Quality of life assessment in patients on chronic dialysis: Comparison between haemodialysis and peritoneal dialysis at a national hospital in Vietnam

Correlation of ageing with Health related-quality of life of patients in 13 groups of disease in Poland

Background Age is a non-modifiable risk factor important in the etiology of many diseases. The ageing process of the body absolutely contributes to the degeneration of body tissues and the loss of function and the associated health-related quality of life (HR-QoL). Purpose Effect of age on HR-QoL among patients of 13 disease units. Matherial and methods The study was conducted among 7620 patients. The following age groups were included in the analysis: <30 years old, 30-39 years old, 40-49 years old, 50-59 years, 60-69 years, 70-79 years, and ≥ 80 years. The criterion for inclusion in the group was: age ≥ 18 years, written consent to participate in the study, treatment for chronic disease (at least 2 years), absence of other diseases and/or coexisting chronic symptoms. The SF-36 (Physical Component Summary (PCS); Mental Component Summary (MCS); Index of Life Quality (ILQ)) questionnaire was used to assess HR-QoL. Results The chance of having a better HR-QoL at 60-69 years of age decreases 3-fold (OR = 0.33) in MCS compared to the youngest group of patients. As far as PCS is concerned, there is a 5-fold lower chance of better HR-QoL (OR = 0.20). However, in the oldest group of patients, the chance of better HR-QoL in the MCS dimension is more than 12 times lower, and in PCS the chance of better HR-QoL is 33 times lower. A significant correlation between quality of life and age was confirmed. The level of PCS (R=-0.60), MCS (R=-0.50) and ILQ (R=-0.58) decreases with age. Cancer diseases (CD), regardless of the patient's age, showed the strongest association with HRQoL among the 13 analyzed disease entities. The average level of HRQoL was the lowest. A decreased level of HRQoL was noted in patients with cardiovascular disease (CVD) aged 30-39 years. The highest HR-QoL was noted in the group of patients aged 40-49 years for both CD and CVD, in later years HR-QoL decreased in patients with CD and CVD. The chance of better HR-QoL decreases with age. After the age of 60, the highest decrease in HR-QoL is observed in both MCS and PCS. In all age groups, there is more often a chance of better HR-QoL in the MCS dimension than in PCS.

The Burden of Cardiovascular Disease and Geriatric Syndromes in Older Patients Undergoing Chronic Hemodialysis

BACKGROUND

There is limited evidence on the complexity of cardiovascular disease (CVD) and geriatric syndromes in older patients with end-stage renal disease. Our aims were to (1) examine the prevalence of CVD in older patients on chronic hemodialysis, (2) compare the burden of geriatric syndromes in patients with and without CVD, and (3) examine the impact of CVD on hospitalization.

METHODS

This prospective, observational, multi-center study was conducted at two dialysis units of two major hospitals in Vietnam. Consecutive older adults receiving chronic hemodialysis were recruited from November 2020 to June 2021. CVD was defined as having one of these conditions: heart failure, ischemic heart disease, or stroke. Participants were assessed for geriatric conditions including frailty, malnutrition, impairment in instrumental activities/activities of daily living, depression, falls, and polypharmacy. Multivariable logistic regression analysis was applied to examine the impact of CVD on 6-month hospitalization, adjusting for age, sex, duration of dialysis, Charlson Comorbidity Index, and geriatric conditions. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

There were 175 participants (mean age 72.4 ± 8.5 and 58.9% female). CVD was present in 80% of the participants (ischemic heart disease: 49.7%, heart failure: 60.0%, and stroke: 25.7%). Participants with CVD had a higher burden of geriatric syndromes compared to those without CVD. During the 6-month follow-up, 48.6% of the participants were hospitalized (56.4% of those with CVD vs. 17.1% of those without CVD), p < 0.001). CVD independently increased the risk of hospitalization (adjusted OR 3.32, 95% CI 1.12-9.80).

CONCLUSIONS

In this study, there was a very high prevalence of CVD in older patients undergoing chronic dialysis. Participants with CVD had a higher burden of geriatric syndromes and their risk of 6-month hospitalization increased by three times. There is a need for a multidisciplinary and patient-centered approach to treatment planning for these patients.

The effect of renal replacement therapy on health-related quality of life in end-stage renal disease: a meta-analysis

BACKGROUND

End-stage renal disease (ESRD) patients judge health-related quality of life (HRQoL) as an essential outcome. In meta-analysis studies, there is ongoing debate regarding the impact of renal replacement therapy (RRT) methods on HRQoL in ESRD patients. Hence, the main objective of this study was to examine the influence of RRT method utilization on HRQoL in individuals with ESRD. Additionally, the secondary objective was to explore the impact of RRT method use on HRQoL, considering various moderator variables.

METHODS

RRT methods called hemodialysis (HD), peritoneal dialysis (PD), home dialysis (HoD), and kidney transplantation (KT) are used to treat ESRD. HD was defined as in-center HD (ICHD) and home HD (HHD). HoD was defined as HHD and PD. The estimated Hedges' g were conducted by random effect meta-analysis.

RESULTS

A total of 111 publications, including 50.151 patients, were included. KT was better at improving patients' HRQoL than other methods. PD was better at improving patients' HRQoL than HD. HoD was better at improving patients' HRQoL than ICHD. Sensitivity analyses yielded similar results. Publication bias was not tested. The subgroup and meta-regression analyses showed that the moderating variables had a statistically significant effect on the HRQoL of patients with ESRD.

CONCLUSION

For the treatment of ESRD, either KT, PD, or HoD can be used in terms of HRQoL. We need to improve the factors affecting the HRQoL of ESRD patients undergoing HD and ICHD. Healthcare professionals should consider the factors that influence HRQoL and choose an RTT method for each ESRD patient.

Survival Rates in Elderly Patients on Continuous Ambulatory Peritoneal Dialysis

Purpose

The present study aimed at evaluating the survival rate, its associated factors, and the causes of death in elderly patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in Vietnam.

Patients and Methods

This is a retrospective, observational study conducted among patients aged ≥65 years who underwent CAPD at Thong Nhat Hospital, Ho Chi Minh City, Vietnam, from April 2012 to December 2020. The Kaplan-Meier method was used to calculate the cumulative survival rate, and the Log rank test was used to analyze the factors associated with the survival rate of patients.

Results

This study enrolled a total of 68 patients with a mean age of 71.93 ± 7.44 years at the initiation of CAPD. The most common complication among kidney failure patients was diabetic nephropathy (39.71%). The rate of concomitant cardiovascular diseases was 58.82%. The average survival rate was 45.59 ± 4.01 months. Peritonitis was the most common factor causing death (31.25%), followed by cardiovascular diseases (28.12%) and malnutrition (25%). The factors that impacted the survival rate included concomitant cardiovascular diseases, low serum albumin (<35 g/dL), and an indication of CAPD due to exhausted vascular access for hemodialysis at baseline. The main factor associated with a shorter survival time was concomitant cardiovascular diseases.

Conclusion

It is necessary to improve the survival time beyond 5 years for elderly patients undergoing CAPD, especially for those with concomitant cardiovascular diseases. Besides the prevention of peritonitis, adequate measures to protect from cardiovascular diseases and malnutrition will reduce the mortality rate in patients on CAPD.