to promote quality of life in the patients. One of the widely used disease-specific instruments to measure the quality of life is the Kidney Transplant Questionnaire (KTQ-25).

OBJECTIVES

The current study aimed to perform a cross-cultural adaptation and assess the psychometric properties of the KTQ-25 to Persian.

MATERIALS AND METHODS

The KTQ-25 was trasnlated according to International Quality of Life Assessment (IQOLA) translation methodology. Cronbach's alpha coefficient, and test-re-test were used to determine internal consistency, and reliability respectively.

RESULTS

In the test-re-test reliability of all questionnaire items, Pearson correlation was r = 0.96 (P < 0.001). Cronbach's alpha coefficient estimated the internal consistency for each scale andalpha equal or more than 0.73 was considered satisfactory. Criterion-related validity, measured by the correlation coefficients between the KTQ-25 and the SF-36 Health Survey, was r = 0.63 (P < 0.001).

CONCLUSIONS

The psychometric properties of the Kidney Transplant Questionnaire (KTQ-25) in Persian have proven to be satisfactory, therefore the application of this questionnaire in clinical practice can be recommended.

Markov Chain Monte Carlo simulation for projection of end stage renal disease patients in Greece

End stage renal disease (ESRD) treatment methods are considered to be among the most expensive procedures for chronic conditions worldwide which also have severe impact on patients' quality of life. During the last decade, Greece has been among the countries with the highest incidence and prevalence, while at the same time with the lowest kidney transplantation rates. Predicting future patients' number on Renal Replacement Therapy (RRT) is essential for health care providers in order to achieve more effective resource management. In this study a Markov Chain Monte Carlo (MCMC) simulation is presented for predicting the future number of ESRD patients for the period 2009-2020 in Greece. The MCMC model comprises Monte Carlo sampling techniques applied on probability distributions of the constructed Markov Chain. The model predicts that there will be 15,147 prevalent patients on RRT in Greece by 2020. Additionally, a cost-effectiveness analysis was performed on a scenario of gradually reducing the hemodialysis patients in favor of increasing the transplantation number by 2020. The proposed scenario showed net savings of 86.54 million Euros for the period 2009-2020 compared to the base-case prediction.

Relationship of sleep quality and quality of life in children with monosymptomatic enuresis

BACKGROUND

Health-related quality of life (QoL) in children with monosymptomatic nocturnal enuresis might be influenced by impaired quality of sleep. The aim of this study was to evaluate possible deteriorations in QoL and sleep quality and the association between these parameters in children with monosymptomatic nocturnal enuresis.

METHODS

The study consisted of 44 children with monosymptomatic nocturnal enuresis and 27 healthy controls aged 6-15 years. KINDL QoL and Pittsburgh Sleep Quality Index (PSQI) were applied to all children.

RESULTS

Mean total KINDL scores in enuresis and control groups were 65.1 +/- 11.0 vs. 67.4 +/- 13.7, respectively (P = 0.44). PSQI scores were not significantly different between the groups (P > 0.05l). In the enuresis group, age showed significant negative correlation with self-esteem domain of KINDL (r = -0.39, P = 0.01) and positive correlation with sleep duration sub-score of the PSQI (r = 0.37, P = 0.03). Duration of enuresis showed significantly negative correlation with total KINDL score and self-esteem domain (r = -0.32 and r = -0.39, P = 0.04 and P = 0.01, respectively). There was significant correlation between physical well-being sub-score of KINDL with daytime dysfunction and total scores of PSQI (r = -0.53, P = 0.001 and r = -0.41, P = 0.02, respectively). Daytime dysfunction sub-score of PSQI was significantly correlated with friends sub-score of KINDL (r = -0.33, P = 0.04).

CONCLUSIONS

As age of the child and duration of enuresis increase, self-esteem domain of QoL worsens. Moreover, there is a significant correlation of physical well-being and friends domains of QoL score and total and daytime dysfunction scores of PSQI. These findings necessitate global evaluation of QoL and sleep quality in children with monosymptomatic nocturnal enuresis to increase efficacy of health care.