Demographic factors affecting quality of life of hemodialysis patients - Lahore, Pakistan

Serum Vitamin B12 Deficiency in Chronic Hemodialysis Patients

Introduction Essential vitamins like folate and vitamin B12 are crucial for many physiological functions. Patients with renal failure undergoing regular hemodialysis in the general population may experience harmful effects from vitamin B12 deficits. Therefore, this study aimed to determine the frequency of vitamin B12 deficiency in hemodialysis patients and its association with other clinical parameters. Methods This cross-sectional study was conducted at the dialysis unit of Patel Hospital and Lifeline Hospital, Karachi, using a non-probability consecutive sampling technique after obtaining ethical approval from Lifeline Hospital (LLH/HR/02-22). The study duration was six months, from January 10, 2023, to July 22, 2023. A total of 135 adult renal failure patients with ages >18 and <70 years on maintenance hemodialysis for >1 year were included in the study. The chi-square test was used to determine the association between vitamin B12 deficiency and age and gender. A p-value of 0.05 was considered statistically significant. Results The study findings showed that out of 135 patients, 82 (60.7%) were males and 53 (39.3%) were females, with a mean age of 50.80 ± 10.03 years. The duration of hemodialysis was approximately 1-2 years in 98 (72.6%) patients, 2-3 years in 27 (20.0%) patients, and 3-4 years in only 9 (6.7%) patients. The mean serum vitamin B-12 levels were 411.61 ± 224.95 pg/ml, with 30 (22.2%) of the subjects being deficient. In terms of duration of hemodialysis, there was a significant association (p= 0.013). Between patients with normal 4 (4%) and deficient 5 (17%) vitamin B12 and 3-4 years of hemodialysis. Conclusion In this study, we found that a significant proportion of patients on chronic hemodialysis had vitamin B12 deficiency. Moreover, vitamin B12 deficiency was significantly associated with duration of hemodialysis. Therefore, we recommend periodic vitamin B12 testing in hemodialysis patients to avoid any associated complications.

Pain and quality of life of patients with end-stage renal disease undergoing hemodialysis in Aseer region, Saudi Arabia

BACKGROUND

Pain has an adverse effect on HRQoL and has social, psychological, and physical repercussions for ESRD patients. In the present study, we assessed chronic pain in ESRD patients on HD in terms of severity and interference with activity. We also assessed the impact it has on these patients, along with looking at the factors that were linked to QoL in this population.

METHODS

A multicenter, cross-sectional study carried out between April and July of 2023 in the hemodialysis units of Asir Central Hospital and Khamis Mushait General Hospital. Brief Pain Inventory and European Quality of Life scale 5 dimensions (EQ-5D) scale, including its European Quality of Life visual analogue scale (EQ-VAS) component, were used to assess pain and QoL, respectively.

RESULTS

A total of 97 participants were included in the final study. The average interference level of pain with daily functions was 22.5 ± 15.0 out of 70. The mean interference score was significantly higher among patients at rural areas (28.2 ± 16.3; P = 0.012), and those who undergone dialysis session for ≥ 4 times per week (31.6 ± 16.7; P = 0.026). The overall score of quality of life ranged from 20% to 92% with mean score of 36.5 ± 12.8%. The multiple linear regression analysis revealed that patients with higher BMI, more frequent dialysis sessions per week, and higher level of pain interference with daily functions demonstrated lower QoL (B= - 2.36, - 1.46, and - 0.64, respectively.

CONCLUSIONS

Pain has a significant negative impact on QoL in ESRD patients undergoing HD. Patients with higher BMI, more frequent dialysis sessions, and higher level of pain interference with daily functions are at higher risk of lower QoL. These findings provide valuable information for educators, physicians, and other healthcare providers working with patients undergoing HD.

Examinations of effects of socio-demographic features and disease-related data of patients with hemodialysis on the quality of life

This study aimed to detect the effects of demographic features and disease-related data of individuals with hemodialysis treatment on quality of life. The research universe consisted of 113 patients who received dialysis treatment in three state hospitals. Sampling was not used in this research with 97 volunteer patients who complied with the study criteria. The data collection process was performed face-to-face between 1 May and 30 June 2020. Data was collected using the Participant Information Form and the Quality of Life Scale (Short From-36). In our research, 50.5% of participants were male and 49.5% were female. The age of 61.9% of participants was ≥ 51 years and 78.4% were married. Most participants (67%) had ≥ 3 children, 35.1% received dialysis treatment for 3-10 years, 90.7% had dialysis three times a week, and 64.9% had an arterio-venous fistula vascular access line. In addition, 24% had another family member who received dialysis treatment, with hypertension as the etiology in 35.6% of chronic renal failure (CRF). The findings showed that 93.8% patients had no previous transplantation, and 62.9% considered future transplantation.Within the scope of this research, the findings suggest that the quality of life of dialysis patients was poor. Demographic features and disease data affected the quality of life at different levels.

Health-related quality of life of dialysis patients during early COVID-19 lockdowns: a snapshot from a public hospital in Malaysia

Background

End-stage renal disease is the last stage of chronic kidney disease and can affect the quality of life (QOL) of dialysis patients. The aim of this study was to assess the quality of life and examine its determinants.

Methods

A cross-sectional survey involving patients on dialysis in a tertiary hospital was conducted from July 2020 to September 2020. Demographic data were collected using a predesigned questionnaire. QOL was measured using the 36-item KDQOL questionnaire, and statistical analysis was carried out using SPSS version 25.

Results

Of the 108 patients, 59 were men and 49 were women, and the mean age was 48.15 ± 15.4 years. The results showed that there was no significant difference in the mean score of all components of health-related quality of life in different types of dialysis. The demographic data, which included age, gender, ethnicity, marital status, education level, occupation, and monthly income, did not significantly affect the QOL of dialysis patients. Patients with a dialysis duration of more than 5 years had a better QOL compared to other groups. Laboratory parameters such as low albumin and low hemoglobin showed a significant correlation with the health-related quality of life of dialysis patients.

Conclusion

The quality of life among patients on dialysis was impaired, especially in terms of burden of the kidney disease. Hypoalbuminemia and anemia were the two factors that influenced QOL.

Health-related quality-of-life measures used in hemodialysis patients in Albania

Background

Chronic kidney disease is a growing worldwide public health concern. On the other hand, patients’ perception of health is an important outcome measure in the assessment of the influence of chronic disease and received treatment. Interest in measuring health-related quality of life has increased together with an awareness that such humanistic outcomes require valid and reliable measures. The aimed study was to evaluate the health-related quality of life (QoL) and to investigate the relationship between selected demographic and clinical characteristics and Health-related Quality of Life (HRQoL) scores in hemodialysis patients.

Methods

This survey study was conducted on hemodialysis patients (209 patients) during the periods 2017–2018. The QoL includes 25 questions classified into five dimensions, which are mobility, personal care, common activities, discomfort and pain, anxiety, and depression. P value < .05 was considered statistically significant.

Results

Overall 209 hemodialysis patients, the mean of the five domains varies from a minimum value of 1.75 ± 1.06 for personal care to a maximum value of 2.65 ± 1.44 for anxiety and/or depression. In our study, among hemodialysis patients is seen a significant association scored between the quality of life and demographic variables like age groups (p = 0.034), and gender (p = 0.01) as in the previous studies. The presence of comorbidities was significantly associated with the QOL (p = 0.001). About the questionnaire, “How good or bad your health is today” the average score resulted to be 47.08 ± 4.5.

Conclusion

As we saw from the results of this study, a considerable number of the patients live with low income. Age, sex, and comorbidities are dependent factors of HRQoL. Therefore, we suggest that future studies include other factors that will evaluate hemodialysis efficiency and find the association between these and QoL.

Factors and Predictors of Health Related Quality of Life of the General Population of Pakistan

Background and Objective

The standards of living, improvement in public health, and medical care in Pakistan are increasing day by day, health-related quality of life (HRQoL) has been increasingly acknowledged in various patient's reported outcomes in Pakistan. However, a large-scale general population-based study on assessing HQRoL in Pakistan was not conducted. Therefore, this study aimed to evaluate HRQoL for the general Pakistani population.

Material and Methods

A cross-sectional study with a population sample (n = 16,672) was selected from all Pakistan provinces using a stratified sampling approach. The EQ-5D-3L tool was used to measure the HRQoL of the general population of Pakistan. The descriptive and inferential statistics have been done by using SPSS version 20.

Results

Overall, 121 health states were reported in this study. EQ-5D index and EQ-VAS scores were 0.74 ± 0.32 and 0.75 ± 0.25, respectively. The percentage of people responding to any problems increased with age. Males have better health as compared to females in all age groups. All demographics were significantly associated (P < 0.01) with the mean EQ5D index and VAS scores except residence (p > 0.05). The regression model reported that age was the best predictor of the EQ-5D index scores after adjusting for the covariates (beta = 0.19; p < 0.001). This study provides Pakistani population HRQoL data measured by the EQ-5D tool, based on a national representative sample.

Conclusion

The current study concluded that Age, City, Gender, Education, Occupation, Residence, and House occupancy are significantly affecting HRQOL. The socioeconomically deprived groups and females have inferior health status than more advantaged. The trends detected in high-income nations were usually similar to Pakistan.

Factors influencing health-related quality of life in people with chronic kidney disease: A structural equation modelling approach

AIMS AND OBJECTIVES

To test whether the revised Wilson and Cleary model could identify which factors contribute to health-related quality of life in chronic kidney disease.

BACKGROUND

Chronic kidney disease affects a person's health-related quality of life detrimentally although nursing practice informed by theory is only beginning to emerge.

DESIGN

A cross-sectional study reported using the STROBE guidelines.

METHODS

About 886 participants with chronic kidney disease (varying grades) completed validated measures of symptoms (renal version of the Integrated Palliative care Outcome Scale), and general health perceptions and health-related quality of life (European Quality of Life five-dimension three-level). Socio-demographic and renal characteristics were also collected. Data were analysed using descriptive statistics and structural equation modelling.

RESULTS

Biological function (decreased kidney function and haemoglobin and greater number of comorbidities), directly contributed to increased symptom burden. Symptoms demonstrated strong negative relationships with both general health perceptions and health-related quality of life. General health perceptions had a direct positive relationship with health-related quality of life. As age increased, health-related quality of life decreased. The only environmental characteristic of significance was the distance between home and hospital although it was not directly associated with health-related quality of life. Overall, the model explained approximately half of the deterioration in health-related quality of life.

CONCLUSIONS

The model demonstrated how various factors influence alteration of health-related quality of life in people with chronic kidney disease. Early identification of these factors could assist nurses to introduce effective management strategies into patient care plans proactively.

RELEVANCE TO CLINICAL PRACTICE

Comprehensive symptom assessment needs to occur not only in kidney failure but in earlier chronic kidney disease grades to enable timely interventions targeted at improving people's wellbeing.

PATIENT OR PUBLIC CONTRIBUTION

Validated interviewer administered questionnaires were completed by participants with chronic kidney disease in this study.

Perceived predictors of quality of life in patients with end-stage renal disease on dialysis

BACKGROUND

Reduced quality of life (QOL) is associated with shorter survival, and is more marked in patients with end-stage renal disease (ESRD). Predictors of health, which include policymaking, social factors, health services, individual behaviour, biology and genetics, have an impact on the QOL of patients with ESRD. Patients with ESRD in South Africa are cared for in public and private hospitals, with public health institutions characterised by several challenges.

OBJECTIVE

To explore and analyse the perceived predictors of QOL in patients with ESRD in the three district hospitals that provide renal services in KwaZulu-Natal.

METHODS

An exploratory, descriptive qualitative research approach based on grounded theory research design was used and three focus group discussions (FGDs) were conducted. The researcher recruited 18 participants, 6 in each focus group. Three phases of data analysis were followed: open coding, axial coding, and selective coding.

RESULTS

Predictors of QOL that emerged were the geographic location of the patients, accessibility of haemodialysis centres, patients' adaptation and acceptance of the condition, self-management, support by family members and caregivers and availability of adequately trained nurses.

CONCLUSION

Predictors of QOL in patients with ESRD are associated with an increased risk of morbidity and mortality resulting from dialysis. The broad range of dimensions of life is negatively affected and requires intervention by the renal team and policymakers to improve the QOL of patients.

Physical performance and health-related quality of life among older adults on peritoneal dialysis: a cross-sectional study

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.

Assessing quality of life using WHOQOL-BREF: A cross-sectional insight among patients on warfarin in Malaysia

Background and aim

The effect of anticoagulation control on overall Health-Related Quality of Life (HRQoL) in patients taking warfarin in Malaysia has not been explored yet. Therefore, this study aimed to evaluate HRQoL among patients on warfarin in Malaysia.

Methods

HRQoL among patients on warfarin was measured using WHOQOL-BREF (World Health Organization Quality of life Assessment: Brief Version). Descriptive and inferential statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 22.

Results

Out of 319 patients, more female patients were observed than the males (n = 221, 69.3%, and n = 98, 30.7% respectively). Mean scores for the physical (61.14 ± 15.96), psychological (68.58 ± 16.11), social (63.55 ± 27.06) and environmental domains (62.78 ± 17.58) were observed. Statistically, a significant association was found between the comorbidities other than CVDs with health satisfaction (p = 0.002), physical (p = 0.001), psychological (p < 0.001), social (p = 0.003) and environmental domains of the WHOQOL-BREF. A weak positive correlation between overall health satisfaction and the social domain (r = 0.153) and a moderate positive correlation between the physical and environmental domains (r = 0.628) of the WHOQOL-BREF were observed.

Conclusion

Patients had overall better perceived HRQoL scores in the psychological domain as compared with the rest of the domains of the WHOQOL-BREF. Age, gender, employment status, education level, the indication of use and duration of warfarin therapy associated with overall perceived HRQoL.

Determinants of health-related quality of life among warfarin patients in Pakistan

INTRODUCTION

The effect of anticoagulation control on overall Health-Related Quality of Life (HRQoL) in patients taking warfarin in Pakistan has not been explored yet. Therefore, this study aimed to evaluate HRQoL among warfarin patients in Pakistan.

METHODS

This cross-sectional study was conducted among patients on warfarin in Pakistan. By purposive sampling, data were collected using demographic data collection form and the World Health Organization Quality of Life: Brief Version (WHOQOL-BREF). The WHOQOL-BREF is comprised of four domains; physical, psychological, social relationships, and environment. Descriptive and inferential statistical analysis was done using SPSS version 22.

RESULTS

Out of 295 warfarin patients, more females than males (<0.001) were observed (n = 184, 62.4%, and n = 111, 37.6% respectively). One hundred and eighteen (40.0%) patients were less than 30-years of age, whereas one hundred and seventy-seven (60.0%) patients were above 30-years of age. Mean scores for the physical (62.44±15.36), psychological (67.84±15.54), social (64.27±26.28) and environment domains (63.45±17.66) were observed.

CONCLUSION

Patients had overall lower to moderate but satisfactory HRQoL scores in all four domains. Age, gender, employment status, education level, the indication of use and duration of warfarin therapy was associated with one or more domains of HRQoL among warfarin patients. The findings of this study would serve as a primary database for future studies. This study highlights how non-clinical factors could impact HRQoL in studied patients.

Assessment of Quality of Life among End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis

Background:

Renal failure is a chronic disease that can seriously affect quality of life (QOL). Health-Related QOL represents the physical, psychological, and social domains of health that are influenced by a person's experience, beliefs, expectations, and perceptions. The aim of this study is to explore QOL of Stage 5 chronic kidney disease (CKD) patients on maintenance hemodialysis (MHD) in South India.

Materials and Methods:

This was a cross-sectional observational study conducted among patients with CKD undergoing MHD at 11 major centers in South India. Demographic data were collected using a predesigned questionnaire. QOL index was measured using the 26-item WHOQOL-BREF questionnaire, and statistical analysis was carried out using the SPSS version 24 (Academy of Medical Sciences, Kannur, Kerala, India).

Results:

Five hundred and three patients undergoing MHD were enrolled, and the following QOL scores were recorded: social relationship (51.65 ± 21.03), environmental (46.91 ± 19.29), psychological (41.07 ± 20.30), and physical health (40.17 ± 17.05). QOL of patients declined with aging in all four domains. Being male, younger, educated, and unmarried appeared to have a favorable effect on several aspects of patients' QOL.

Conclusion:

The evaluation of QOL in CKD patients undergoing hemodialysis showed that it was relatively compromised. Because the patients had a chronic, progressive irreversible disease, the most affected was physical domain. Age, education, employment, and marital status were found to affect one or more domains of QOL. Age and education are significant independent variables; as the age increases, QOL decreases, and higher the education better the QOL.

Health-related quality of life in end-stage renal disease patients, using the Missoula-Vitas quality of life index: a multicenter study

Background and aims

Assessment of Health-related Quality of Life in chronic hemodialysis patients (CHD) is a predictive indicator of the outcome of the disease, including mortality and hospitalization. Regular surveys of the quality of life (QoL) in CHD patients have been conducted worldwide, using various, internationally validated and standardized tools, including the Missoula-VITAS Quality of Life Index scale (MVQOLI). The aim of this study was to examine the reliability and validity of the Bulgarian version of the Missoula-VITAS Quality of Life Index-15 (B-MVQOLI-15) and QoL in CHD patients using this instrument.

Methods

Our study was designed as multi-center cross-sectional. It incorporated 263 end-stage renal disease (ESRD) patients on CHD from across the country and applied the B-MVQOLI-15. Internal consistency and convergent validity of the index were assessed. Non-parametric methods were used to evaluate the impact of demographic factors on the different dimensions scores and on the total score. The relationship between the total QoL score, the total MVQOLI-15 score and dimensions scores were measured based on Spearman's rho Correlation Coefficient.

Results

The total MVQOLI-15 score in the study was 16.44, which is slightly above the middle of the index scale. The patients with higher education were less satisfied with the level of their symptom control compared to patients with lower education. However, high education patients seem to manage better with everyday life compared to those with low education. Men seem to feel more satisfied than women when fulfilling their daily activities (P=0.026). Retired patients and unemployed expressed more satisfaction, compared to the employed (P=0.021). Also, patients on dialysis for over 5 years had lower QoL scores (P=0.043).

Conclusions

B-MVQOLI-15 is a reliable instrument to measure QoL in Bulgarian patients with CHD. The majority of CHD patients rate their QoL as "Fair". Four of all five dimensions positively affect the QoL of CHD patients. The most important dimensions positively affecting the QoL of CHD patients were: interpersonal relationships and transcendent factors. Future studies are necessary to assess the adequacy of the delivered dialysis, the level of medico-social care and the needs of ESRD patients treated with CHD in order to improve their QoL.

Assessing the quality of life among Pakistani general population and their associated factors by using the World Health Organization's quality of life instrument (WHOQOL-BREF): a population based cross-sectional study

BACKGROUND

Measuring quality of life (QOL) in a population is important for the predictions of health and social care needs. In Pakistan, health related quality of life data exist but there are no quality of life data of general population. In this study, quality of life was assessed among the Pakistani general population and their associated factors by using the World Health Organization's quality of life instrument (WHOQOL-BREF).

METHODOLOGY

A population-based cross-sectional study was carried out in all 52 Union Councils of District Abbottabad, Khaber Pkutunkhua province, Pakistan from March 2015 to August 2015. Multi-stage cluster sampling technique was employed in this study. Quality of life was measured by using the validated WHOQOL-BREF instrument, along with socioeconomic, demographic, and World Bank social capital questions in this population- based study. The data were collected through households, utilizing face to face interviews. The association between socio-demographic variables and quality of life domains were determined by using both univariate and multivariate analysis. Descriptive statistics were derived, and a multilevel linear regression using backward analysis allowing to obtain final model for each domain was achieved to recognize the variables that affect quality of life score.

RESULTS

A total of 2063 participants were included in this study (51.2% male, 48.2% female). Mean age of participants was 37.9, SD = 13.2; ranging from 18 to 90. Mean score of quality of life domains (physical, psychological, social relationship and environmental domains) were 65.0 (SD = 15.2), 67.4 (SD = 15.0), 72.0 (SD = 16.5), 55.5 (SD = 15.0), respectively. Overall, socioeconomic status was established to be the strongest predictor of poorer quality of life for all domains as a change in SES from high to low results in reduction about (β = - 5.85, β = - 9.03, β = - 8.33, β = - 9.98, p < 0.001). Similarly, type of residency was negatively associated with physical, psychological and environmental domains while age and sex were negatively associated with physical, psychological and relationship domains in final model. Furthermore social capital (β = 0.09, β = 0.13, β =0.14, β =0.15, p < 0.001) had a positive effect on Pakistani quality of life. Overall, subjective quality of life was found to be low in our population and extremely varied by socio-demographic variables.

CONCLUSIONS

Increasing age, having average and lower socioeconomic status and living in the rural area were found to be the strong predictor of poorer quality of life in all domains, while total social capital score had a positive effect on Pakistani quality of life scores.

The role of socio-demographic factors in depression and anxiety of patients on hemodialysis: an observational cross-sectional study

PURPOSE

Depression and anxiety have high prevalence in patients on hemodialysis and are strongly associated with socio-economic factors. The aim of this study was to evaluate the prevalence of depression and anxiety in hemodialyzed patients in Greece and its association with socio-demographic factors.

METHODS

Four hundred and fourteen (414) patients on hemodialysis (262 males and 152 females) from 24 dialysis centers in Greece participated in this observational cross-sectional study. Mean age was 63.54 (54.06-72.41), and mean time of dialysis treatment was 36 (16-72) months. Depression and anxiety were assessed by the state-trait anxiety inventory (STAI), the beck depression inventory (BDI) and the hospital anxiety and depression scale (HADS). Multinomial logistic regression was performed to estimate the factors being independently associated with anxiety and depression levels (HADS scale). Multiple linear regression was performed to estimate the factors being independently associated with BDI and STAI.

RESULTS

From a total of 414 participants, (29.4%, n = 122) had depression and 35.9% (n = 149) had anxiety. Depression and anxiety were significantly associated with females, low level of education, increased patients' age, retirement, poor financial situation, marital status and co-morbidities.

CONCLUSION

The overall study findings indicated a significant correlation between the levels of anxiety and depression in patients on hemodialysis. Patients with high levels of anxiety had higher levels of depression and those with high depression scores had higher anxiety scores.

Predicting Quality of Life Changes in Hemodialysis Patients Using Machine Learning: Generation of an Early Warning System

Objective

To predict changes in the quality of life scores of hemodialysis patients for the coming month and the development of an early warning system using machine learning

Methods

It was a prospective cohort study (one-month duration) at the dialysis center of a tertiary care hospital in Pakistan. The study started on 1^st October 2016. About 78 patients have been enrolled till now. Bachelor of Medicine and Bachelor of Surgery (MBBS) qualified doctors administered a proforma with demographics and the validated Urdu version of World Health Organization Quality Of Life-BREF (WHOQOL-BREF). It was to be repeated after one month to the same patient by the same investigator. Simple statistics were computed using SPSS version 24 (IBM Corp., Armonk, NY) while machine learning was performed using R (version 3.0) and Orange (version 3.1).

Results

Using machine learning algorithms, two models (classification tree and Naïve Bayes) were generated to predict an increase or decrease of 5% in a patient’s WHOQOL-BREF score over one month. The classification tree was selected as the most accurate model with an area under curve (AUC) of 83.3% (accuracy: 81.9%) for the prediction of 5% increase in QOL and an AUC of 76.2% (accuracy: 81.8%) for the prediction of 5% decrease in QOL over the coming month. The factors associated with an increase of QOL by 5% or more over the next month included younger age (<19 years) and higher iron sucrose doses (>278mg/month). Drops in psychological, physical, and social domain scores lead to a decrease of 5% or more in QOL scores over the following month.

Conclusion

An early warning system, dialysis data interpretation for algorithmic-prediction on quality of life (DIAL) was built for the early detection of deteriorating QOL scores in the hemodialysis population using machine learning algorithms. The model pointed out that working on psychological and environmental domains, in particular, may prevent the drop in QOL scores from occurring. DIAL, if implemented on a larger scale, is expected to help patients in terms of ensuring a better QOL and in reducing the financial burden in the long term.

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

PURPOSE

Higher health-related quality of life (HRQOL) in dialysis patients has been associated with fewer hospitalizations and lower mortality. Since Arab patients on dialysis have better survival rates than Jewish patients, we hypothesized that they would have higher HRQOL. We also studied the impact of several risk factors on HRQOL in each population.

METHODS

Based on a national dialysis registry, patients from 64 hemodialysis units were recruited to participate. Patients who consented were interviewed face-to-face, using the Kidney Disease Quality of Life Short Form (KDQOL-SF36) questionnaire.

RESULTS

Five hundred and fifty-eight (50.6%) Jewish and 544 (49.4%) Arab patients participated in the study. For Arab patients mean crude scores for the "mental component summary" and KDQOL scores were significantly lower than for Jewish patients [31.6 (95% Cl 30.0-33.3) vs. 38.0 (95% Cl 36.1-39.9), p < 0.0001 and 55.6 (95% Cl 54.5-56.7) vs. 59.8 (95% Cl 58.6-60.9), p < 0.0001, respectively]. Much lower scores were observed for Arabs in the "emotional role" and "work status" subscales. The two populations had similar general health assessments and albumin level. For both, HRQOL was positively associated with higher educational level, higher albumin level, and dialysis connection by fistula or graft; and negatively associated with low income and diabetes. HRQOL was negatively associated with previous cerebrovascular accident among Arabs and with female gender among Jews.

CONCLUSIONS

Differences between Jews and Arabs in subscales related to psychosocial factors suggest that cultural differences in the perceptions of sickness and health may be relevant here. Future studies should explore such possibility and focus on the large gap in the "work status" subscale.

Assessment of quality of life in patients undergoing hemodialysis using WHOQOL-BREF questionnaire: a multicenter study

Background

Assessment of quality of life (QOL) of patients with end-stage renal disease has become increasingly important, both in order to evaluate the influence of the disease on patients and the type of renal replacement therapy they require. Therefore, in this study, we aimed to assess QOL in patients undergoing hemodialysis and evaluated the effects of various sociodemographic factors affecting QOL of such patients in Nepal.

Methods

A cross-sectional study was conducted among 150 patients with chronic kidney disease undergoing hemodialysis at two major centers in Nepal. Demographic data including age, sex, ethnicity, educational status, marital status, employment, income, duration of illness, and duration on hemodialysis were collected. QOL was assessed using the World Health Organization Quality of life (WHOQOL-BREF) questionnaire. Four domains (physical, psychological, social, and environmental) and two items (overall perception of QOL and health) of the WHOQOL-BREF were the primary end points of this study. Bivariate relationship between sociodemographic factors and QOL scores were analyzed using independent samples t-test and one-way analysis of variance. Multiple linear regression analysis was performed to determine independent predictors of QOL.

Results

Following QOL scores were recorded: environmental domain (53.17±15.59), psychological domain (51.23±18.61), social domain (49.86±21.64), and physical domain (45.93±16.90). Older age was associated with a better QOL score in the social domain (p=0.005), and employed patients scored better in the environmental domain (p=0.019). Unemployed patients and those of the Terai/Madhesi ethnic group had significantly low scores in overall perception of health (p<0.05) as compared to other groups. Low income status and increased duration on hemodialysis were found to be the only independent negative predictors of QOL in patients with hemodialysis (p<0.05).

Conclusion

Patients with chronic kidney disease on dialysis had overall low QOL scores in all four domains. Age, ethnicity, employment status, income, and duration on hemodialysis affected one or more domains of QOL in such patients. Low income status and increased duration on hemodialysis were the only independent negative predictors of QOL of patients on maintenance hemodialysis.

Assessment of hemodialysis adequacy and its relationship with individual and personal factors

Background:

Hemodialysis is the most common renal replacement therapy in the world, and hemodialysis adequacy is an important and influencial factor in the reduction of various complications experienced by these patients. Multiple factors influence hemodialysis adequacy. This study was conducted to determine hemodialysis adequacy and its relationship with individual and personal factors in patients undergoing hemodialysis in three hemodialysis centers of Isfahan, Iran.

Materials and Methods:

This descriptive, cross-sectional study was conducted in partnership with 202 patients undergoing hemodialysis in three hemodialysis centers of Isfahan. The data were collected using a researcher-made questionnaire, and hemodialysis adequacy was measured using the urea reduction ratio (URR). Data analysis was conducted using Spearman's correlation coefficient, Mann–Whitney and Kruskal–Wallis tests, and descriptive statistics (frequency distribution). In this study, the level of significance was considered to be 0.05.

Results:

Hemodialysis adequacy in 56.4% of patients was optimal, in 29.7% near optimum, and in 13.9% less than optimal. Statistical tests showed a significant correlation between hemodialysis adequacy and age (P = 0.05), prehemodialysis systolic blood pressure (BP) (P = 0.02) and diastolic BP (P = 0.04), the duration of hemodialysis in months (P = 0.02), and patients’ sex (P = 0.01). There was no significant correlation between hemodialysis adequacy and the number of hemodialysis cessations per week (P = 0.20), interdialytic weight gain (P = 0.40), prehemodialysis blood urea nitrogen (P = 0.40), creatinine (P = 0.10), hemoglobin (P = 0.20), hematocrit (P = 0.08), venous access type (P = 0.30), needle distance and direction (P = 0.70), underlying causes of end-stage renal disease (P = 0.50), and personnel's shift (P = 0.90).

Conclusions:

The results of the study showed that approximately half of the patients did not have an optimal level of hemodialysis adequacy, and multiple individual and personnel factors affect hemodialysis adequacy directly or conversely.