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Valderrama-Rios MC, Sánchez R, Sanabria M. Psychometric properties of the Kidney Disease Quality of Life short form 36 (KDQOL-36) scale for the assessment of quality of life in Colombian patients with chronic kidney disease on dialysis. Int Urol Nephrol 2024; 56:2337-2350. [PMID: 38376660 PMCID: PMC11190008 DOI: 10.1007/s11255-024-03940-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/01/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Considering the importance of incorporating quality of life (QoL) construct during the health care of patients with stage 5 chronic kidney disease (CKD) on dialysis, it is necessary to have evidence on the clinimetric properties of the instruments used for its measurement. This study aimed to establish the clinimetric properties of the Kidney Disease Quality of Life Short Form 36 (KDQOL-36) scale in patients with stage 5 CKD on dialysis in Colombia. METHODS A scale validation study was conducted using the classical test theory methodology. The statistical analysis included exploratory factor analysis (EFA) and confirmatory (CFA) techniques performed on two independent subsamples; concurrent criterion validity assessments; internal consistency using four different coefficients; test-retest reliability; and sensitivity to change using mixed model for repeated measures. RESULTS The KDQOL-36 scale was applied to 506 patients with a diagnosis of stage 5 CKD on dialysis, attended in five renal units in Colombia. The EFA endorsed the three-factor structure of the scale, and the CFA showed an adequate fit of both the original and empirical models. Spearman's correlation coefficient values ≥0.50 were found between the domains of the CKD-specific core of the KDQOL-36 scale and the KDQ. Cronbach's alpha, McDonald's omega, Greatest lower bound (GLB), and Guttman's lambda coefficients were ≥0.89, indicating a high degree of consistency. A high level of concordance correlation was found between the two moments of application of the instrument, with values for Lin's concordance correlation coefficient ≥0.7. The application of the instrument after experiencing an event that could modify the quality of life showed statistically significant differences in the scores obtained. CONCLUSION The KDQOL-36 scale is an adequate instrument for measuring QoL in Colombian patients with stage 5 CKD on dialysis.
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Affiliation(s)
| | - Ricardo Sánchez
- Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia, Bogotá, DC, Colombia
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Hao J, Wang Y, Wang Y, Zhang J, Gao J, Kang L, Wang X, Yang J, Zhang L, Liu J. Analysis of influencing factors on quality of life in patients with chronic kidney disease undergoing maintenance haemodialysis. Heliyon 2024; 10:e25817. [PMID: 38375281 PMCID: PMC10875423 DOI: 10.1016/j.heliyon.2024.e25817] [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: 10/26/2023] [Revised: 12/24/2023] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
Objective To investigate and analyse the quality of life (QoL) of patients with chronic kidney disease (CKD) undergoing maintenance haemodialysis (MHD), explore influencing factors and provide a basis for formulating corresponding intervention measures. Methods A cross-sectional study was conducted on 190 patients with CKD undergoing MHD in hospital between March 2021 and March 2022. A general information questionnaire and the Kidney Disease Quality of Life Short Form were used to collect data. The QoL scores of patients with CKD undergoing MHD were calculated and compared by t-test and analysis of variance. Pearson correlation analysis was used to analyse the correlation between QoL scores and related factors. Stepwise multiple linear regression analysis was used to screen the influencing factors of QoL. Results The total score of QoL of patients with CKD undergoing MHD was 59.32 ± 11.67, and the scores of physical component summary, mental component summary and kidney disease component summary were 50.21 ± 9.32, 48.76 ± 10.81 and 66.34 ± 12.76, respectively. The QoL scores of patients with CKD undergoing MHD were significantly different in age, education level, marital status, employment status, monthly income, dialysis frequency, dialysis duration and complications (p < 0.05). The QoL scores were positively correlated with education level, monthly income and dialysis frequency, and negatively correlated with age, dialysis duration and blood phosphorus level (p < 0.05). Stepwise multiple linear regression analysis showed that age, education level, employment status, dialysis frequency, dialysis duration and blood phosphorus level were the main influencing factors of QoL (p < 0.05). Conclusion The QoL of patients with CKD undergoing MHD is low, and it is affected by multiple factors. We suggest that healthcare workers should pay attention to the physical and mental health of patients with CKD undergoing MHD, provide individualised and comprehensive nursing interventions and improve their QoL.
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Affiliation(s)
- Jianping Hao
- Blood Purification Center, Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - Yifei Wang
- Blood Purification Center, Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - Yali Wang
- Blood Purification Center, Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - Jing Zhang
- Blood Purification Center, Beijing Puren Hospital, Beijing 100062, China
| | - Jia Gao
- Blood Purification Center, Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - Liyuan Kang
- Blood Purification Center, Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - Xin Wang
- Department of Nursing, Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - Jiankun Yang
- National drug clinical trial organization, Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - Lili Zhang
- Department of Nursing, Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - Jing Liu
- Blood Purification Center, Beijing You An Hospital, Capital Medical University, Beijing 100069, China
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Notomi S, Kitamura M, Otsuka E, Ejima Y, Sawase K, Nishino T, Funakoshi S. Mortality risk factors among patients undergoing hemodialysis in a nursing home. Geriatr Gerontol Int 2023; 23:660-664. [PMID: 37448264 DOI: 10.1111/ggi.14639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
AIM This study aimed to verify the impact of low body mass index (BMI) on mortality in nursing home residents undergoing hemodialysis and to clarify other associated mortality risk factors. METHODS This retrospective study included patients admitted to a nursing home affiliated with Nagasaki Renal Center between April 2014 and March 2022. Medical data were collected on admission, and participants were divided into low and high BMI groups according to their median BMI values. The patients were followed up until March 2023. The association between survival and patient history was also analyzed. RESULTS Of the 106 patients (average age, 81.3 ± 7.9 years; male, 36.8%; median dialysis vintage, 32.5 [interquartile range (IQR), 13.8-79.3] months), 52 and 54 were classified into the low (median < 18.4 kg/m2 ) and high (≥18.4 kg/m2 ) BMI groups, respectively. Multivariable Cox proportional hazards analysis indicated that BMI (hazard ratio, 0.87; 95% confidence interval [CI]: 0.82-0.94; P < 0.001) was closely associated with survival. Multivariable logistic regression revealed that dementia was associated with low BMI (odds ratio: 2.89, 95% CI: 1.07-7.83, P = 0.03). CONCLUSIONS Low BMI was an important factor contributing to poor patient survival. Dementia was associated with low BMI. Therefore, the management of both nutrition and dementia is essential for nursing home residents undergoing hemodialysis. Geriatr Gerontol Int 2023; 23: 660-664.
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Affiliation(s)
| | - Mineaki Kitamura
- Nagasaki Renal Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Emiko Otsuka
- Nagasaki Renal Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yusuke Ejima
- Special Nursing Care Home Kokuraan, Nagasaki, Japan
| | | | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Bhandari S, Parfrey P, White C, Anker SD, Farrington K, Ford I, Kalra PA, McMurray JJV, Robertson M, Tomson CRV, Wheeler DC, Macdougall IC. Predictors of quality of life in patients within the first year of commencing haemodialysis based on baseline data from the PIVOTAL trial and associations with the study outcomes. J Nephrol 2023; 36:1651-1662. [PMID: 36995528 PMCID: PMC10061401 DOI: 10.1007/s40620-023-01571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/01/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Impaired quality of life is common in patients with end-stage kidney disease. We report the baseline quality of life measures in participants from the PIVOTAL randomized controlled trial and the potential relationship with the primary outcome (all-cause mortality, myocardial infarction, stroke, and heart failure hospitalisation), and associations with key baseline characteristics. METHODS This was a post hoc analysis of 2141 patients enrolled in the PIVOTAL trial. Quality of life was measured using EQ5D index, Visual Analogue Scale, and the KD-QoL [Physical Component Score and Mental Component Score]. RESULTS Mean baseline EQ5D index and visual analogue scale scores were 0.68 and 60.7 and 33.7 (Physical Component Score) and 46.0 (Mental Component Score), respectively. Female sex, higher Body Mass Index, diabetes mellitus, history of myocardial infarction, stroke or heart failure were associated with significantly worse EQ5D index and visual analogue scale. Higher C-reactive protein levels and lower transferrin saturation were associated with worse quality of life. Haemoglobin was not an independent predictor of quality of life. A lower transferrin saturation was an independent predictor of worse physical component score. A higher C-reactive protein level was associated with most aspects of worse quality of life. Impaired functional status was associated with mortality. CONCLUSION Quality of life was impaired in patients starting haemodialysis. A higher C-reactive protein level level was a consistent independent predictor of the majority of worse quality of life. Transferrin saturation ≤ 20% was associated with worse physical component score of quality of life. Baseline quality of life was predictive of all-cause mortality and the primary outcome measure. EUDRACT REGISTRATION NUMBER 2013-002267-25.
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Affiliation(s)
- Sunil Bhandari
- Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust and Hull York Medical School, Hull, HU3 2JZ, UK.
| | - Patrick Parfrey
- Divison of Nephrology, Health Sciences Centre, St Johns, NL, Canada
| | - Claire White
- Department of Renal Medicine, King's College Hospital, London, UK
| | | | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - John J V McMurray
- Department of Cardiology, University of Glasgow, Glasgow, Scotland, UK
| | - Michele Robertson
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - David C Wheeler
- University College London, London, UK
- George Institute for Global Health, Sydney, Australia
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Berhe T, Tegegne GT, Berha AB. Quality of life and associated factors among chronic kidney disease patients at Zewditu Memorial and Tikur Anbessa Specialised Hospitals, Ethiopia: a cross-sectional study design. BMJ Open 2023; 13:e069712. [PMID: 37263701 DOI: 10.1136/bmjopen-2022-069712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is associated with significant morbidity, mortality, healthcare cost and reduced health-related quality of life (HRQoL). This study aimed to assess HRQoL and associated factors among patients with CKD at both Zewditu Memorial and Tikur Anbessa Specialised Hospitals, Ethiopia. METHOD A cross-sectional study design was performed. All patients who visited the renal clinics in both hospitals from March to July 2019 were targeted, and data were collected using interviews and medical records. HRQoL was assessed using the Kidney Disease and Quality of Life-36 tool. Normality assessment was done for HRQoL subscales. Descriptive statistics, logistic regression, t-test and one-way analysis of variance were performed. RESULT A total of 300 patients with CKD were included. Around 62% of them were in either stage 3 or 4 CKD. The mean domain scores of physical component summary (PCS), mental component summary (MCS), burden of kidney disease, effect of kidney disease and symptoms and problems of kidney disease (SPKD) subscales were 50.4, 59.5, 63.1, 74.6 and 80.4, respectively. The lowest HRQoL was seen in the PCS scale, while the highest was in SPKD. In addition, the study revealed that a lower level of education, elevated serum creatinine and a history of smoking were significantly associated with poor PCS score. Further, the presence of three or more comorbidities, CKD-related complications and a lower haemoglobin level were significantly associated with poor MCS. CONCLUSION The overall mean scores of PCS and MCS were low, below the standard level. Level of education, serum creatinine and smoking history were significantly associated with PCS, while the presence of comorbidity, complications and haemoglobin level were significantly associated with MCS. Stakeholders working on CKD management should design a relevant strategy targeting patients, patients' care providers and healthcare professionals to improve HRQoL of patients.
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Affiliation(s)
- Teshome Berhe
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gobezie T Tegegne
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Correia de Carvalho M, Nunes de Azevedo J, Azevedo P, Pires C, Machado JP, Laranjeira M. Effectiveness of Acupuncture on Health-Related Quality of Life in Patients Receiving Maintenance Hemodialysis. Healthcare (Basel) 2023; 11:healthcare11091355. [PMID: 37174896 PMCID: PMC10178503 DOI: 10.3390/healthcare11091355] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
Patients with kidney failure (KF) receiving maintenance hemodialysis (HD) experience numerous symptoms that impair their health-related quality of life (HRQOL) and contribute to high mortality rates. Acupuncture is often used for symptom enhancement and HRQOL. This blinded, randomized, controlled patient-assessor trial evaluated the effectiveness of acupuncture compared with sham acupuncture on patients' HRQOL receiving maintenance HD as a secondary analysis. Seventy-two participants were randomly assigned to verum acupuncture (VA), sham acupuncture (SA), or waiting-list (WL) groups. The outcome was an improvement in HRQOL, assessed using the Kidney Disease Quality of Life-Short Form, version 1.3 (KDQOL-SF™ v1.3) at baseline, after treatment, and at 12-week follow-up. Non-parametric tests were used for statistical analysis. Of the 72 randomized patients, 67 were included in the complete analysis set. As for the changes between baseline and after treatment, the VA group showed significantly increased scores on most of the KDQOL-SF™ v1.3 scales compared to SA or WL groups (p < 0.05). No statistically significant differences between groups were observed in the changes from baseline to follow-up (p > 0.05). Compared to the sham treatment, acupuncture improved the HRQOL in patients receiving maintenance HD after treatment but not at follow-up.
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Affiliation(s)
| | | | - Pedro Azevedo
- TECSAM-Tecnologia e Serviços Médicos SA, 5370-530 Mirandela, Portugal
| | - Carlos Pires
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, 3000-115 Coimbra, Portugal
| | - Jorge Pereira Machado
- ICBAS, School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal
- CBSin, Center of BioSciences in Integrative Health, 4000-105 Porto, Portugal
| | - Manuel Laranjeira
- ICBAS, School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal
- INC, Instituto de Neurociências, 4100-141 Porto, Portugal
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Anderson BM, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Cognitive Impairment, Frailty, and Adverse Outcomes Among Prevalent Hemodialysis Recipients: Results From a Large Prospective Cohort Study in the United Kingdom. Kidney Med 2023; 5:100613. [PMID: 36941845 PMCID: PMC10024232 DOI: 10.1016/j.xkme.2023.100613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Rationale & Objective Frailty and cognitive impairment are common in hemodialysis recipients and have been associated with high mortality. There is considerable heterogeneity in frailty reporting, with little comparison between commonly used frailty tools and little exploration of the interplay between cognition and frailty. The aims were to explore the relationship between frailty scores and cognition and their associations with hospitalization and mortality. Study Design Prospective cohort study. Setting & Population Prevalent hemodialysis recipients linked to national datasets for hospitalization and mortality. Predictors Montreal Cognitive Assessment (MoCA), Frailty Phenotype, Frailty Index (FI), Edmonton Frailty Scale, and Clinical Frailty Scale (CFS) were performed at baseline. Cognitive impairment was defined as MoCA scores of <26, or <21 in dexterity impairment, <18 in visual impairment. Outcomes Mortality, hospitalization. Analytical Approach Cox proportional hazards model for mortality, censored for end of follow-up. Negative binomial regression for admission rates, censored for death/end of follow-up. Results In total, 448 participants were recruited with valid MoCAs and followed up for a median of 685 days. There were 103 (23%) deaths and 1,120 admissions of at least one night. Cognitive impairment was identified in 346 (77.2%) participants. Increasing frailty by all definitions was associated with poorer cognition. Cognition was not associated with mortality (HR, 0.99; 95% CI, 0.95-1.03; P = 0.41) or hospitalization (IRR, 1.01; 95% CI, 0.99-1.04; P = 0.39) on multivariable analyses. There were interactions between MoCA scores and increasing frailty by FI (P = 0.002) and Clinical Frailty Scale (P = 0.005); admissions were highest when both MoCA and frailty scores were high, and when both scores were low. Limitations As frailty is a dynamic state, a single cross-sectional assessment may not accurately reflect its year-to-year variability. In addition, these findings are in maintenance dialysis and may not be transferable to incident hemodialysis. There were small variations in application of frailty tool criteria from other studies, which may have influenced the results. Conclusions Cognitive impairment is highly prevalent in this hemodialysis cohort. The interaction between cognition and frailty on rates of admission suggests the MoCA offers value in identifying higher risk hemodialysis populations with both high and low degrees of frailty.
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Affiliation(s)
- Benjamin M. Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Muhammad Qasim
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gonzalo Correa
- Department of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Felicity Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
- PIONEER: HDR-UK hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J. Ferro
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A. Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Address for Correspondence: Dr. Adnan Sharif, Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2WB, United Kingdom.
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McKeaveney C, Witham M, Alamrani AO, Maxwell AP, Mullan R, Noble H, Shields J, Reid J. Quality of life in advanced renal disease managed either by haemodialysis or conservative care in older patients. BMJ Support Palliat Care 2023; 13:87-94. [PMID: 32917654 DOI: 10.1136/bmjspcare-2020-002237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Consideration of quality of life (QoL) in people with end-stage renal disease has become an important part of treatment decision-making. The aim of this study was to report on QoL and other functional outcomes in patients with advanced chronic kidney disease (CKD). METHOD This was a cross-sectional study. Two samples of older patients (>60 years old) either conservatively managed (CM) or receiving hospital-based haemodialysis (HD), compared Kidney Disease Quality of Life (KDQoL-36) outcomes. RESULTS Data from 263 CM patients (CKD 4 n=188, mean age 73.6 years, 48 women; CKD 5 n=75, mean age 74.4 years, 26 women) and 74 patients on HD (mean age 73.8 years, 24 women) were analysed. Significant group differences were identified for two subscales of KDQoL-36. Symptoms/Problems List subscale was significantly better for those receiving HD compared with those CM with CKD 5 (p=<0.001). Symptom/Problem List scores of CM CKD stage 4 patients were not significantly different compared with HD patients but were significantly better than CM CKD stage 5 patients (p<0.001). Burden of Kidney Disease subscale was significantly better for both CKD 4 (p<0.001) and CKD 5 (p<0.001) CM patients when compared with those receiving HD. CONCLUSION Symptoms of advanced CKD significantly impact QoL for patients CM with CKD stage 5. Conversely, QoL is significantly impacted for those in receipt of HD due to the burden of treatment. These findings provide evidence for the use of QoL tools to help with clinical prognostication in advanced CKD. Using QoL tools will ensure specialist support is available for appropriate management of patients with CKD.
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Affiliation(s)
- Clare McKeaveney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Miles Witham
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Abrar O Alamrani
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Alexander Peter Maxwell
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland.,Regional Nephrology Unit, Belfast City Hospital, Belfast Health Social Care Trust, Belfast, Northern Ireland
| | - Robert Mullan
- Department of Nephrology, Antrim Area Hospital, Northern Health Social Care Trust, Antrim, Northern Ireland
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Joanne Shields
- Regional Nephrology Unit, Belfast City Hospital, Belfast Health Social Care Trust, Belfast, Northern Ireland
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
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Vogt B, Painter DF, Saad Berreta R, Lokhande A, Shah AD. Hospitalization in maintenance peritoneal dialysis: a review. Hosp Pract (1995) 2023; 51:18-28. [PMID: 36652395 DOI: 10.1080/21548331.2023.2170613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Although hemodialysis continues to be the dominant form of dialysis in the United States, peritoneal dialysis rates continue to rise both nationally and worldwide. Peritoneal dialysis offers patients increased flexibility due to the ability to dialyze at home, leading to potential quality of life benefits for patients. However, questions exist regarding clinical outcomes in patients on peritoneal dialysis and the literature has not recently been reviewed. This review examines hospitalizations within patients utilizing peritoneal dialysis, including comparison to other dialysis modalities. Much heterogeneity exists within the literature, often explained by patient population. Recent data show all-cause, cardiovascular, and infection-related hospitalizations to be high in patients on peritoneal dialysis, although data variation limits conclusions in comparison to other modalities. This review found there is insufficient evidence to suggest admission rates are different in peritoneal dialysis than in-center hemodialysis. While the rate is similar to infectious causes, most studies report cardiovascular complications to be the leading cause of hospitalization. Some evidence suggests that cardiovascular hospitalizations occur at a higher rate in peritoneal dialysis, but further studies are required. The infection-related hospitalization rate appears to be higher in peritoneal dialysis due to rates of peritonitis, but rates of life-threatening bacteremia are lower. Differences in reporting of hospital days vs. length of stay challenge the interpretability of length of stay data between modalities, but patients on PD may spend more days per year in the hospital. In summary, hospitalization is highly prevalent in patients on peritoneal dialysis and few definitive conclusions can be drawn in comparison to other dialysis modalities. In eligible patient populations who desire increased flexibility, peritoneal dialysis is a reasonable modality choice.
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Affiliation(s)
- Braden Vogt
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - David F Painter
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Anagha Lokhande
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ankur D Shah
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Kidney Disease and Hypertension, Rhode Island Hospital, Providence, Providence, RI, USA.,Division of Nephrology, Medicine Service, Providence Veterans Affairs Medical Center, Providence, RI, USA
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10
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Wang W, Si H, Yu R, Qiao X, Jin Y, Ji L, Liu Q, Bian Y, Yu J, Wang C. Effects of reversible cognitive frailty on disability, quality of life, depression, and hospitalization: a prospective cohort study. Aging Ment Health 2022; 26:2031-2038. [PMID: 34889147 DOI: 10.1080/13607863.2021.2011835] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Cognitive frailty, a potentially reversible condition describing the concurrence of physical frailty and mild cognitive impairment (MCI), has been recently proposed to incorporate subjective cognitive decline (SCD), a reversible pre-MCI state with more readily available cognitive reserve, as well as pre-physical frailty. Reversible cognitive frailty has been associated with dementia and mortality. We aimed to examine the association of reversible cognitive frailty with other adverse outcomes including disability, poor quality of life (QOL), depression, and hospitalization. METHODS This was a cohort study with 1-year follow-up among 735 Chinese community-dwelling older adults with intact cognition. Reversible cognitive frailty was operationalized with the presence of pre-physical or physical frailty identified by the Frailty Phenotype and SCD identified by the simplified SCD questionnaire including four self-report cognitive domains of memory, naming, orientation, and mathematical reasoning. Adverse outcomes included incident Activities of Daily Living (ADL)-Instrumental ADL (IADL) disability, poor physical, mental and overall QOL, depression, and hospitalization over 1-year follow-up. RESULTS The prevalence of reversible cognitive frailty was 27.8%. Participants with reversible cognitive frailty had higher risk of the incidence of ADL-IADL disability, poor physical QOL, poor mental QOL, poor overall QOL, and depression (Odds Ratios: 1.67-4.38, P < 0.05), but not higher risk of hospitalization over 1-year follow-up. CONCLUSION Reversible cognitive frailty was not uncommon and associated with incident disability, poor QOL, and depression among community-dwelling older adults. Early identification of reversible cognitive frailty can facilitate targeted interventions and may promote independence in older adults. UNLABELLED Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2011835.
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Affiliation(s)
- Wenyu Wang
- School of Nursing, Peking University, Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, Beijing, China
| | - Ruby Yu
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, Beijing, China
| | - Lili Ji
- School of Nursing, Peking University, Beijing, China
| | - Qinqin Liu
- School of Nursing, Peking University, Beijing, China
| | - Yanhui Bian
- School of Nursing, Peking University, Beijing, China
| | - Jiaqi Yu
- School of Nursing, Peking University, Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, Beijing, China
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So S, Li K, Hoffman AT, Josland E, Brown MA. Quality of Life in Patients with Chronic Kidney Disease Managed with or without Dialysis: An Observational Study. KIDNEY360 2022; 3:1890-1898. [PMID: 36514416 PMCID: PMC9717644 DOI: 10.34067/kid.0001602022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/11/2022] [Indexed: 01/12/2023]
Abstract
Background Emerging research suggests that quality of life (QOL) outcomes, such as maintenance of independence, rather than length of life, are the main priority for many patients with end stage kidney disease (ESKD). There is therefore a need to focus on whether QOL for older patients on dialysis differs significantly from conservative kidney management (CKM). This study aimed to describe the QOL trajectory for patients with ESKD, comparing CKM to dialysis and transplantation. Methods This retrospective, observational study included all patients who attended the Kidney Supportive Care Clinic at St. George Hospital and had one or more EuroQOL (EQ5D5L) questionnaires between July 2014 and May 2020. Kruskal-Wallis tests compared QOL scores between groups at baseline and 12 months. Wilcoxon signed rank tests compared QOL scores from baseline to 18 months within groups. Chi-squared tests compared proportions of patients reporting problems with QOL "domains" between the groups at baseline and 12 months. McNemar's tests compared changes in proportions of patients reporting problems with QOL "domains" within groups from baseline to 12 months. Results A total of 604 patients had an initial survey. At baseline, patients who were managed conservatively reported more problems with mobility, self-care, and ability to perform usual activities. However, pain/discomfort and anxiety/depression were no higher in the conservative population. CKM patients reported no significant decline in mobility, self-care, ability to perform their usual activities, pain/discomfort, or anxiety/depression after 12 months or in QOL scores after 18 months compared with the other groups. Conclusions QOL scores or symptom burdens did not change significantly in patients receiving CKM compared with dialysis, suggesting that appropriately supported CKM can maintain patients' QOL.
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Affiliation(s)
- Sarah So
- Department of Palliative Care, St. George Hospital, Kogarah, Sydney, Australia,Department of Renal Medicine, Nepean Hospital, Kingswood, Sydney, Australia,The University of New South Wales, Sydney, Australia
| | - Kelly Li
- The University of New South Wales, Sydney, Australia,Department of Renal Medicine, St. George Hospital, Kogarah, Sydney, Australia
| | - Anna T. Hoffman
- Department of Renal Medicine, St. George Hospital, Kogarah, Sydney, Australia
| | - Elizabeth Josland
- Department of Renal Medicine, St. George Hospital, Kogarah, Sydney, Australia
| | - Mark A. Brown
- The University of New South Wales, Sydney, Australia,Department of Renal Medicine, St. George Hospital, Kogarah, Sydney, Australia
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Sawma T, Sanjab Y. The association between sense of coherence and quality of life: a cross-sectional study in a sample of patients on hemodialysis. BMC Psychol 2022; 10:100. [PMID: 35428334 PMCID: PMC9013051 DOI: 10.1186/s40359-022-00805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients on hemodialysis universally experience detriments in their general quality of life (QOL). Sense of coherence (SOC) is a long-standing factor that affects QOL. Nevertheless, the association between SOC and QOL in patients on hemodialysis was seldom investigated. Our research aims to study this association in a sample of Lebanese adult patients on hemodialysis. Methods In this cross-sectional study, SOC was measured using the short version of the “Orientation of Life" scale (SOC-13). QOL was assessed using the Kidney Disease Quality of Life- Short Form (KDQOL-SF). The association between SOC and QOL and its submodalities was first explored using Pearson Correlation and multivariate linear regression analyses, controlling for sociodemographic variables and medical variables. Results 157 patients on hemodialysis (mean(SD) age: 62.1(13.81) years; 58.6% males) were included. Mean QOL score was 51.65 and that of SOC was 48.06. SOC was strongly corrected with the total QOL (r = 0.832; p value < 0.001), as well as its physical functioning (r = 0.767; p value < 0.001), emotional functioning (r = 0.757; p value < 0.001), cognitive functioning (r = 0.740; p value < 0.001), and social functioning (r = 0.773; p value < 0.001) submodailties. SOC was moderately correlated with professional functioning submodality of QOL (r = 0.618; p value < 0.001), but not correlated with the satisfaction with the quality of care (r = 0.052; p = 0.520). Within the regression models accounting for sociodemographic and medical variables, SOC was significantly associated with the total QOL (unstandardized B = 0.803; 95% CI 0.714, 0.893), physical functioning (unstandardized B = 0.761; standardized B = 0.763; 95% CI 0.661, 0.861), emotional functioning (unstandardized B = 1.205; standardized B = 0.757; 95% CI 1.037, 1.372), professional functioning (unstandardized B = 1.142; standardized B = 0.498; 95% CI 0.843, 1.442), cognitive functioning (unstandardized B = 1.239; standardized B = 0.739; 95% CI 1.058, 1.420), and social functioning (unstandardized B = 0.912; standardized B = 0.768; 95% CI 0.790, 1.034). Conclusions In a sample of adult patients on hemodialysis, SOC was positively significantly associated with QOL and its submodalities, expect the satisfaction with the quality of care. The confirmation of the general hypothesis that relates the SOC with the QOL encourages more salutogenic research among this patient population.
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13
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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. Qual Life Res 2021; 31:1441-1459. [PMID: 34748139 DOI: 10.1007/s11136-021-03018-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
Abstract
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.
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Chrifi Alaoui A, Touti W, Al Borgi Y, Sqalli Houssaini T, El Rhazi K. Comparison of quality of life in end-stage renal disease patients undergoing hemodialysis and peritoneal dialysis in a Moroccan city. Semin Dial 2021; 35:50-57. [PMID: 34704278 DOI: 10.1111/sdi.13034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE End-stage renal disease patients (ESRD) generally complain about a poor quality of life (QOL). The current study aims to describe and compare ESRD patients' QOL according to dialysis modalities (hemodialysis [HD] and peritoneal dialysis [PD]). METHODS This is a cross-sectional study, conducted in dialysis facilities of a Moroccan university hospital, during October 2018. All adult ESRD patients, treated either by HD or PD for more than 3 months and agreeing to participate, were included. Medical data were collected using a questionnaire, whereas the QOL data were collected using the Kidney Disease Quality of Life Short Form (KDQOL SF v 1.3) scale previously validated in dialectal Arabic. The patients' characteristics and QOL data were compared between dialysis modalities (HD vs. PD), using a linear regression, before and after adjustment on several demographic and medical factors as well as a propensity score created to reduce the effect of confounding factors related to the choice of the treatment. RESULTS Out of the 91 included patients (50.5% of men, median age 52.0 (IQR [36.5; 62.0]) years), 71 were on HD and 20 were on PD. The highest subscale score, for all participants, was the social support's one with a median of 83.3 (IQR [66.7; 100]), and the lowest one was the kidney disease burden with a median of 25.0 (IQR [0.00; 46.9]). The univariate analysis showed that the Physical Component Score (PCS), the cognitive function, and the dialysis staff encouragement were better in PD patients (p = 0.03, p = 0.04, and p = 0.007, respectively), while the multiple linear regression indicates that the PCS, the dialysis Staff encouragement, and the patient's satisfaction subscores decreased within patients on HD compared with those on PD (p = 0.01, p = 0.03, and p = 0.02, respectively) and that the burden of the kidney disease and the work status subscores increased within patients on HD against those on PD (p = 0.007 and p = 0.04, respectively). CONCLUSION This study showed a significant difference between dialysis modalities in some sides of quality of life.
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Affiliation(s)
- Amina Chrifi Alaoui
- Department of Epidemiology, Clinical Research and Biostatistics, Faculty of Medicine and Pharmacy, Fez, Morocco
| | - Wiam Touti
- Department of Nephrology and Hemodialysis, Hassan II University Hospital, Fez, Morocco
| | - Yassine Al Borgi
- Department of Nephrology and Hemodialysis, Hassan II University Hospital, Fez, Morocco
| | - Tarik Sqalli Houssaini
- Department of Nephrology and Hemodialysis, Hassan II University Hospital, Fez, Morocco.,Laboratory of Epidemiology and Health Sciences' Researches (ERESS), Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Karima El Rhazi
- Department of Epidemiology, Clinical Research and Biostatistics, Faculty of Medicine and Pharmacy, Fez, Morocco.,Laboratory of Epidemiology and Health Sciences' Researches (ERESS), Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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15
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Myers J, Chan KN, Chen Y, Lit Y, Massaband P, Kiratli BJ, Tan JC, Rabkin R. Association of physical function and performance with peak VO 2 in elderly patients with end stage kidney disease. Aging Clin Exp Res 2021; 33:2797-2806. [PMID: 33686542 DOI: 10.1007/s40520-021-01801-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Physical function is impaired in end stage renal disease (ESRD). Various instruments have been used to assess the functional capabilities and health status of patients with ESRD, but it is not known which has the best association with peak VO2. AIMS To assess the association between functional measures in ESRD. METHODS Thirty nine elderly ESRD patients were evaluated with commonly used functional, health status, and quality of life measures, including maximal cardiopulmonary exercise testing (CPET), 6-min walk (6MWT), sit-to-stand test (STS), Veterans Specific Activity Questionnaire (VSAQ), upper and lower body strength, pulmonary function tests, and body composition determined by dual X-ray absorptiometry. The association between performance on these functional tools, clinical variables, and exercise test responses was assessed, and a non-exercise test multivariate model was developed to predict peak VO2. RESULTS Peak VO2 was modestly related to VSAQ score (r = 0.59, p < 0.01), indices of upper and lower body strength (r = 0.45, p < 0.01 for both), and FEV1 (r = 0.51, p < 0.01). Functional and quality of life questionnaires were generally poorly related to one another and to peak VO2. In a multivariate model, 6MWT performance, forced expiratory volume in 1 s (FEV1), and VSAQ score were the best predictors of peak VO2, yielding a multiple R = 0.82, accounting for 67% of the variance in peak VO2. CONCLUSION Exercise capacity can be reasonably estimated using non-exercise test variables in patients with ESRD, including a symptom questionnaire (VSAQ), 6MWT and FEV1. CLINICAL TRIAL INFORMATION ClinicalTrials.gov identifier: NCT01990495. Registered Nov 21, 2013.
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Affiliation(s)
- Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA, 94304, USA.
- Cardiology Division, Stanford University, Stanford, CA, USA.
| | - Khin N Chan
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Yu Chen
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Yiming Lit
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Nephrology Division, Stanford University, Stanford, CA, USA
| | - Payam Massaband
- Radiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - B Jenny Kiratli
- Spinal Cord Injury Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jane C Tan
- Division of Nephrology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | - Ralph Rabkin
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Nephrology Division, Stanford University, Stanford, CA, USA
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16
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Yuksel E, Aydin E. The relationship between serum vitamin D levels and health-related quality of life in peritoneal dialysis patients. Int Urol Nephrol 2021; 54:927-936. [PMID: 34292490 DOI: 10.1007/s11255-021-02951-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Enver Yuksel
- Department of Nephrology, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey.
| | - Emre Aydin
- School of Medicine, Department of Nephrology, University of Dicle, Diyarbakır, Turkey
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17
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Ito M, Nawano T, Masakane I, Yamaguchi I, Kudo K, Nagasawa J, Yabuki K. Clinical impact of patient-centered care for hemodialysis patients using routine assessment of symptom burden. Ther Apher Dial 2021; 26:417-424. [PMID: 34190410 DOI: 10.1111/1744-9987.13704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
The study aimed to verify the impact of our clinical strategy, which emphasizes patient-centered care, based on patient-reported outcome measures (PROMs) results in hemodialysis patients. We developed our original PROM (comprising 20 items) to assess patients' symptom burden. To confirm the validity of our clinical pattern, we performed various analyses using PROM data. We retrospectively enrolled 383 individuals (mean age 66.3 years; 252 men), collected their PROM data in December 2013, and followed them up for 3 years. We noted a lower mortality rate and a lower prevalence of itching in our facilities than in previous surveys and reports in Japan. Furthermore, we observed that the severity of symptom burden affected medium-term prognosis. This is the first study to report the results of patient-centered medical practice utilizing PROMs in dialysis care. Careful attention should be paid to patients' symptom burden, as performed in objective data management.
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Affiliation(s)
- Minoru Ito
- Department of Nephrology and Dialysis Center, Yabuki Hospital (Seieikai Medical Corporation), Yamagata, Japan
| | - Takaaki Nawano
- Department of Nephrology and Dialysis Center, Yabuki Hospital (Seieikai Medical Corporation), Yamagata, Japan.,First Department of Internal Medicine, Yamagata University, School of Medicine, Yamagata, Japan
| | - Ikuto Masakane
- Department of Nephrology and Dialysis Center, Yabuki Hospital (Seieikai Medical Corporation), Yamagata, Japan
| | - Ichiro Yamaguchi
- Dialysis Center, Tendo-Onsen Yabuki Clinic (Seieikai Medical Corporation), Yamagata, Japan
| | - Kenichi Kudo
- Dialysis Center, Honcho Yabuki Clinic (Seieikai Medical Corporation), Yamagata, Japan
| | - Junichiro Nagasawa
- Dialysis Center, Honcho Yabuki Clinic (Seieikai Medical Corporation), Yamagata, Japan
| | - Kiyotaka Yabuki
- Department of Surgery, Yabuki Hospital (Seieikai Medical Corporation), Yamagata, Japan
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18
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Dumaine CS, Ravani P, Parmar MK, Leung KCW, MacRae JM. In-center nocturnal hemodialysis improves health-related quality of life for patients with end-stage renal disease. J Nephrol 2021; 35:245-253. [PMID: 34050903 DOI: 10.1007/s40620-021-01066-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Conventional in-center hemodialysis (HD) is associated with significant symptom burden and reduced health-related quality of life (HRQOL). The HRQOL effects of conversion to in-center nocturnal hemodialysis (INHD) remain unclear, especially amongst those with poor HRQOL. METHODS Prospective cohort study of HD patients converting to INHD. Linear regression models summarized the mean score at baseline and at 12 months for the cohort. To assess whether patients with low baseline HRQOL derive greater benefit, we compared values before and after by levels of baseline score for each domain (below vs equal to or above the median) using a formal interaction test (t test). RESULTS 36 patients started INHD, 7 withdrew (5 transplanted, 1 death, 1 moved) and 5 declined follow-up. After 12 months the mental component score (MCS) increased by 7.1 points to a value of 51.0 (95% CI + 1.5 to 10.9, p = 0.01). Amongst patients with baseline scores below the median, improvements were seen in: Symptoms/Problems of Kidney Disease (+ 15.2, 95% CI + 5.5 to + 24.9, p = 0.003), Effects of Kidney Disease (+ 16.9, 95% CI + 2.2 to + 31.7, p = 0.026), Physical Component Score (+ 9.4, 95% CI + 1.69 to + 17.2, p = 0.018), MCS (+ 10.7, 95% CI + 2.4 to + 19.1, p = 0.013). Burden of Kidney Disease domain change was not significant (+ 15.1, 95% CI - 2.1 to + 32.3, p = 0.083). DISCUSSION INHD is a potential intervention for HD patients who struggle with reduced HRQOL, especially for those who struggle with poor mental health. Medical benefits of reduced pill burden and improved phosphate control occur with transition to INHD.
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Affiliation(s)
- Chance S Dumaine
- Division of Nephrology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Pietro Ravani
- Division of Nephrology, Cumming School of Medicine, University of Calgary, HRIC Building, 3230 Hospital Dr NW, Calgary, AB, T2N4Z6, Canada
| | | | - Kelvin C W Leung
- Division of Nephrology, Cumming School of Medicine, University of Calgary, HRIC Building, 3230 Hospital Dr NW, Calgary, AB, T2N4Z6, Canada
| | - Jennifer M MacRae
- Division of Nephrology, Cumming School of Medicine, University of Calgary, HRIC Building, 3230 Hospital Dr NW, Calgary, AB, T2N4Z6, Canada. .,Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, AB, Canada.
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Physical Function in Kidney Transplantation: Current Knowledge and Future Directions. CURRENT TRANSPLANTATION REPORTS 2021; 7:46-55. [PMID: 33457184 DOI: 10.1007/s40472-020-00271-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose of review Low physical function (PF) is common among individuals with end-stage kidney disease. In this review, we explore data on the impacts of PF on access to kidney transplantation (KT) and KT outcomes. We also discuss the latest interventions to improve PF in pre- and post-KT settings. Recent Findings Many US KT programs measure PF or related constructs when assessing KT candidacy. Although carefully selected KT candidates with low PF can benefit from KT with respect to survival and quality of life, low PF decreases the likelihood of being listed for KT and increases the risk of adverse post-KT outcomes. Recent trials suggest that exercise is a promising strategy to improve PF among KT candidates and recipients. Summary PF is a potentially modifiable risk factor for adverse pre- and post-KT outcomes. Research is needed to determine the ideal PF metric for use in KT evaluations and interventions to improve PF.
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20
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Physical performance and health-related quality of life among older adults on peritoneal dialysis: a cross-sectional study. Int Urol Nephrol 2021; 53:1033-1042. [PMID: 33392883 DOI: 10.1007/s11255-020-02737-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Identifying performance-based tests that meaningful for patients may facilitate the implementation of rehabilitation programs. The primary aim of this study was to determine the independent associations between different performance-based tests and health-related quality of life (HRQoL) among elderly peritoneal dialysis (PD) patients. METHODS This cross-sectional study was conducted in China. Patients on PD who were 60 years of age or above were included. HRQoL was assessed using the Medical Outcomes Study Short Form 36. Physical function was determined by handgrip strength, timed up and go (TUG) test, 5-repetition sit-to-stand test, and comfortable gait speed. Depressive symptoms were measured using the self-reported Geriatric Depression Scale (GDS-15). Multiple linear regression analyses were performed to examine the factors influencing HRQoL. RESULTS In total, 115 participants with a mean age of 69.7 were included (46 women and 69 men). TUG (β =- 0.460, p < 0.001), prealbumin (β = 0.223, p = 0.014), and education level (β = 0.183, p = 0.042) were associated with physical health. GDS score (β = - 0.475, p < 0.001), serum albumin level (β = 0.264, p = 0.003), and sex (β = 0.217, p = 0.012), were associated with mental HRQoL. CONCLUSION TUG could be a valuable test for use in clinical practice and research aiming at facilitating tailed exercise programs, as it was associated with self-perceived physical HRQoL and could be meaningful to elderly PD patients. Depressive symptoms and nutrition were another two important rehabilitation areas for optimizing the overall HRQoL of older adults on PD.
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Edmonston DL, Roe MT, Block G, Conway PT, Dember LM, DiBattiste PM, Greene T, Hariri A, Inker LA, Isakova T, Montez-Rath ME, Nkulikiyinka R, Polidori D, Roessig L, Tangri N, Wyatt C, Chertow GM, Wolf M. Drug Development in Kidney Disease: Proceedings From a Multistakeholder Conference. Am J Kidney Dis 2020; 76:842-850. [DOI: 10.1053/j.ajkd.2020.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/27/2020] [Indexed: 01/02/2023]
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22
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Harhay MN, Rao MK, Woodside KJ, Johansen KL, Lentine KL, Tullius SG, Parsons RF, Alhamad T, Berger J, Cheng XS, Lappin J, Lynch R, Parajuli S, Tan JC, Segev DL, Kaplan B, Kobashigawa J, Dadhania DM, McAdams-DeMarco MA. An overview of frailty in kidney transplantation: measurement, management and future considerations. Nephrol Dial Transplant 2020; 35:1099-1112. [PMID: 32191296 DOI: 10.1093/ndt/gfaa016] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Indexed: 02/07/2023] Open
Abstract
The construct of frailty was first developed in gerontology to help identify older adults with increased vulnerability when confronted with a health stressor. This article is a review of studies in which frailty has been applied to pre- and post-kidney transplantation (KT) populations. Although KT is the optimal treatment for end-stage kidney disease (ESKD), KT candidates often must overcome numerous health challenges associated with ESKD before receiving KT. After KT, the impacts of surgery and immunosuppression represent additional health stressors that disproportionately impact individuals with frailty. Frailty metrics could improve the ability to identify KT candidates and recipients at risk for adverse health outcomes and those who could potentially benefit from interventions to improve their frail status. The Physical Frailty Phenotype (PFP) is the most commonly used frailty metric in ESKD research, and KT recipients who are frail at KT (~20% of recipients) are twice as likely to die as nonfrail recipients. In addition to the PFP, many other metrics are currently used to assess pre- and post-KT vulnerability in research and clinical practice, underscoring the need for a disease-specific frailty metric that can be used to monitor KT candidates and recipients. Although frailty is an independent risk factor for post-transplant adverse outcomes, it is not factored into the current transplant program risk-adjustment equations. Future studies are needed to explore pre- and post-KT interventions to improve or prevent frailty.
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Affiliation(s)
- Meera N Harhay
- Department of Medicine, Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA, USA.,Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.,Tower Health Transplant Institute, Tower Health System, West Reading, PA, USA
| | - Maya K Rao
- Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | | | | | - Krista L Lentine
- Center for Abdominal Transplantation, St Louis University School of Medicine, St Louis, MO, USA
| | - Stefan G Tullius
- Department of Surgery, Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronald F Parsons
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Tarek Alhamad
- Division of Nephrology, Washington University School of Medicine, St Louis, MO, USA
| | - Joseph Berger
- Department of Internal Medicine, Division of Nephrology, UT Southwestern Medical Center, Dallas, TX, USA
| | - XingXing S Cheng
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Raymond Lynch
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Sandesh Parajuli
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jane C Tan
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce Kaplan
- Vice President System Office, Baylor Scott and White Health, Temple, TX, USA
| | - Jon Kobashigawa
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Darshana M Dadhania
- Department of Transplantation Medicine, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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23
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O'Halloran P, Noble H, Norwood K, Maxwell P, Murtagh F, Shields J, Mullan R, Matthews M, Cardwell C, Clarke M, Morton R, Shah K, Forbes T, Brazil K. Nurse-led advance care planning with older people who have end-stage kidney disease: feasibility of a deferred entry randomised controlled trial incorporating an economic evaluation and mixed methods process evaluation (ACReDiT). BMC Nephrol 2020; 21:478. [PMID: 33187506 PMCID: PMC7663906 DOI: 10.1186/s12882-020-02129-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advance Care Planning is recommended for people with end-stage kidney disease but evidence is limited. Robust clinical trials are needed to investigate the impact of advance care planning in this population. There is little available data on cost-effectiveness to guide decision makers in allocating resources for advance care planning. Therefore we sought to determine the feasibility of a randomised controlled trial and to test methods for assessing cost-effectiveness. METHODS A deferred entry, randomised controlled feasibility trial, incorporating economic and process evaluations, with people with end-stage kidney disease, aged 65 years or older, receiving haemodialysis, in two renal haemodialysis units in Northern Ireland, UK. A nurse facilitator helped the patient make an advance care plan identifying: a surrogate decision-maker; what the participant would like to happen in the future; any advance decision to refuse treatment; preferred place of care at end-of-life. RESULTS Recruitment lasted 189 days; intervention and data collection 443 days. Of the 67 patients invited to participate 30 (45%) declined and 36 were randomised to immediate or deferred advance care plan groups. Twenty-two (61%) made an advance care plan and completed data collection at 12 weeks; 17 (47.2%) were able to identify a surrogate willing to be named in the advance care plan document. The intervention was well-received and encouraged end-of-life conversations, but did not succeed in helping patients to fully clarify their values or consider specific treatment choices. There was no significant difference in health system costs between the immediate and deferred groups. CONCLUSIONS A trial of advance care planning with participants receiving haemodialysis is feasible and acceptable to patients, but challenging. A full trial would require a pool of potential participants five times larger than the number required to complete data collection at 3 months. Widening eligibility criteria to include younger (under 65 years of age) and less frail patients, together with special efforts to engage and retain surrogates may improve recruitment and retention. Traditional advance care planning outcomes may need to be supplemented with those that are defined by patients, helping them to participate with clinicians in making medical decisions. TRIAL REGISTRATION Registered December 16, 2015. ClinicalTrials.gov Identifier: NCT02631200 .
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Affiliation(s)
- Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Kelly Norwood
- School of Psychology, Ulster University, Cromore Road, Coleraine, Co. Londonderry, BT52 1SA, UK
| | - Peter Maxwell
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL, UK
- Regional Nephrology Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Fliss Murtagh
- Hull York Medical School, University of Hull, Allam Medical Building, Hull, HU6 7RX, UK
| | - Joanne Shields
- Regional Nephrology Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Robert Mullan
- Renal Unit, Antrim Area Hospital, Bush Road, Antrim, BT41 2RL, UK
| | - Michael Matthews
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
- Renal Unit, Antrim Area Hospital, Bush Road, Antrim, BT41 2RL, UK
| | - Christopher Cardwell
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Rachael Morton
- NHMRC Clinical Trials Centre, University of Sydney, Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia
| | - Karan Shah
- NHMRC Clinical Trials Centre, University of Sydney, Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia
| | - Trisha Forbes
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
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24
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Phase 3 trial Design of the Hepatocyte Growth Factor Mimetic ANG-3777 in Renal Transplant Recipients With Delayed Graft Function. Kidney Int Rep 2020; 6:296-303. [PMID: 33615054 PMCID: PMC7879201 DOI: 10.1016/j.ekir.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 01/03/2023] Open
Abstract
Introduction One-third of kidney transplantation patients experience acute kidney injury (AKI) resulting in delayed graft function (DGF), associated with increased risk of graft failure and mortality. Preclinical and phase 2 data indicate that treatment with ANG-3777 (formerly BB3), a hepatocyte growth factor (HGF) mimetic, may improve long-term kidney function and reduce health care resource use and cost, but these data require validation in a phase 3 randomized controlled trial. Methods The Graft Improvement Following Transplant (GIFT) trial is a multicenter, double-blind randomized controlled trial, designed to determine the efficacy and safety of ANG-3777 in renal transplantation patients showing signs of DGF. Subjects are randomized 1:1 to ANG-3777 (2 mg/kg) administered intravenously once daily for 3 consecutive days starting within 30 hours after transplantation, or to placebo. Results The primary endpoint is estimated glomerular filtration rate (eGFR) at 12 months. Secondary endpoints include proportion of subjects with eGFR >30 at days 30, 90, 180, and 360; proportion of subjects whose graft function is slow, delayed, or primary nonfunction; length of hospitalization; and duration of dialysis through day 30. Adverse events are assessed throughout the study. Conclusion GIFT will generate data that are important to advancing treatment of DGF in this medically complex population.
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25
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Hussein WF, Gomez N, Sun SJ, Yu J, Yang F, Ajuria M, Abra GE, Schiller B. Use of a gentamicin-citrate lock leads to lower catheter-related bloodstream infection rates and reduced cost of care in hemodialysis patients. Hemodial Int 2020; 25:20-28. [PMID: 33006269 DOI: 10.1111/hdi.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/12/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Central venous catheters (CVC) are a major contributor to infections in hemodialysis (HD) patients, leading to high morbidity and mortality. Gentamicin-citrate (GC) lock is used as standard of care at centers belonging to a mid-size dialysis organization. Four outpatient HD centers acquired by the organization continued to use heparin for catheter locks for a period of time before converting to the provider's standard of using GC lock. METHODS In this retrospective observational study, we included patients receiving HD by CVC at these four centers. We report rates of CVC-related bloodstream infections (CVC-BSI) during the heparin lock and the GC lock periods; crude rate ratios and adjusted rate ratios using Cox survival analyses adjusting for potential confounders; microbiology patterns; safety signals (gentamicin resistance, hospitalizations and deaths); and financial impact on payer. FINDINGS A total of 220 and 281 patients used tunneled CVCs, accounting for 25,245 and 44,550 catheter days in the heparin and the GC lock periods, respectively. CVC-BSI event rates were 66% lower in the GC lock period (CVC-BSI event rate: 0.20 per 1000 catheter-days) than the heparin lock period (rate: 0.59 per 1000 catheter days); rate ratio 0.34 (95% confidence interval (CI) 0.15-0.78, P = 0.01). In the fully adjusted multivariable Cox model, use of GC lock was associated with 70% reduction in CVC-BSI events (HR 0.30, 95% CI 0.12-0.72, P = 0.01). No increased risk of gentamicin resistance, hospitalizations, or death associated with use of GC lock were observed. Use of GC lock was associated with an estimated saving of $1533 (95% CI: $259-$4882) per patient per year. DISCUSSION Use of GC lock led to significant reductions in CVC-BSIs with no signal for harm, and is associated with significant cost savings in dialysis care.
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Affiliation(s)
- Wael F Hussein
- Satellite Healthcare, 300 Santana Row, Suite 300, San Jose, California, USA.,Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Norma Gomez
- Satellite Healthcare, 300 Santana Row, Suite 300, San Jose, California, USA
| | - Sumi J Sun
- Satellite Healthcare, 300 Santana Row, Suite 300, San Jose, California, USA
| | - Junhua Yu
- Satellite Healthcare, 300 Santana Row, Suite 300, San Jose, California, USA
| | - Fang Yang
- Satellite Healthcare, 300 Santana Row, Suite 300, San Jose, California, USA
| | - Michael Ajuria
- Satellite Healthcare, 300 Santana Row, Suite 300, San Jose, California, USA.,Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Graham E Abra
- Satellite Healthcare, 300 Santana Row, Suite 300, San Jose, California, USA.,Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Brigitte Schiller
- Satellite Healthcare, 300 Santana Row, Suite 300, San Jose, California, USA.,Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
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26
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Song YH, Cai GY, Xiao YF, Chen XM. Risk factors for mortality in elderly haemodialysis patients: a systematic review and meta-analysis. BMC Nephrol 2020; 21:377. [PMID: 32867718 PMCID: PMC7457491 DOI: 10.1186/s12882-020-02026-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Older haemodialysis patients accompany a high burden of functional impairment, limited life expectancy, and healthcare utilization. This meta-analysis aimed to evaluate how various risk factors influenced the prognosis of haemodialysis patients in late life, which might contribute to decision making by patients and care providers. Methods PubMed, Embase, and Cochrane Central were searched systematically for studies evaluating the risk factors for mortality in elderly haemodialysis patients. Twenty-eight studies were included in the present systematic review. The factors included age, cardiovascular disease, diabetes mellitus, type of vascular access, dialysis initiation time, nutritional status and geriatric impairments. Geriatric impairments included frailty, cognitive or functional impairment and falls. Relative risks with 95% confidence intervals were derived. Results Functional impairment (OR = 1.45, 95% CI: 1.20–1.75), cognitive impairment (OR = 1.46, 95% CI: 1.32–1.62) and falls (OR = 1.14, 95% CI: 1.06–1.23) were significantly and independently associated with increased mortality in elderly haemodialysis patients. Low body mass index conferred a mortality risk (OR = 1.43, 95% CI: 1.31–1.56) paralleling that of frailty as a marker of early death. The results also confirmed that the older (OR = 1.43, 95% CI: 1.22–1.68) and sicker (in terms of Charlson comorbidity index) (OR = 1.41, 95% CI: 1.35–1.50) elderly haemodialysis patients were, the more likely they were to die. In addition, increased mortality was associated with early-start dialysis (OR = 1.18, 95% CI: 1.01–1.37) and with the use of a central venous catheter (OR = 1.53, 95% CI: 1.44–1.62). Conclusions Multiple factors influence the risk of mortality in elderly patients undergoing haemodialysis. Geriatric impairment is related to poor outcome. Functional/cognitive impairment and falls in elderly dialysis patients are strongly and independently associated with mortality.
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Affiliation(s)
- Yu-Huan Song
- Department of Nephrology, Aerospace Center Hospital, 15 Yuquan Road, Beijing, 100049, China.,Department of Nephrology, Chinese PLA Generl Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, 100853, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese PLA Generl Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, 100853, China.
| | - Yue-Fei Xiao
- Department of Nephrology, Aerospace Center Hospital, 15 Yuquan Road, Beijing, 100049, China.
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese PLA Generl Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, 100853, China
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27
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Sturgill DA, Bal N, Nagavally S, Wolfgram DF. The Relationship between Dialysis Metrics and Patient-Reported Cognition, Fatigue, and Physical Function. KIDNEY DISEASES 2020; 6:364-370. [PMID: 33490116 DOI: 10.1159/000508919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022]
Abstract
Introduction The impact of achieving hemodialysis laboratory and hemodynamic quality metrics on patient-reported outcomes (PROs) is unknown. Objective To determine if meeting dialysis laboratory quality of care measures is associated with improved PROs. Methods In this cross-sectional study, we measured the relationship between dialysis patients' Patient Reported Outcome Measurement Information System (PROMIS) scores and commonly used dialysis quality of care measures. Results PROMIS surveys were administered to 92 dialysis patients. The mean ± SD scores demonstrated higher fatigue (55.0 ± 9.8) and lower physical function (37.9 ± 7.9) but similar cognition (50.3 ± 10.9) compared to general population normative scores of 50 ± 10. Dialysis patients meeting Kt/V goals had no better scores than those who did not. Meeting the hemoglobin (Hgb) value of ≥10 g/dL was associated with a lower fatigue score, but no difference in cognitive or physical function scores. Meeting the serum albumin goal of ≥4.0 mg/dL was associated with a higher physical function score but made no difference for cognitive function or fatigue score. As a continuous variable, a higher Hgb was associated with lower reported fatigue (HR -1.74 95%, CI [-3.09, -0.39]), but no other measures were associated with PRO scores when adjusted for demographics and comorbidities. Conclusions We found little association between measures currently used to assess the quality of dialysis care and PROs. Encouraging improved utilization of PROs and incorporating PROs into quality measurements might give a more robust assessment of quality of care. Future studies should assess the benefits of this approach.
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Affiliation(s)
- Daniel A Sturgill
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Naveet Bal
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sneha Nagavally
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dawn F Wolfgram
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Hall RK, Rutledge J, Luciano A, Hall K, Pieper CF, Colón-Emeric C. Physical Function Assessment in Older Hemodialysis Patients. Kidney Med 2020; 2:425-431. [PMID: 32775982 PMCID: PMC7406854 DOI: 10.1016/j.xkme.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
RATIONALE & OBJECTIVE Physical function is not routinely measured in older adults receiving dialysis. We evaluated the appropriateness of repeated measurements of physical function, including Short Physical Performance Battery (SPPB), handgrip strength, and activities of daily living (ADLs), in older adults receiving dialysis. STUDY DESIGN Prospective study. SETTING & PARTICIPANTS 37 community-dwelling adults 65 years and older receiving in-center hemodialysis at 5 dialysis units located in North Carolina. EXPOSURES SPPB (an assessment of standing balance, chair stands, and gait speed), handgrip strength, and Katz and Lawton ADLs at baseline and subsequent 3-month intervals up to 6 months. OUTCOMES Completion rate, presence of floor or ceiling effects, and presence of clinically meaningful change in physical function measurements. RESULTS Of 55 potential participants, we enrolled 37 (67%) older adults receiving hemodialysis. Among 35 enrolled participants who completed baseline assessment in a dialysis unit, mean age was 70.1 (SD, 5) years, 46% (n = 16) were women, 77% (n = 27) were African American, and median time receiving dialysis was 2.7 (IQR, 0.6-5.0) years. There were 3 deaths within the observation period, and study retention at 3 and 6 months was 83% (n = 29) and 74% (n = 26), respectively. Participants tolerated measurements; only 2 participants did not attempt 1 of the performance-based tests at a study visit. Baseline median SPPB score, grip strength, and gait speed were 6 (IQR, 4-9), 55 (IQR, 42-70) kg, and 0.76 (IQR, 0.46-0.86) m/s, respectively. Baseline median for Katz and Lawton ADLs were 6 (IQR, 6-6) and 7 (IQR, 4-8), respectively; ceiling effects were observed for both measures. For some participants, clinically meaningful changes (improvement or decline) in SPPB score, grip strength, and gait speed occurred at each 3-month interval. LIMITATIONS Limited geographic and ethnic variation. CONCLUSIONS SPPB, handgrip strength, and gait speed alone are appropriate measures for interval physical function assessment in community-dwelling older adults receiving in-center hemodialysis.
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Affiliation(s)
- Rasheeda K. Hall
- Renal Section, Durham Veterans Affairs Healthcare System, Durham, NC
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC
- Division of Nephrology, Department of Medicine, Duke University, Durham, NC
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
| | - Jeanette Rutledge
- Division of Nephrology, Department of Medicine, Duke University, Durham, NC
| | - Alison Luciano
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
| | - Katherine Hall
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
- Division of Geriatric Medicine, Department of Medicine, Duke University, Durham, NC
| | - Carl F. Pieper
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Cathleen Colón-Emeric
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
- Division of Geriatric Medicine, Department of Medicine, Duke University, Durham, NC
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Chuasuwan A, Pooripussarakul S, Thakkinstian A, Ingsathit A, Pattanaprateep O. Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis: a systematic review and meta-analysis. Health Qual Life Outcomes 2020; 18:191. [PMID: 32552800 PMCID: PMC7302145 DOI: 10.1186/s12955-020-01449-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/11/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE End-stage renal disease (ESRD) leads to renal replacement therapy and certainly has an impact on patients' health-related quality of life (HRQoL). This study aimed to review and compare the HRQoL between peritoneal dialysis (PD) and hemodialysis (HD) patients using the 36-Item Short Form Health Survey (SF-36), EuroQoL-5-dimension (EQ-5D) and the Kidney Disease Quality of Life Instrument (KDQOL). METHODOLOGY Systematic review was conducted by identify relevant studies through MEDLINE and SCOPUS up to April 2017. Studies were eligible with following criteria: studied in ESRD patients, compare any pair of renal replacement modalities, and reported HRQoL. The unstandardized mean differences (USMD) of HRQoL among modalities were calculated and pooled using a random-effect models if heterogeneity was present, otherwise a fixed-effect model was applied. RESULTS A total of twenty-one studies were included with 29,000 participants. Of them, mean age and percent male were 48.1 years and 45.1, respectively. The pooled USMD (95% CI) of SF-36 between PD and HD (base) were 1.86 (0.47, 3.24) and 0.42 (- 1.99, 2.82) for mental component and physical component summary scores, respectively. For EQ-5D, the pooled USMD of utility and visual analogue scale (VAS) score were 0.02 (- 0.06, 0.10) and 3.56 (1.73, 5.39), respectively. The pooled USMD of KDQOL were 9.67 (5.67, 13.68), 6.71 (- 5.92, 19.32) 6.30 (- 0.41, 12.18), 2.35 (- 4.35, 9.04), 2.10 (0.07, 4.13), and 1.21 (- 2.98, 5.40) for burden of kidney disease, work status, effects of kidney disease, quality of social interaction, symptoms, and cognitive function. CONCLUSION Patients with chronic kidney disease (CKD) stage 5 or ESRD treated with PD had better generic HRQoL measured by SF-36 and EQ-5D than HD patients. In addition, PD had higher specific HRQoL by KDQOL than HD patients in subdomain of physical functioning, role limitations due to emotional problems, effects and burden of kidney disease.
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Affiliation(s)
- Anan Chuasuwan
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, Thailand.,Nephrology Division, Department of Medicine, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Siriporn Pooripussarakul
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, Thailand
| | - Atiporn Ingsathit
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, Thailand.,Nephrology Division, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, Thailand.
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30
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Lawitz E, Flisiak R, Abunimeh M, Sise ME, Park JY, Kaskas M, Bruchfeld A, Wörns MA, Aglitti A, Zamor PJ, Xue Z, Schnell G, Jalundhwala YJ, Porcalla A, Mensa FJ, Persico M. Efficacy and safety of glecaprevir/pibrentasvir in renally impaired patients with chronic HCV infection. Liver Int 2020; 40:1032-1041. [PMID: 31821716 DOI: 10.1111/liv.14320] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Chronic hepatitis C virus (HCV) infection increases the risk of incident chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD). Previously available direct-acting antiviral regimens are not approved for patients with advanced CKD across all HCV genotypes. METHODS EXPEDITION-5 is a phase 3 study to evaluate efficacy and safety of the fixed-dose combination of glecaprevir and pibrentasvir (G/P) for chronic HCV infection (genotype 1 through 6) in adults without cirrhosis or with compensated cirrhosis and with stage 3b, 4 or 5 CKD. Patients received approved duration of G/P according to HCV genotype, cirrhosis status and prior HCV treatment experience. The primary efficacy endpoint was percentage of patients with sustained virologic response at 12 weeks post-treatment (SVR12). RESULTS Among the 101 patients enrolled in the study, 24% had predialysis CKD and 76% were on dialysis. Eighty-four patients were treated with G/P for 8 weeks, 13 patients for 12 weeks and four patients for 16 weeks. Fifty-five per cent of patients had genotype 1, 27% had genotype 2, 15% had genotype 3 and 4% had genotype 4, and none had genotype 5 or 6 infection. The SVR12 rate was 97% (98/101, 95% confidence interval, 91.6-99.0). No patients experienced virologic failure. Adverse events (AEs) reported in at least 5% of the patients were pruritus, bronchitis, hypertension and generalized pruritus. Serious AEs were reported in 12% of patients; none related to study drug. CONCLUSIONS G/P treatment yielded high SVR12 rates irrespective of the presence of stage 3b, 4 or 5 CKD. No safety signals were detected. CLINICALTRIALS. GOV IDENTIFIER This Phase 3 clinical trial was funded by AbbVie and registered with clinicaltrials.gov as NCT03069365 (EXPEDITION-5).
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Affiliation(s)
- Eric Lawitz
- The Texas Liver Institute, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | | | - Meghan E Sise
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | - Jun Y Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Annette Bruchfeld
- Department of Renal Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Marcus-Alexander Wörns
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andrea Aglitti
- Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy
| | | | | | | | | | | | | | - Marcello Persico
- Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy
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31
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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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Dano S, Pokarowski M, Liao B, Tang E, Ekundayo O, Li V, Edwards N, Ford H, Novak M, Mucsi I. Evaluating symptom burden in kidney transplant recipients: validation of the revised Edmonton Symptom Assessment System for kidney transplant recipients - a single-center, cross-sectional study. Transpl Int 2020; 33:423-436. [PMID: 31919903 DOI: 10.1111/tri.13572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/20/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022]
Abstract
We assessed the validity of the Edmonton Symptom Assessment System (ESAS-r) in kidney transplant recipients (KTR). A cross-sectional sample of 252 KTR was recruited. Individual ESAS-r symptom scores and symptom domain scores were evaluated. Internal consistency, convergent validity, and construct validity were assessed with Cronbach's α, Spearman's rank correlations, and a priori-defined risk group comparisons. Mean (SD) age was 51 (16), 58% were male, and 58% Caucasian. ESAS-r Physical, Emotional, and Global Symptom Scores demonstrated good internal consistency (α > 0.8 for all). ESAS-r Physical and Global Symptom Scores strongly correlated with PHQ-9 scores (0.72, 95% CI: 0.64-0.78 and 0.74, 95% CI: 0.67-0.80). For a priori-defined risk groups, individual ESAS-r symptom score differed between groups with lower versus higher eGFR [pain: 1 (0-3) vs. 0 (0-2), delta = 0.18; tiredness: 3 (1-5) vs. 1.5 (0-4), delta = 0.21] and lower versus higher hemoglobin [tiredness: 3 (1-6) vs. 2 (0-4), delta = 0.27]. ESAS-r Global and Physical Symptom Scores differed between groups with lower versus higher hemoglobin [13 (6-29) vs. 6.5 (0-18.5), delta = 0.3, and 9 (2-19) vs. 4 (0-13), delta = 0.24] and lower versus higher eGFR [11 (4-20) vs. 6.5 (2-13), delta = 0.21, and 7 (2-16) vs. 3 (0-9), delta = 0.26]. These data support reliability and construct validity of ESAS-r in KTR. Future studies should explore its clinical utility for symptom assessment among KTR.
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Affiliation(s)
- Sumaya Dano
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Martha Pokarowski
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Betty Liao
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Evan Tang
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Oladapo Ekundayo
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vernon Li
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nathaniel Edwards
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Heather Ford
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
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Hayashino Y, Okamura S, Tsujii S, Ishii H. Predictive Validity of Each Item of the 8-Item Short-Form Health Survey for All-Cause Mortality in Japanese patients with type 2 diabetes: A prospective Cohort Study (Diabetes Distress and Care Registry at Tenri [DDCRT 19]). Exp Clin Endocrinol Diabetes 2019; 129:722-728. [PMID: 31822020 DOI: 10.1055/a-1044-2041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS While health-related quality of life (HRQOL) is reported to be associated with mortality, this assessment was made using surveys with a large number of questions, not specifically focused on populations with diabetes, or in western countries alone. We thus evaluated the predictive validity of summary scores, and each item score of the 8-Item Short-Form Health Survey in Japanese individuals with type-2 diabetes. MATERIALS AND METHODS Longitudinal data from 3269 individuals with diabetes were obtained from a large Japanese diabetes registry. To assess the independent correlation between the 10-point scores of the SF-8 physical component summary (PCS) and mental component summary (MCS), each item score, and all-cause mortality, the Cox proportional hazards model was used with adjustment for potential confounders. RESULTS Mean cohort parameters included age (64.9 years [SD 11.2]), body mass index (24.6 kg/m2 [SD, 3.9]), and HbA1c level (7.5% [SD, 1.2]; or 58.6 mmol/mol [SD, 12.7]). We recorded 248 deaths during the median follow-up of 7.2 years (incidence ratio, 12.2 per 1000 person-years). Multivariable-adjusted HRs for all-cause mortality were 0.780 (95%CI, 0.674-0.902; p=0.001) and 0.776 (95%CI, 0.656-0.917; p=0.003), respectively, for 10-point increment of PCS and MCS scores. Higher score of any single item of SF-8 was associated with lower risk of all-cause mortality even after adjusting for possible confounders. CONCLUSIONS As assessed by the SF-8, higher PCS, MCS, and any single 1-item scores were associated with lower risk of all-cause mortality in Japanese individuals with type 2 diabetes.
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Affiliation(s)
| | | | - Satoru Tsujii
- Department of Endocrinology, Tenri Hospital, Tenri, Japan
| | - Hitoshi Ishii
- Department of Diabetology, Nara Medical University, Kashihara, Japan
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Merino Martínez RM, Morillo Gallego N, Sánchez Cabezas AM, Gómez López VE, Crespo Montero R. Relación entre la calidad de vida relacionada con la salud y la ansiedad/depresión en pacientes en hemodiálisis crónica. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000300006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: El objetivo del presente estudio fue analizar la Calidad de Vida Relacionada con la Salud en pacientes hemodiálisis y su relación con la ansiedad y la depresión.
Pacientes y Método: Se estudiaron 122 pacientes en hemodiálisis, con una edad de 66,47±14,2 años (34,4% mujeres). Se realizó un estudio descriptivo y transversal, en el área de influencia del Servicio de Nefrología del Hospital Reina Sofía de Córdoba. Se estudió la Calidad de Vida Relacionada con la Salud (cuestionario KDQOL-SF), Ansiedad y Depresión (cuestionario Escala de Ansiedad y Depresión de Goldberg) y la comorbilidad asociada.
Resultados: En el KDQOL, las dimensiones más afectadas fueron: Situación Laboral, Carga de la Enfermedad Renal, Función Sexual y Sueño. En las dimensiones del cuestionario SF, las áreas más afectadas fueron: Rol Físico, Salud General y Función Física. El 42,6% de los pacientes presentaron probabilidad de tener ansiedad, el 52,5% depresión, y el 32,8% presentaban la probabilidad de padecer ambas alteraciones (ansiedad y depresión). La ansiedad y la depresión se asociaron de forma significativa a peores puntuaciones en todas las dimensiones del cuestionario KDQOL-SF. Conclusiones: Los pacientes en hemodiálisis presentan peor calidad de vida que la población sana de referencia, especialmente en las dimensiones Carga de la enfermedad renal, Sueño, Salud general, Vitalidad, Función física y Rol físico. Esta disminución de la calidad de vida está relacionada con la probabilidad de padecer ansiedad y/o depresión. El sexo femenino, la comorbilidad asociada y el tiempo en hemodiálisis, se asocian también a peor calidad de vida.
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Hall RK, Luciano A, Pendergast JF, Colón-Emeric CS. Self-reported Physical Function Decline and Mortality in Older Adults Receiving Hemodialysis. Kidney Med 2019; 1:288-295. [PMID: 32734209 PMCID: PMC7380442 DOI: 10.1016/j.xkme.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Rationale & Objective Timely recognition of functional decline in older adults receiving dialysis will allow clinicians to pursue interventions to prevent further disability and/or lead patient-centered goals of care discussions. Annual change in the 12-Item Short Form Health Survey (SF-12) physical component score (PCS) could identify patients with functional decline. Our objectives were to assess SF-12 PCS change over a year, risk factors associated with SF-12 PCS change, and the association of SF-12 PCS change with mortality in a survivor cohort of older adults receiving dialysis. Study Design Retrospective study. Setting & Participants 1,371 adults 65 years or older receiving hemodialysis for 6 or more months who completed SF-12 PCSs 300 or more days apart from 2012 to 2013. Exposures Serum albumin level; hemodialysis access type; SF-12 PCS change (for mortality analyses). Outcomes SF-12 PCS change and mortality. Analytical Approach Multivariable-adjusted linear regression model; Cox proportional hazards model. Results We excluded 24% (n = 801) of our cohort for death before the second SF-12 PCS. Among the 1,371 with sufficient SF-12 PCS data, mean age was 79.9 ± 4.5 years. Average SF-12 PCS change in 1 year was minimal (−0.9 ± 9.6), but 39.3% (n = 539) and 32.2% (n = 442) had clinically relevant SF-12 PCS decline and improvement, respectively. Albumin level and access type were not statistically associated with SF-12 PCS change. SF-12 PCS change was not associated with mortality (adjusted HR, 0.98; 95% CI, 0.96-1.00). Limitations 2 time points to assess SF-12 PCS change; covariate assessment only at baseline; survivor bias. Conclusions In this cohort of older adults receiving hemodialysis, nearly one-fourth died, while among survivors, it was more common for SF-12 PCS to decline than improve in a year. Annual SF-12 PCS change was not associated with traditional risk factors for functional impairment or mortality risk. Additional research is needed to identify appropriate measures and frequency of assessment for functional decline.
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Affiliation(s)
- Rasheeda K. Hall
- Durham Veterans Affairs Geriatric Research, Education and Clinical Center, Durham, NC
- Renal Section, Durham Veterans Affairs Medical Center, Durham, NC
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC
- Address for Correspondence: Rasheeda Hall, MD, MBA, MHSc, Box DUMC 2747, 2424 Erwin Rd, Ste 605, Durham, NC 27710.
| | - Alison Luciano
- Center for the Study of Aging and Human Development, Durham, NC
| | - Jane F. Pendergast
- Center for the Study of Aging and Human Development, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Cathleen S. Colón-Emeric
- Durham Veterans Affairs Geriatric Research, Education and Clinical Center, Durham, NC
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC
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Alencar SBVD, de Lima FM, Dias LDA, Dias VDA, Lessa AC, Bezerra JM, Apolinário JF, de Petribu KC. Depression and quality of life in older adults on hemodialysis. ACTA ACUST UNITED AC 2019; 42:195-200. [PMID: 31389496 PMCID: PMC7115449 DOI: 10.1590/1516-4446-2018-0345] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/03/2019] [Indexed: 01/28/2023]
Abstract
Objective: Depression is highly prevalent in hemodialysis patients, but few studies have evaluated older hemodialysis patients. The aim of this study was to evaluate the prevalence of depression, its associated factors and its impact on quality of life in an older population on hemodialysis. Methods: This was a cross-sectional study including 173 hemodialysis patients aged 60 years or older in Recife, Brazil. Depression was evaluated using the Mini-International Neuropsychiatric Interview when depressive symptoms (according to the 5-item Geriatric Depression Scale) were present. Quality of life was assessed with the Control, Autonomy, Self-realization and Pleasure Questionnaire (CASP-16). Data were also collected on sociodemographic, laboratory (albumin, parathormone, hemoglobin, and phosphorus) and dialysis (dialysis vintage, vascular access and hemodialysis adequacy) characteristics. Results: Depression was present in 22.5% of the sample. Depressed patients presented low CASP-16 quality of life scores (31.6 vs. 24.2, p < 0.001), twice the odds of albumin levels < 3.8 g/dL (OR 2.36; 95%CI 1.10-5.07; p = 0.027) and higher parathormone levels (OR 1.06; 95%CI 1.00-1.13; p = 0.05). Conclusion: Older hemodialysis patients have a high prevalence of depression. Depressed patients presented poor quality of life, lower serum albumin and higher parathormone levels. Teams dealing with older hemodialysis patients should include depression and quality of life assessments in care protocols.
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Affiliation(s)
- Saulo B V de Alencar
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Fábia M de Lima
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Luana do A Dias
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Victor do A Dias
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Anna C Lessa
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Jéssika M Bezerra
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Julianna F Apolinário
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Kátia C de Petribu
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
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Obesity phenotype and patient-reported outcomes in moderate and severe chronic kidney disease: a cross-sectional study from the CKD-REIN cohort study. Qual Life Res 2019; 28:1873-1883. [DOI: 10.1007/s11136-019-02110-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
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Higuita-Gutiérrez LF, Velasco-Castaño JJ, Jiménez Quiceno JN. Health-Related Quality of Life in Patients with Chronic Kidney Disease in Hemodialysis in Medellín (Colombia). Patient Prefer Adherence 2019; 13:2061-2070. [PMID: 31849455 PMCID: PMC6911811 DOI: 10.2147/ppa.s229670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/05/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Hemodialysis is a treatment that is essential for the survival of patients with terminal chronic kidney disease. However, it is highly invasive, non-curative, and physically, psychologically, socially, and financially demanding, which has an impact on the patient's health-related quality of life (HRQL). In Colombia, research from the point of view of patients undergoing hemodialysis is scarce. PATIENTS AND METHODS We conducted a cross-sectional study involving 142 patients undergoing hemodialysis. We used an instrument that included the demographic and clinical information as well as the Charlson Comorbidity Index and Karnofsky Performance Status Scale. HRQL was assessed using EQ-5D-5L and KDQOL-36. The analysis was done using measures of central tendency for quantitative variables and relative frequencies for qualitative variables, in addition bivariate and multivariate regression analyses were conducted. RESULTS Based on the scores of the EQ-5D-5L scale, it was found that 14.5% subjects showed severe mobility problems, 5.8% were unable to bathe or dress by themselves, 12.9% were unable to perform usual activities, 13.5% were experiencing pain or discomfort (between strong and extreme), and 58.6% showed a certain degree of anxiety or depression. The KDQOL-36 scores were 67.4 ± 19.4 for the symptoms domain and 35.0 ± 27.5 for the disease burden domain. Results of the linear regression analysis showed that the main factors associated with HRQL were the Karnofsky Index and serum albumin levels (p < 0.05). CONCLUSION The result of this study revealed the impact on the quality of life of Colombian patients undergoing hemodialysis with chronic kidney disease who were highly affected by the disease burden. KDQOL-36 has excellent properties of reliability, internal consistency, and discriminant power; thus, its use is recommended in subsequent studies to monitor HRQL in this population.
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Affiliation(s)
- Luis Felipe Higuita-Gutiérrez
- Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, Colombia
- Correspondence: Luis Felipe Higuita-Gutiérrez Tel +57 4446065 Ext. 4228 Email
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Aguiar R, Pei M, Qureshi AR, Lindholm B. Health-related quality of life in peritoneal dialysis patients: A narrative review. Semin Dial 2018; 32:452-462. [PMID: 30575128 DOI: 10.1111/sdi.12770] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Rute Aguiar
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden.,Nephrology, Hospital Espírito Santo, Évora, Portugal
| | - Ming Pei
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden.,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Abdul Rashid Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
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