Quality of Life in Dialysis Patients: A Retrospective Cohort Study

The association between plant and animal protein intake and quality of life in patients undergoing hemodialysis

Background

Hemodialysis (HD) patients often experience a significant reduction in quality of life (QOL). The source of dietary protein intake may influence the renal function and complications of HD patients. The present study assessed the relationship between plant and animal protein intake and QOL in HD patients.

Methods

264 adult patients under dialysis for at least three months were included in this cross-sectional study. Dietary intakes were collected using a valid and reliable 168-item semi-quantitative food frequency questionnaire (FFQ) over the past year. Total, animal, and plant proteins were calculated for each patient. To evaluate QOL, Kidney Disease Quality of Life Short Form (KDQOL-SF 1/3) was used. Anthropometric measures were assessed according to standard protocols.

Results

In this study, the average age of participants was 58.62 ± 15.26 years old; most (73.5%) were men. The mean of total, plant, and animal proteins intake were 66.40 ± 34.29 g/d, 34.60 ± 18.24 g/d, and 31.80 ± 22.21 g/d. Furthermore, the mean score of QOL was 59.29 ± 18.68. After adjustment for potential confounders, a significant positive association was found between total dietary protein intake and QOL (β = 0.12; p = 0.03). Moreover, there was a significant association between plant-based protein intake and QOL (β = 0.26; p < 0.001). However, the association between animal protein intake and QOL was insignificant (β = 0.03; p = 0.60).

Conclusion

Higher total and plant proteins intake were associated with better QOL in HD patients. Further studies, particularly prospective ones, are needed to corroborate these associations.

Intradialytic Protein Ingestion and Exercise do Not Compromise Uremic Toxin Removal Throughout Hemodialysis

OBJECTIVE

Dietary protein and physical activity interventions are increasingly implemented during hemodialysis to support muscle maintenance in patients with end-stage renal disease (ESRD). Although muscle maintenance is important, adequate removal of uremic toxins throughout hemodialysis is the primary concern for patients. It remains to be established whether intradialytic protein ingestion and/or exercise modulate uremic toxin removal during hemodialysis.

METHODS

We recruited 10 patients with ESRD (age: 65 ± 16 y, BMI: 24.2 ± 4.8 kg/m²) on chronic hemodialysis treatment to participate in this randomized cross-over trial. During hemodialysis, patients were assigned to ingest 40 g protein or a nonprotein placebo both at rest (protein [PRO] and placebo [PLA], respectively) and following 30 min of exercise (PRO + exercise [EX] and PLA + EX, respectively). Blood and spent dialysate samples were collected throughout hemodialysis to assess reduction ratios and removal of urea, creatinine, phosphate, cystatin C, and indoxyl sulfate.

RESULTS

The reduction ratios of urea and indoxyl sulfate were higher during PLA (76 ± 6% and 46 ± 9%, respectively) and PLA + EX interventions (77 ± 5% and 45 ± 10%, respectively) when compared to PRO (72 ± 4% and 40 ± 8%, respectively) and PRO + EX interventions (73 ± 4% and 43 ± 7%, respectively; protein effect: P = .001 and P = .023, respectively; exercise effect: P = .25 and P = .52, respectively). Nonetheless, protein ingestion resulted in greater urea removal (P = .046) during hemodialysis. Reduction ratios and removal of creatinine, phosphate, and cystatin C during hemodialysis did not differ following intradialytic protein ingestion or exercise (protein effect: P > .05; exercise effect: P>.05). Urea, creatinine, and phosphate removal were greater throughout the period with intradialytic exercise during PLA + EX and PRO + EX interventions when compared to the same period during PLA and PRO interventions (exercise effect: P = .034, P = .039, and P = .022, respectively).

CONCLUSION

The removal of uremic toxins is not compromised by protein feeding and/or exercise implementation during hemodialysis in patients with ESRD.

Associations among body composition parameters and quality of life in peritoneal dialysis patients

Health-related quality of life (HRQOL) is an important issue among patients undergoing dialysis treatment. Peritoneal dialysis (PD) is associated with a number of adverse body composition changes. However, whether body composition is associated with HRQOL is uncertain. The purpose of this study was to analyze the effects of body composition on HRQOL in PD patients. We performed a cross-sectional observational study on the association between body composition and HRQOL in PD patients at a single center. Body composition was determined by multifrequency bioimpedance spectroscopy. HRQOL is summarized to three composite scores: kidney disease component summary (KDCS), physical component summary (PCS), and mental component summary (MCS). The relationships between HRQOL and the hydration index, lean tissue index (LTI), and fat tissue index (FTI) were analyzed by regression analysis. One hundred and ninety-seven PD patients were included in the present study. Patients with severe fluid overload showed a lower PCS. The hydration index and FTI showed statistically significant negative associations with PCS. In subgroup analysis, the associations between the hydration index and PCS remained robust after stratifying according to sex, age, and residual urine. Our results indicated that both the hydration index and FTI were negatively associated with HRQOL, especially PCS.

Is malnutrition a determining factor of health-related quality of life in hemodialysis patients? A cross-sectional design examining relationships with a comprehensive assessment of nutritional status

PURPOSE

To identify relationships between health-related quality of life (HRQOL) and nutritional status in hemodialysis (HD) patients.

METHOD

Secondary data from a cross-sectional survey was utilized. HRQOL was assessed for 379 HD patients using the generic Short Form 36 (SF-36) and disease-specific Kidney-Disease Quality of Life-36 (KDQOL-36). Malnutrition was indicated by malnutrition inflammation score (MIS) ≥ 5, and presence of protein-energy wasting (PEW). The individual nutritional parameters included the domains of physical status, serum biomarkers, and dietary intake. Multivariate associations were assessed using the general linear model.

RESULTS

MIS ≥ 5 was negatively associated with SF-36 scores of physical functioning (MIS < 5 = 73.4 ± 8.0 SE vs MIS ≥ 5 = 64.6 ± 7.7 SE, P < 0.001), role-limitation-physical (MIS < 5 = 65.3 ± 14.3 SE vs MIS ≥ 5 = 52.9 ± 14.0 SE, P = 0.006), general health (MIS < 5 = 53.7 ± 7.5 SE vs MIS ≥ 5 = 47.0 ± 7.1 SE, P = 0.003), and PCS-36 (MIS < 5 = 40.5 ± 3.3 SE vs MIS ≥ 5 = 35.9 ± 3.1 SE, P < 0.001); and KDQOL-36 score of symptoms/problems (MIS < 5 = 78.9 ± 5.6 SE vs MIS ≥ 5 = 74.8 ± 5.4 SE, P = 0.022), but not with PEW by any tool. Of individual nutritional parameters, underweight (68.1 ± 5.4 SE, P = 0.031), normal weight (63.8 ± 2.8 SE, P = 0.023), and overweight (64.3 ± 2.9 SE, P = 0.003) patients had significantly higher physical functioning scores compared to obese patients (44.8 ± 5.5 SE). Serum albumin levels were positively associated with physical functioning (P = 0.041) score. HGS was also positively associated with physical functioning (P = 0.036), and vitality (P = 0.041) scores. Greater dietary phosphorus intakes were significantly associated with lower scores for role limitation-physical (P = 0.008), bodily pain (P = 0.043), and PCS-36 (P = 0.024).

CONCLUSION

Malnutrition diagnosis by MIS, but not PEW, indicated associations with HRQOL in HD patients. Individual nutritional parameters that related to higher HRQOL were BMI < 30 kg/m², better dietary phosphorus control, greater muscle strength and higher visceral protein pool.

Amino acid removal during hemodialysis can be compensated for by protein ingestion and is not compromised by intradialytic exercise: a randomized controlled crossover trial

BACKGROUND

Patients with end-stage renal disease (ESRD) undergoing hemodialysis experience a rapid decline in skeletal muscle mass and strength. Hemodialysis removes amino acids (AAs) from the circulation, thereby lowering plasma AA concentrations and stimulating proteolysis.

OBJECTIVES

In the present study, we evaluate the impact of intradialytic protein ingestion at rest and following exercise on AA removal and plasma AA availability in patients with ESRD.

METHODS

Ten patients (age: 65 ± 16 y, male/female: 8/2, BMI: 24.2 ± 4.8 kg/m2, serum albumin: 3.4 ± 0.3 g/dL) with ESRD undergoing hemodialysis participated in this randomized controlled crossover trial. During 4 hemodialysis sessions, patients were assigned to ingest 40 g protein or a placebo 60 min after initiation, both at rest (PRO and PLA, respectively) and following exercise (PRO + EX and PLA + EX, respectively). Spent dialysate and blood samples were collected every 30 min throughout hemodialysis to assess AA removal and plasma AA availability.

RESULTS

Plasma AA concentrations declined by 26.1 ± 4.5% within 30 min after hemodialysis initiation during all interventions (P < 0.001, η2p > 0.79). Protein ingestion, but not intradialytic exercise, increased AA removal throughout hemodialysis (9.8 ± 2.0, 10.2 ± 1.6, 16.7 ± 2.2, and 17.3 ± 2.3 g during PLA, PLA + EX, PRO, and PRO + EX interventions, respectively; protein effect P < 0.001, η2p = 0.97; exercise effect P = 0.32, η2p = 0.11). Protein ingestion increased plasma AA concentrations until the end of hemodialysis, whereas placebo ingestion resulted in decreased plasma AA concentrations (time effect P < 0.001, η2p > 0.84). Plasma AA availability (incremental AUC) was greater during PRO and PRO + EX interventions (49 ± 87 and 70 ± 34 mmol/L/240 min, respectively) compared with PLA and PLA + EX interventions (-227 ± 54 and -208 ± 68 mmol/L/240 min, respectively; protein effect P < 0.001, η2p = 0.98; exercise effect P = 0.21, η2p = 0.16).

CONCLUSIONS

Protein ingestion during hemodialysis compensates for AA removal and increases plasma AA availability both at rest and during recovery from intradialytic exercise. Intradialytic exercise does not compromise AA removal or reduce plasma AA availability during hemodialysis in a postabsorptive or postprandial state.

Estimation of Muscle Mass in the Integrated Assessment of Patients on Hemodialysis

Assessment of muscle mass (MM) or its proxies, lean tissue mass (LTM) or fat-free mass (FFM), is an integral part of the diagnosis of protein-energy wasting (PEW) and sarcopenia in patients on hemodialysis (HD). Both sarcopenia and PEW are related to a loss of functionality and also increased morbidity and mortality in this patient population. However, loss of MM is a part of a wider spectrum, including inflammation and fluid overload. As both sarcopenia and PEW are amendable to treatment, estimation of MM regularly is therefore of major clinical relevance. Whereas, computer-assisted tomography (CT) or dual-energy X-ray absorptiometry (DXA) is considered a reference method, it is unsuitable as a method for routine clinical monitoring. In this review, different bedside methods to estimate MM or its proxies in patients on HD will be discussed, with emphasis on biochemical methods, simplified creatinine index (SCI), bioimpedance spectroscopy (BIS), and muscle ultrasound (US). Body composition parameters of all methods are related to the outcome and appear relevant in clinical practice. The US is the only parameter by which muscle dimensions are measured. BIS and SCI are also dependent on either theoretical assumptions or the use of population-specific regression equations. Potential caveats of the methods are that SCI can be influenced by residual renal function, BIS can be influenced by fluid overload, although the latter may be circumvented by the use of a three-compartment model, and that muscle US reflects regional and not whole body MM. In conclusion, both SCI and BIS as well as muscle US are all valuable methods that can be applied for bedside nutritional assessment in patients on HD and appear suitable for routine follow-up. The choice for either method depends on local preferences. However, estimation of MM or its proxies should always be part of a multidimensional assessment of the patient followed by a personalized treatment strategy.

The relationship between serum vitamin D levels and health-related quality of life in peritoneal dialysis patients

INTRODUCTION

We aimed to investigate the relationship between Vitamin D level and quality of life in patients undergoing peritoneal dialysis as renal replacement therapy.

METHODS

50 peritoneal dialysis patients aged between 18 and 73 years were included in this study. KDQOL-36 questionnaire was applied to rate the quality of life of the patients. This questionnaire consisted of 36 questions divided into five subscales. The patients were divided into two groups according to serum vitamin D levels. Patients with a serum 25(OH) D level < 20 ng/mL were identified as vitamin D deficiency group and those with a serum 25(OH)D level ≥ 20 ng/mL were identified as normal vitamin D group.

RESULTS

The patients had a mean age of 41.16 ± 16.05 years, 56% of them were females. The mean 25(OH) D levels of patients with 25 (OH) D levels < 20 ng/mL and those with ≥ 20 ng/mL were 10.50 ± 4.62 ng/mL and 25.55 ± 4.11 ng/mL, respectively. We found that all subscales of KDQOL-36 were lower with statistically significance in the group with Vitamin D (Vit-D) deficiency. Hemoglobin level was detected as independent risk factor for Symptom and problem list subscales and SF-12 physical component summary subscale (PCS) (P = 0.029, P = 0.047). Vit-D deficiency was detected as independent risk factors for kidney disease burden subscale and PCS (P = 0.035, P = 0.019). Hypertension was detected as independent risk factor for kidney disease burden subscale (P = 0.015).

CONCLUSION

Our study is the first to investigate the relationship between serum Vit-D level and quality of life by KDQOL-36 scale in peritoneal dialysis patients. We revealed that patients with low Vit-D levels had worse quality of life in all subscales.

Health-related quality of life and long-term mortality in young and middle-aged hemodialysis patients

PURPOSE

The relationship of health-related quality of life (HRQoL) with mortality in young and middle-aged hemodialysis (HD) patients has scarcely been studied and remains unclear. The aim of the study was to examine whether physical and mental components of HRQoL are related to long-term risks of all-cause and cardiovascular (CV) death in this particular HD population.

METHODS

A long-term observational prospective study included 238 prevalent HD patients aged 18-64 years. The median follow-up was 50 (22, 96) months (maximum 13.9 years). HRQoL variables of the Short Form 36 Health Survey (SF-36), clinical, and demographic data were assessed at the time of inclusion. Associations of baseline HRQoL scores with all-cause and CV mortality were assessed using Kaplan-Meier survival plots and Cox regression analysis adjusted for clinical and demographic confounders.

RESULTS

The majority of HRQoL parameters were associated with outcomes in univariable analyses. In multivariable regression models adjusted for clinical and demographic confounders, Physical Functioning (PF) and Physical Component Summary Score (PCS) remained independently related to all-cause mortality [hazard ratio (HR) for a 1-point increase in PF and PCS were 0.981, 95% confidence interval (CI) 0.972-0.989 and 0.954, CI 0.929-0.980, respectively] and CV death (HR for a 1-point increase in PF and PCS were 0.975, CI 0.962-0.988 and 0.950, CI 0.915-0.985, respectively).

CONCLUSION

PF and PCS assessment seems to be relevant for refining the prognosis and clinical decision-making in young and middle-aged HD patients.

Health-related quality of life associated with risk of death in Brazilian dialysis patients: an eight-year cohort

PURPOSE

Despite the advancements in renal replacement therapy, patients with end-stage renal disease face several limitations, with significant impacts on health-related quality of life (HRQoL) and mortality. This study aims to examine associations between quality of life and risk of death in Brazilian patients who underwent dialysis therapy between 2007 and 2015.

METHODS

Observational, prospective, non-concurrent cohort study of patients who underwent dialysis therapy at the Brazilian Public Health System (SUS) and were followed up for 8 years. Semi-structured questionnaires interrogating socioeconomic and demographic characteristics, as well as HRQoL measures (36 Item Short-Form Health Survey, SF-36), were employed. The Cox proportional risk model was used to investigate associations between HRQoL and risk of death.

RESULTS

Our sample comprised 1162 patients; of these, 884 were on hemodialysis (HD) and 278 on peritoneal dialysis (PD). Among the HD patients, death was associated with the physical (HR: 0.993; 95% CI: 0.989-0.997) and physical summary component (HR: 0.994; 95% CI: 0.989-0.999) domains of HRQoL. Regarding the PD patients, death was associated with the bodily pain (HR: 0.994; 95% CI: 0.990-0.998), mental health (HR: 0.094; 95% CI: 0.990-0.998), emotional problems (HR: 0.993; 95% CI: 0.987-0.998), social functioning (HR: 1.012; 95% CI: 1.002-1.023), physical problems (HR: 0.992; 95% CI: 0.986-0.998) and mental summary component (HR: 0.989; 95% CI: 0.981-0.997) domains of HRQoL.

CONCLUSIONS

Our data suggest that early and timely intervention measures aiming to enhance the HRQoL of dialysis patients are an essential component of professional practice and may contribute to improving the management of factors associated with dialysis patients' mortality.

Impact of clinical, sociodemographic and quality of life factors on dialysis patient survival: a nine-year follow-up cohort study

Although renal replacement therapy has contributed to the survival of chronic kidney failure (CKF) patients, mortality remains a major concern. This study aimed to identify the factors associated with mortality in a prospective cohort of CKF patients. Sociodemographic, clinical, nutritional, lifestyle and quality of life data were collected from 712 patients. The instruments used were the Short-Form Health Survey (SF-36), Global Subjective Assessment (GSA) and Charlson Comorbidity Index (CCI) questionnaires. A total of 444 patients died during the study. After five years of follow-up, factors such as not being married (hazard ratio - HR = 1.289, 95%CI: 1.001; 1.660), a low frequency of leisure activities (HR = 1.321; 95%CI: 1.010; 1.727) and not being transplanted (HR = 7.246; 95%CI: 3.359; 15.630) remained independently associated with the risk of mortality. At the end of the follow-up period, factors such as not being married (HR = 1.337, 95%CI: 1.019; 1.756), not being transplanted (HR = 7.341, 95%CI: 3.829; 14.075) and having a worse nutritional status (HR = 1.363, 95%CI: 1.002; 1.853) remained independently associated with an increased risk of mortality, whereas a high schooling level (10 to 12 years, HR = 0.578, 95%CI: 0.344; 0.972; and over 12 years, HR = 0.561, 95%CI: 0.329; 0.956) and a better SF-36 physical functioning score (HR = 0.992, 95%CI: 0.987; 0.998) were protective factors associated with survival. The survival of patients with CKF is associated with factors not restricted to the clinical spectrum. The following factors were associated with high mortality: not being married, low schooling level, a limited social routine, a longer time on dialysis, worse nutritional status, and worse physical functioning.

The Effects of Chronic Dialysis on Physical Status, Quality of Life, and Arterial Stiffness: A Longitudinal Study in Prevalent Dialysis Patients

INTRODUCTION

It is widely known that dialysis patients have significantly impaired functional outcomes and arterial stiffness, but still few studies have investigated the effects of dialysis longitudinally by a multidimensional approach. We aimed to assess longitudinal patterns of physical activity (PA), physical functioning (PF), health-related quality of life (HrQoL), body composition (BC), and arterial stiffness in prevalent dialysis patients.

MATERIALS AND METHODS

Thirty-nine prevalent dialysis patients (23 conventional hemodialysis [CHD] and 16 peritoneal dialysis) with a mean vintage of 25.7 (±22.1) months were included in this observational prospective study with a 2-year follow-up, and at baseline 20 healthy controls were included. Measurements were performed every 6 months. HrQoL was assessed using the Short Form-36 (SF-36) questionnaire. PA was assessed using the SenseWear™ Pro3 accelerometer. PF was assessed by walking speed, the PF subscale of the SF-36, and handgrip strength (HGS). BC was assessed using the Body Composition Monitor® and arterial stiffness by measuring carotid-femoral pulse wave velocity (PWV). The longitudinal trend was assessed using linear mixed models, correcting for sex, age, and dialysis vintage. For PWV, the trend was additionally corrected for diabetes and systolic blood pressure.

RESULTS

After correction, no statistically significant changes over time were observed for the parameters of PA, PF, HrQoL, and BC. In the combined group and in the group of CHD patients only, a significant change was observed for PWV (overall trend: p = 0.007 and p = 0.008, respectively). A statistically significant difference at baseline was observed between dialysis patients and healthy controls in all parameters, except for HGS and PWV.

DISCUSSION/CONCLUSION

We observed no statistically significant changes in functional outcomes during a 2-year follow-up period, but a significant increase was observed for arterial stiffness. These results might suggest that after a certain period in time, a relatively stable course is present in functional outcomes, but an ongoing deterioration in arterial stiffness occurs, which might increase the risk of cardiovascular disease and all-cause mortality in these patients.

Factors affecting supportive needs in hemodialysis patients: A literature review

Background

Explaining the factors affecting supportive needs of patients under hemodialysis seems to be essential to supply their needs. Also, it can help healthcare providers to make favorite decisions about care planning to improve the patients' quality of life.

Objective

This study was conducted to determine the factors affecting supportive needs in hemodialysis patients using a literature review.

Methods

This literature review was carried out in PubMed, MEDLINE, SCOPUS, SID, Magiran, and Iranmedex. Data based were searched from 2000 to 2018 using the keywords of "Need", "Supportive Need", and "Hemodialysis". In a total of 239 full texts of published articles, 12 such relevant articles were selected.

Results

The finding showed that the factors affecting the supportive need of patients can be categorised into two: internal and external factors. Internal factors consist of patient-related factors, disease-related factors, and treatment-related factors. External factors consist of personal living circumstances, health system-related factors and socioeconomic factors.

Conclusion

By explaining the factors affecting supportive need in hemodialysis patients, it may help clinicians and researchers to identify the patients' need, developing an appropriate questionnaire, and implementing suitable intervention. As a result, it can improve their quality of life.

End-Stage Renal Disease Patients Lose a Substantial Amount of Amino Acids during Hemodialysis

BACKGROUND

Poor nutritional status is frequently observed in end-stage renal disease patients and associated with adverse clinical outcomes and increased mortality. Loss of amino acids (AAs) during hemodialysis (HD) may contribute to protein malnutrition in these patients.

OBJECTIVE

We aimed to assess the extent of AA loss during HD in end-stage renal disease patients consuming their habitual diet.

METHODS

Ten anuric chronic HD patients (mean ± SD age: 67.9 ± 19.3 y, BMI: 23.2 ± 3.5 kg/m2), undergoing HD 3 times per week, were selected to participate in this study. Spent dialysate was collected continuously and plasma samples were obtained directly before and after a single HD session in each participant. AA profiles in spent dialysate and in pre-HD and post-HD plasma were measured through ultra-performance liquid chromatography to determine AA concentrations and, as such, net loss of AAs. In addition, dietary intake before and throughout HD was assessed using a 24-h food recall questionnaire during HD. Paired-sample t tests were conducted to compare pre-HD and post-HD plasma AA concentrations.

RESULTS

During an HD session, 11.95 ± 0.69 g AAs were lost via the dialysate, of which 8.26 ± 0.46 g were nonessential AAs, 3.69 ± 0.31 g were essential AAs, and 1.64 ± 0.17 g were branched-chain AAs. As a consequence, plasma total and essential AA concentrations declined significantly from 2.88 ± 0.15 and 0.80 ± 0.05 mmol/L to 2.27 ± 0.11 and 0.66 ± 0.05 mmol/L, respectively (P < 0.05). AA profiles of pre-HD plasma and spent dialysate were similar. Moreover, AA concentrations in pre-HD plasma and spent dialysate were strongly correlated (Spearman's ρ = 0.92, P < 0.001).

CONCLUSIONS

During a single HD session, ∼12 g AAs are lost into the dialysate, causing a significant decline in plasma AA concentrations. AA loss during HD can contribute substantially to protein malnutrition in end-stage renal disease patients. This study was registered at the Netherlands Trial Registry (NTR7101).

Dietary Protein and Physical Activity Interventions to Support Muscle Maintenance in End-Stage Renal Disease Patients on Hemodialysis

End-stage renal disease patients have insufficient renal clearance capacity left to adequately excrete metabolic waste products. Hemodialysis (HD) is often employed to partially replace renal clearance in these patients. However, skeletal muscle mass and strength start to decline at an accelerated rate after initiation of chronic HD therapy. An essential anabolic stimulus to allow muscle maintenance is dietary protein ingestion. Chronic HD patients generally fail to achieve recommended protein intake levels, in particular on dialysis days. Besides a low protein intake on dialysis days, the protein equivalent of a meal is extracted from the circulation during HD. Apart from protein ingestion, physical activity is essential to allow muscle maintenance. Unfortunately, most chronic HD patients have a sedentary lifestyle. Yet, physical activity and nutritional interventions to support muscle maintenance are generally not implemented in routine patient care. To support muscle maintenance in chronic HD patients, quantity and timing of protein intake should be optimized, in particular throughout dialysis days. Furthermore, implementing physical activity either during or between HD sessions may improve the muscle protein synthetic response to protein ingestion. A well-orchestrated combination of physical activity and nutritional interventions will be instrumental to preserve muscle mass in chronic HD patients.

The effect of transportation modality to dialysis facilities on health-related quality of life among hemodialysis patients: results from the Japanese Dialysis Outcomes and Practice Pattern Study

Background

For hemodialysis (HD) patients, travel to the dialysis facility is an issue that can affect their quality of life (QOL), both physically and mentally. However, evidence on this association of transportation modality with health-related QOL (HRQOL) is scarce.

Methods

We conducted a cohort study among maintenance HD patients participating in the Japanese Dialysis Outcomes and Practice Pattern Study Phase 5. The study included patients who were functionally independent and able to walk. The primary exposure was the means of transportation to the dialysis facility, categorized into three groups, namely transportation by other drivers (Group 1), transportation via self-driving (Group 2) and transportation by bicycle or walking with or without public transportation (Group 3). The primary outcomes were physical and mental health composite scores (PCS and MCS) in the 12-item Short Form at 1 year after study initiation.

Results

Among 1225 eligible patients (Group 1, 34.4%; Group 2, 45.0%; Group 3, 20.7%), 835 were analyzed for the primary outcomes. Linear regression analyses revealed that patients in Groups 2 and 3 had significantly higher PCS and MCS at 1 year than those in Group 1 {adjusted mean differences of PCS 1.42 [95% confidence interval (CI) 0.17–2.68] and 1.94 [95% CI 0.65–3.23], respectively, and adjusted mean differences of MCS 2.53 [95% CI 0.92–4.14] and 2.20 [95% CI 0.45–3.95], respectively}.

Conclusions

Transportation modality was a significant prognostic factor for both PCS and MCS after 1 year in maintenance HD patients.

Treating symptoms to improve the quality of life in patients on chronic hemodialysis

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.

Modality transition on renal replacement therapy and quality of life of patients: a 10-year follow-up cohort study

PURPOSE

Despite advance in renal replacement therapy (RRT), patients with chronic end-stage renal disease (ESRD) face various limitations, and renal transplantation (Tx) is the treatment that impacts most on quality of life (QoL). This study aimed to assess changes in QoL in a cohort of ESRD dialysis patients.

METHODS

Sociodemographic, clinical, nutritional, lifestyle, and QoL data were collected from 712 patients at baseline (time 1) and after 10 years of follow-up (time 2) for patients surviving. The QoL was assessed through the 36-Item Short Form Health Survey (SF-36) and the multiple linear regression model was used to analyze the factors associated with change in QoL.

RESULTS

A total of 205 survivors were assessed and distributed into three groups according to current RRT (Dialysis-Dialysis, Dialysis-Tx, and Dialysis-Tx-Dialysis). At time 1, only age was significantly different among groups; at time 2, transplant patients sustained greater social participation, job retention, and improvement in SF-36 scores. The factors associated with change in QoL were more time on dialysis interfering negatively on physical functioning (p = 0.002), role-physical limitations (p  = 0.002), general health (p  = 0.007), social functioning (p = 0.02), role-emotional (p = 0.003), and physical components ( p = 0.002); non-participation in social groups at times 1 and 2 reducing vitality (p = 0.02) scores; and having work at time 2, increasing vitality (p = 0.02) and mental health (p  = 0.02) scores.

CONCLUSIONS

QoL was shown to be dynamic throughout the years of RRT, transplantation being the treatment with more benefits to the ESRD. More time on dialysis and limited social and occupational routine were associated with a reduction in QoL.

Health-related quality of life in peritoneal dialysis patients: A narrative review

Health-related quality of life (HRQOL) is an important aspect of patients´ health that should be an integral part of the evaluation of patient-centered outcomes, not least because HRQOL associates with patients´ morbidity and mortality. This applies also to chronic kidney disease patients, including those dependent on renal replacement therapies, the type of which may influence patients´ perception of HRQOL. Several studies have addressed HRQOL in chronic kidney disease patients undergoing renal replacement therapies, especially transplanted patients and hemodialysis patients, while publications concerning peritoneal dialysis (PD) patients are scarcer. This review describes some of the methods used to assess HRQOL, factors influencing HRQOL in PD patients, HRQOL in PD vs hemodialysis, and the relation between HRQOL and patient outcomes. We conclude that assessment of HRQOL-often neglected at present-should be included as a standard measure of patient-centered outcomes and when monitoring the quality and effectiveness of renal care including PD treatment.

Health-related quality of life in end-stage renal disease patients: the effects of starting dialysis in the first year after the transition period

BACKGROUND/AIMS

Prevalent dialysis patients have low scores of health-related quality of life (HRQOL) which are associated with increased risk of hospitalization and mortality. Also in CKD-5 non-dialysis patients, HRQOL scores seem to be lower as compared with the general population. This study firstly aimed to compare HRQOL between CKD-5 non-dialysis and prevalent dialysis patients in a cross-sectional analysis and to assess longitudinal changes over 1 year after the dialysis initiation. Secondly, the correlation between HRQOL and physical activity (PA) was explored.

METHODS

Cross-sectional 44 CKD-5 non-dialysis, 29 prevalent dialysis, and 20 healthy controls were included. HRQOL was measured by Short Form-36 questionnaires to measure physical and mental domains of health expressed by the physical component summary (PCS) and mental component summary (MCS) scores. PA was measured by a SenseWear™ pro3. Longitudinally, HRQOL was assessed in 38 CKD-5 non-dialysis patients (who were also part of the cross-sectional analysis), before dialysis initiation until 1 year after dialysis initiation.

RESULTS

PCS scores were significantly lower both in CKD-5 non-dialysis patients and in prevalent dialysis patients as compared with healthy controls (p < 0.001). MCS scores were significantly lower in both CKD-5 non-dialysis patients (p = 0.003), and in dialysis patients (p = 0.022), as compared with healthy controls. HRQOL scores did not change significantly from the CKD-5 non-dialysis phase into the first year after dialysis initiation. PA was significantly related to PCS in both CKD-5 non-dialysis patients (r = 0.580; p < 0.001), and dialysis patients (r = 0.476; p = 0.009).

CONCLUSIONS

HRQOL is already low in the CKD-5 non-dialysis phase. In the first year after dialysis initiation, HRQOL did not change significantly. Given the correlation between PCS score and PA, physical activity programs may be potential tools to improve HRQOL in both CKD-5 non-dialysis as well as in prevalent dialysis patients.

Differences in quality of life between Jewish and Arab patients on hemodialysis

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.

Depression, anxiety and health-related quality of life amongst patients who are starting dialysis treatment

BACKGROUND

Chronic kidney disease (CKD) has a severe impact on patients' health-related quality of life (HRQL). The start of renal replacement therapy (RRT) significantly influences psychological, physical and social aspects of life.

OBJECTIVES

To analyse the HRQL and psychological status (anxiety and depression) at the start of RRT.

METHODS

We undertook an observational descriptive cross-sectional study. A total of 152 patients starting RRT were recruited for the study. HRQL was measured by the Kidney Disease and Quality of Life Short Form questionnaire. Levels of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale questionnaire. Comorbidities and sociodemographic and clinical factors were also evaluated.

FINDINGS

HRQL in patients with end-stage kidney disease (ESKD) is significantly affected by the initiation of RRT in all respects. States of anxiety and depression were present in 26.6% and 27% of patients, respectively. These states are significantly related to the emotional component of the quality of life.

CONCLUSION

The initiation of RRT has a strong impact on HRQL in comparison with a reference population and with other stages of CKD. The early detection of an altered psychological state is important, as this condition should be treated from the first stages of the disease, as it can significantly affect the subsequent development of RRT and the patient's quality of life.

Quality of life development during initial hemodialysis therapy and association with loss of residual renal function

INTRODUCTION

Health related quality of life (HRQOL) is markedly reduced in hemodialysis patients compared to the general population. We investigated the course of self-reported HRQOL over time and the association with selected factors, focusing on changes in glomerular filtration rate (GFR).

METHODS

Eighty-two newly started hemodialysis patients from the SAFIR cohort filled out the Kidney Disease Quality of Life Short Form Version 1.3 (KDQOL-SF^TM ) questionnaire at baseline, 6 and 12 months. The SAFIR study was a randomized, placebo-controlled, double-blind intervention study, examining the effects of the angiotensin II receptor blocker irbesartan. HRQOL was a secondary outcome measure. Main inclusion criteria: Dialysis vintage <1 year, left ventricular ejection fraction >30% and urinary output >300 mL/day. GFR was measured with mean creatinine and urea clearance from 24-hour urine collections at baseline, 6 and 12 months.

FINDINGS

Irbesartan treatment did not affect HRQOL. Patients were pooled into one group for further analyses. Decline in GFR correlated significantly with decreasing HRQOL over time. HRQOL was stable over time, with a slight nonsignificant tendency toward improved HRQOL. The largest HRQOL-differences (positive values equal improved HRQOL) observed during the 12 month study period were (mean[95% confidence interval]): Burden of kidney disease:6.4[-2.2;15.0], Role limitations-physical:12.7[-2.1;27.5], and Role limitations-emotional:9.7[-5.2;24.6]. Comorbidity, especially diabetes, hospital admissions, female gender, and age were strongly associated with lower HRQOL in cross sectional analysis.

DISCUSSION

Preservation of residual renal function seems to be important for HRQOL. In newly started HD patients, HRQOL showed little change after 12 months. HRQOL was negatively affected by comorbidity, especially diabetes, hospital admissions, female gender, and age.

Poor sleep and reduced quality of life were associated with symptom distress in patients receiving maintenance hemodialysis

Background

The quality of life in patients receiving chronic hemodialysis is compromised despite of the substantial achievements in treatments. Quality of life in hemodialysis patients have been shown to be associated with decreased survival and increased hospitalization. Therefore, it is necessary to incorporate the managements of symptoms and patient self-perceived well-being as measurements of effective treatments for these patients.

Methods

A survey of symptom distress, quality of sleep and quality of life was performed in 301 maintenance hemodialysis patients using Dialysis Symptom Index, Short Form-36, and Pittsburgh Quality of Sleep Index table. Patients were recruited from five hospitals in Guangdong area of China by convenience sampling.

Results

The prevalence of various symptoms in maintenance hemodialysis patients was between 23.3 and 80.4 %. These patients had compromised sleep and poor quality of life. Moreover, poor quality of sleep and impaired quality of life were associated with high symptom burden of these patients.

Conclusion

The patients receiving chronic hemodialysis generally have heavy symptom distress, which could contribute to the disturbed sleep and impaired quality of life of these patients. Measurements of clinical outcomes for hemodialysis patients should include the management of symptoms and morbidity. The ultimate goal of treatments is to improve patient self-perceived quality of life.