Predictors of quality of life in patients with end-stage renal disease on hemodialysis

Effect of medication therapy management services on medication-burden quality of life in hemodialysis patients

BACKGROUND

Hemodialysis (HD) patients commonly receive polypharmacy leading to increased likelihood of drug related problems (DRPs) and poor quality of life. Medication Therapy Management (MTM) services discover and resolve DRPs and may specifically improve Medication-burden Quality of life (MBQoL) in HD patients. We aimed to assess the effect of MTM services on DRPs and MBQoL among HD patients.

METHODS

A prospective pre-post study was conducted on 104 patients in an HD unit in Alexandria, Egypt. MBQoL was assessed at baseline and after three months of MTM sessions, using the Arabic, validated version of the Patient Reported Outcomes Measure of Pharmaceutical Therapy (PROMPT) questionnaire. Cohen's d test and multiple linear regression were used to assess the effect size of MTM and the factors affecting MBQoL, respectively. DRPs, adverse events and adherence were also monitored.

RESULTS

MBQoL improved significantly after the implementation of MTM (Cohen's d=0.88, p < 0.01) with the largest effect size in the "medicine information and relation with healthcare providers" domain. DRPs decreased significantly after MTM implementation (11.97 ± 4.65 versus 7.63 ± 3.85 per patient, p<0.001). The mean adverse events per patient were also reduced (9.69 ± 4.12 versus 6.56 ± 3.77, p < 0.001).

CONCLUSION

Applying MTM services presents an opportunity to improve care for HD patients by improving MBQoL, decreasing DRPs and adverse events.

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.

Relationship Between Nutritional Parameters and Quality of Life in Patients With End-Stage Kidney Disease on In-Centre Haemodialysis in Al-Ahsa, Saudi Arabia

INTRODUCTION

Nutrition threatens the quality of life (QOL) in end-stage kidney disease (ESKD) patients on haemodialysis (HD). The aim of the study is to assess which nutritional parameters associate with the health-related QOL category score using Arabic translated, adapted, and validated version of the Kidney Disease Quality of Life Short-Form 36 (KDQOL-36).

METHODS

We carried out a cross-sectional study with a total of 60 ESKD patients in one haemodialysis centre in Al-Ahsa, Saudi Arabia. The health-related QOL of the five components of the KDQOL-36 are as follows: physical component score (PCS), mental component score (MCS), the burden of kidney disease (BKD), symptoms and problems of kidney disease (SPKD), and effects kidney disease (EKD) which were grouped into three categories (good, average and poor) based on the score.

RESULTS

Of the 60 HD patients, 43 (71.7%) were between 19 and 59 years old and 41 patients (68.3%) were males. This study revealed that high haemoglobin impact PCS, MCS, SPKD, and EKD in favour of poor health-related QOL, but normal haemoglobin impacts BKD in favour of good QOL. In addition, patients who had a normal serum albumin level had good scores for MCS, BKD, SPKD, and EKD. Also, there was a significant association between Kt/V value with EKD (p=0.001).

CONCLUSION

According to the findings of this study, patients with HD have poor health-related QOL outcomes than those with good nutritional status. This finding demonstrates the critical need for further articles to study this particular group of population.

Out-of-pocket expenditures, catastrophic household finances, and quality of life among hemodialysis patients in Kerala, India

INTRODUCTION

Kidney replacement therapy in chronic kidney disease patients can result in catastrophic health costs, pushing them into poverty in lower middle-income countries. There are only limited studies from India focusing on the financial hardship of these patients. Data on direct nonmedical and indirect cost of hemodialysis (HD) are also limited. This study aims to find the different components of cost for HD and its association with quality of life (QOL) among HD patients.

METHODS

Primary objective was to find the cost of HD, which include direct medical, direct nonmedical and indirect cost. Secondary objective was to study whether the ratio of out-of-pocket (OOP) payments for HD to household income can affect the QOL. The QOL was assessed using EQ-5D-5L instrument. Catastrophic health care expenditure was defined as OOP health care expenditure exceeding 40% of the household income and distress financing as borrowing money or selling assets to meet the OOP expenditure for treatment.

FINDINGS

Of the 152 patients enrolled for the study, 103 (67.8%) were males. Mean age was 60.9 ± 12.5 years. Monthly OOP expenditure for dialysis was USD 478.4 (362.6-663.6) of which direct nonmedical and indirect expenses constitute USD 115.6 (88.4-292.4). Median percentage of household income spent for dialysis was 194.5 (IQR 128-297). One hundred and forty-two (93.4%) had catastrophic healthcare expenditure and 76 (50%) had distressing health care expenditure. On multivariable linear regression, proportion of total household income spend for dialysis was associated with poor QOL in patients undergoing HD; coefficient = -0.04 (95% CI -0.008 - 0.092), p = 0.039.

DISCUSSION

Nonmedical direct and indirect cost is substantial among patients undergoing HD. Nine of 10 patients had catastrophic health care expenditure, which pushed 50% of the patients to distress financing.

Association of Physical Performance, Muscle Strength and Body Composition with Self-Assessed Quality of Life in Hemodialyzed Patients: A Cross-Sectional Study

(1) Patients on chronic hemodialysis (HD) experience impaired quality of life (QoL). We analyzed HD’s relationship with physical performance, body composition, and muscle strength; (2) QoL was assessed with the Short Form-36, composed of physical (PCS) and mental (MCS) health dimensions. Physical performance was assessed with the Short Physical Performance Battery (SPPB), body composition (lean tissue mass% (LTM%), fat tissue mass% (FTM%), and skeletal muscle mass% (SMM%)) was assessed with bioelectrical impedance, and lower extremity strength was assessed with a handheld dynamometer; and (3) we enrolled 76 patients (27 F, 49 M), age 62.26 ± 12.81 years, HD vintage 28.45 (8.65−77.49) months. Their QoL score was 53.57 (41.07−70.64); their PCS and MCS scores were 52.14 (38.69−65.95) and 63.39 (44.64−76.79) and strongly correlated (p < 0.0001, R = 0.738). QoL correlated positively with SPPB (R = 0.35, p ≤ 0.001), muscle strength (R from 0.21 to 0.41, p < 0.05), and LTM% (R = 0.38, p < 0.001) and negatively with FTM% (R = −0.32, p = 0.006). PCS correlated positively with SPPB (R = 0.42 p < 0.001), muscle strength (R 0.25−0.44, p < 0.05), and LTM% (R = 0.32, p = 0.006) and negatively with FTM% (R = −0.25, p = 0.031). MCS correlated positively with SPPB (R = 0.23, p = 0.047), SMM% (R = 0.25; p = 0.003), and LTM% (R = 0.39, p < 0.001) and negatively with FTM% (R = −0.34; p = 0.003). QoL was unrelated to sex (p = 0.213), age (p = 0.157), HD vintage (p = 0.156), and BMI (p = 0.202); (4) Better physical performance, leaner body composition, and higher muscle strength are associated with better mental and physical QoL in HD.

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.

Rapid Electronic Capturing of Patient-Reported Outcome Measures in Older Adults With End-Stage Renal Disease: A Feasibility Study

BACKGROUND

Patients with end-stage renal disease (ESRD) have a high burden of physical and psychological symptoms. Many remain unrecognized for long periods of time, particularly in older adults. The best strategy to monitor patient-reported outcome measures (PROMs) has not been identified.

OBJECTIVE

To assess the feasibility of implementing an iPad-based symptom assessment tool in older adults with ESRD on hemodialysis (HD).

METHODS

We designed an iPad application-delivery system for collecting electronic PROMs (ePROMs). Patient's ≥60 years of age with ESRD on HD were recruited from a single outpatient dialysis unit. Feasibility was evaluated based on recruitment, retention, and the system usability score (SUS). Assessments were completed at baseline, 3 months, and 6 months after enrollment. ANOVA was used to assess longitudinal symptom variability.

RESULTS

Twenty-two patients (49% recruitment rate) were enrolled, with an 82% retention at 6 months. Mean age was 69.4 years (SD 6.6), 63.6% were female, and 81.8% were African American. Participants reported minimal difficulty in using the app, with an overall SUS score of 77.6. There were no significant relationships between demographic characteristics (age, race, or education) and SUS. Baseline SF-12 physical score and SF-12 mental score were 40.4 (SD 9.1) and 33.9 (SD 6.7), respectively. No significant changes were seen in longitudinal ePROMs of pain, depression, or anxiety; but was seen in the dialysis symptom index.

CONCLUSION

In older patients with ESRD, collection of iPad-based ePROMs is feasible. This process can overcome inefficiencies associated with paper questionnaires and enable systematic monitoring of symptom burden.

Hemodialysis patients perceived exercise benefits and barriers: the association with health-related quality of life

BACKGROUND

Patients on hemodialysis have less exercise capacity and lower health-related quality of life than healthy individuals without chronic kidney disease (CKD). One of the factors that may influence exercise behavior among these patients is their perception of exercise benefits and barriers. The present study aimed to assess the perception of hemodialysis patients about exercise benefits and barriers and its association with patients' health-related quality of life.

METHODS

In this cross-sectional study, 227 patients undergoing hemodialysis were randomly selected from two dialysis centers. Data collection was carried out using dialysis patient-perceived exercise benefits and barriers scale (DPEBBS) and kidney disease quality of life short form (KDQOL-SF). Data were analyzed using SPSS software ver. 21.

RESULTS

The mean score of DPEBBS was 68.2 ± 7.4 (range: 24 to 96) and the mean KDQOL score was 48.9 ± 23.3 (range: 0 to 100). Data analysis by Pearson correlation coefficient showed a positive and significant relationship between the mean scores of DPEBBS and the total score of KDQOL (r = 0.55, p < 0.001). Moreover, there was a positive relationship between the mean scores of DPEBBS and the mean score of all domains of KDQOL.

CONCLUSION

Although most of the patients undergoing hemodialysis had a positive perception of the exercise, the majority of them do not engage in exercise; it could be contributed to the barriers of exercise such as tiredness, muscle fatigue, and fear of arteriovenous fistula injury. Providing exercise facilities, encouraging the patients by the health care provider to engage in exercise programs, and incorporation of exercise professionals into hemodialysis centers could help the patients to engage in regular exercise.

Impact of malnutrition on health-related quality of life in patients on maintenance hemodialysis

Malnutrition is considered as one of the most important risk factors that adversely affect the quality of life (QOL) in maintenance hemodialysis (MHD) patients. Many clinically useful nutrition assessment techniques are now available, but the usefulness of such techniques in predicting QOL in MHD patients had not been sufficiently tested. The aim of this study was to explore the relation between different nutritional assessment methods, and QOL and identify nutritional parameter that can best predict physical and mental domains of QOL in MHD patients. This cross-sectional study involved 84 MHD patients. Nutritional status was assessed by using International Society of Renal Nutrition and Metabolism criteria for diagnosis of protein-energy wasting (PEW), malnutrition inflammation score (MIS), subjective global assessment (SGA), anthropometric measurements, bioelectrical impedance analysis, and biochemical tests. Quality of life was evaluated by using the Kidney Disease Quality of Life (36 KDQOL-36). Only mental health composite component of QOL (MHC) showed statistically significant differences between PEW and non-PEW groups. MHC was correlated with serum albumin, MIS, and SGA. Physical health composite component (PHC) was correlated with age, hemodialysis duration, socioeconomic status, comorbidity, educational level, serum creatinine and ferritin, MIS, and SGA. On multiple linear regression analysis, MIS was found to be the most significant predictor of PHC while none of the nutritional parameters can predict MHC. Malnutrition is not uncommon problem in MHD patients that is associated with poor QOL. There are multiple factors associated with PHC and only malnutrition afflicts MHC in those patients.

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.

Quality of life and its determinants among hemodialysis patients: A single-center study

The purpose of this study was to investigate the relation between selected demographic and clinical characteristics and quality of life (QOL) scores in patients with end-stage renal disease who receive dialysis. We conducted the study at one hemodialysis (HD) unit in Bahrain from May 2018 to July 2018. We used standard QOL Index (QOLI) score instrument in Arabic form. This study included 100 patients (66 men and 34 women), aged 22 to 80 years on treatment with maintenance HD for four to 190 months. Inclusion criteria were as follows: those aged >18 years with no severe morbidities or psychological diseases and were on dialysis for at least three months. The following QOL scores were recorded: the health and functioning domain (64.8 ± 15.3), the social and economic domain (65.6 ± 14.1), the psychological/spiritual domain (74.9 ± 14.3), and the family subscale domain (75.9 ± 14.5). Male patients had reduced QOL though not statistically significant and younger patients had better QOL scores. The QOL scores revealed a decreasing trend with decreasing level of education, and they were higher among those who were not working and stayed at home. In addition, the family subclass scores were significantly higher among the married patients. Correlations between the demographic characteristics and QOL scores showed that there was a significant negative correlation between family domain and educational level and marital status, while there was a significant positive correlation between residence and psychological domain. Age, gender, marital status, residence, ethnicity, education level, employment status, income, and duration on HD nonsignificantly affected one or more domains of QOLI scores in such patients. Adequate management of these factors could influence patient outcomes.

Quality of Life and Mental Satisfaction Improve Slowly in Preemptive Kidney Transplantation Compared With Nonpreemptive Kidney Transplantation

BACKGROUND AND AIMS

Preemptive kidney transplantation (PEKT) is recognized as the best therapy to avoid dialysis. However, it is not clear whether PEKT recipients experience an improvement in quality of life (QoL) after kidney transplantation (KT) that exceeds that of non-PEKT recipients, since PEKT recipients have not experienced the heavy burden of dialysis. The aim of this study was to compare the changes in QoL for PEKT and non-PEKT recipients following transplantation.

METHODS

Patients included in this study underwent living donor KT in our hospital. We excluded patients with incomplete SF-36 scores and with factors that could affect QoL, such as complications or rejection. QoL was assessed by the Short Form 36-Item Health Survey version 2.0 preoperatively and 3 and 12 months postoperatively.

RESULTS

Eighty-eight patients underwent living donor KT in our hospital. Twelve PEKT and 20 non-PEKT recipients were enrolled in this retrospective study. In the non-PEKT group, both the physical and mental domain scores dramatically improved from baseline at 3 months, and remained at a similar level at 12 months. In contrast, in the PEKT group, only 1 domain of the physical and mental score improved at 3 months, and the social functioning score gradually improved at 12 months. Although the mental component score showed significant improvement in the non-PEKT group, it did not change in the PEKT group.

CONCLUSIONS

The improvement of QoL after transplantation is more evident in the non-PEKT group. PEKT recipients have less mental satisfaction than non-PEKT recipients.

Development of a framework for minimum and optimal safety and quality standards for hemodialysis and peritoneal dialysis

Substantial heterogeneity in practice patterns around the world has resulted in wide variations in the quality and type of dialysis care delivered. This is particularly so in countries without universal standards of care and governmental (or other organizational) oversight. Most high-income countries have developed such oversight based on documentation of adherence to standardized, evidence-based guidelines. Many low- and lower-middle-income countries have no or only limited organized oversight systems to ensure that care is safe and effective. The implementation and oversight of basic standards of care requires sufficient infrastructure and appropriate workforce and financial resources to support the basic levels of care and safety practices. It is important to understand how these standards then can be reasonably adapted and applied in low- and lower-middle-income countries.

Epidemiology investigation and analysis of patients with hemodialysis in Sichuan province of China

Objectives: To investigate the incidence, pathogenesis, as well as mortality rate and causes of end-stage renal disease patients with hemodialysis (ESRD-HD) in Sichuan province of China. Methods: In this retrospective descriptive study, all the data were exported from the Chinese National Renal Data System (CNRDS). The demographic and pathogenic information from 01 January 2011 to 31 December 2016 were statistically analyzed. Results: According to the data from CNRDS, the incidence of ESRD-HD was high in Sichuan province. From 2011 to 2016, the annual incidence rate of ESRD-HD was 61.84, 73.75, 78.04, 66.04, 72.61, and 60.98 per million population (pmp). Male ESRD-HD patients were higher than female patients (1.5:1). The major causes of ESRD-HD in Sichuan province from 2011 to 2016 were chronic glomerulonephritis and diabetic nephropathy. The annual mortality rate of ESRD-HD was 113.20, 91.25, 73.02, 68.56, 68.57, and 58.39 per 1000 person-years. The descending rate of mortality was parallel in both males and females. The mortality rate was observed to be higher in the elderly group (age ≥ 60). The major cause of mortality was cardiovascular diseases (24.48%). Conclusions: In Sichuan province, the incidence of ESRD-HD annually was gradually descending. The elderly and male patients had higher incidence of ESRD-HD. The annual mortality rate of ESRD-HD was declining year by year, and elderly patients aged ≥ 60 contributed to the highest mortality rates. The major cause of death was cardiovascular diseases. This could contribute to a better understanding of ESRD-HD in southwest of China, thus providing better treatment for ESRD in the future.

Factors predicted with quality of life among hemodialysis patients in private hospital of Thailand

Background: The quality of life (QOL) among the end-stage renal disease patients is an essential component for assessing the success of treatment. This study aimed to determine the factors predicted with quality of life among hemodialysis patients in private hospital of Thailand.Method: This cross-sectional study was conducted by interviewing 188 Thai patients with end-stage renal disease (ESRD), who were on hemodialysis (HD) at Sanamchan Hospital Bangkok. Patients with stable hemodynamic status without any history of mental illness were included in this study. However, those who could not properly communicate were excluded. The descriptive statistics and the multiple linear regression were applied to identify the predictive factors of quality of life (QOL) scores in the end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD). The QoL was assessed in three components including kidney disease component score (KDCS) physical component score (PCS) and mental component score (MCS).Findings: More than half of the participants (57%) in this research were male and (44%) were unemployed. The mean average systolic value of the participants was 157 (25.12 SD) mmHg and the diastolic blood pressure was 81 (5.85 SD) mmHg. Average hematocrit (Hct) was 30.95 (4.38 SD), Kt/v was 1.86 (0.96 SD), and average normalized protein catabolic rate (nPCR) was 1.12 (1.09 SD). The age, income, patients with more than three associated diseases, enough expenses for living, frequency of dialysis per week, and duration of treatment was statistically significant with the kidney disease component score (KDCS) (F = 6.28, p < 0.05). Furthermore, the age, income, patients with more than three associated diseases, hematocrit (Hct) and frequency of dialysis per week were the statistically significant with the physical component score (PCS) (F = 4.99, p < 0.05) while patients with more than three associated diseases and enough expenses for living were the statistically significant with the mental component score (MCS) (F = 3.30, p ≤ 0.05).Conclusion: Study concluded that the factors like; age, expenses for living, frequency of dialysis, patients with more than three associated diseases were had a positive impact on the quality of life among the end-stage renal disease patients coming for dialysis in private hospital of Thailand.

Patient participation in the clinical pathway-Nurses' perceptions of adults' involvement in haemodialysis

AIM

To develop knowledge of nurses' perceptions of participation for patients treated with haemodialysis and their next of kin.

DESIGN

A qualitative study with a hermeneutic approach.

METHODS

The data were collected in 2015 through focus groups with 13 nurses in Central Norway.

RESULTS

The nurses reported that patient participation ranging from non-involvement to shared decision-making was related to whether dialysis was initiated as acute or scheduled. The restrictions required in chronic haemodialysis limited participation. The next of kin were not involved. The nurses highlighted interventions on both the individual and system levels to strengthen participation.

CONCLUSION

Dialysis units should develop strategies for participation related to individual needs and design treatment in cooperation with patients and their families, ensuring involvement early in the clinical pathway. Further research is needed on issues related to next of kin, including their desired level of involvement.

The Quality of Life of Hemodialysis Patients Is Affected Not Only by Medical but also Psychosocial Factors: a Canonical Correlation Study

BACKGROUND

The quality of life (QoL) of patients with end-stage renal disease (ESRD) is very poor, plausibly due to both psychosocial and medical factors. This study aimed to determine the relationship among psychosocial factors, medical factors, and QoL in patients with ESRD undergoing hemodialysis (HD).

METHODS

In total, 55 male and 47 female patients were evaluated (mean age, 57.1 ± 12.0 years). The QoL was evaluated using the Korean version of World Health Organization Quality of Life Scale-Abbreviated Version. The psychosocial factors were evaluated using the Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Montreal Cognitive Assessment, Pittsburgh Sleep Quality Index, and Zarit Burden Interview. The medical factors were assessed using laboratory examinations. Correlation and canonical correlation analyses were performed to investigate the association patterns.

RESULTS

The QoL was significantly correlated with the psychosocial factors, and to a lesser extent with the medical factors. The medical and psychosocial factors were also correlated. The canonical correlation analysis indicated a correlation between QoL and psychosocial factors (1st canonical correlation = 0.696, P < 0.001; 2nd canonical correlation = 0.421, P = 0.191), but not medical factors (1st canonical correlation = 0.478, P = 0.475; 2nd canonical correlation = 0.419, P = 0.751). The medical and psychosocial factors were also correlated (1st canonical correlation = 0.689, P < 0.001; 2nd canonical correlation = 0.603, P = 0.009).

CONCLUSION

Psychosocial factors influence QoL in patients with ESRD, and should thus be carefully considered when caring for these patients in clinical practice.

Health-Related Quality of Life and Its Factors of Hemodialysis Patients in Suzhou, China

<b><i>Background:</i></b> To identify factors of health-related quality of life (HRQOL) of Chinese end-stage renal disease patients undergoing hemodialysis (HD). <b><i>Methods:</i></b> In all, 315 HD patients were recruited from a tertiary hospital in Suzhou, ­China. Each patient completed the Kidney Disease Quality of Life Short Form. It generated 4 types of HRQOL scores: PCS score, MCS score, kidney disease component summary (KDCS) score, and SF-6D index score. Multiple linear regressions were conducted to identify the factors associated with each of the scores. <b><i>Results:</i></b> Factors associated with poorer HRQOL were determined including: middle age and above (≥45 years), without partner, presence of complication, long dialysis vintage (≥4.5 years) with physical component summary; low education level, presence of comorbidity, long dialysis vintage, low hemoglobin level with mental component summary; without partner, presence of comorbidity, long dialysis vintage with KDCS; middle age and above, without partner, low education level; long dialysis vintage, more frequent dialysis (≥2 times/week) with SF-6D. <b><i>Conclusion:</i></b> The study evaluated the HRQOL of HD patients in mainland China.

Renoprotective Effect of Dipeptidyl Peptidase-4 Inhibitors in Patients with Type 2 Diabetes Mellitus

Diabetic nephropathy is one of three major complications of diabetes mellitus, often leading to chronic renal failure requiring dialysis. Recently developed dipeptidyl peptidase-4 (DPP-4) inhibitors may exhibit renoprotective effects in addition to antihyperglycemic effects. In this study, we retrospectively investigated temporal changes in the renal function index of patients with type 2 diabetes mellitus (DM) and examined the influence of DPP-4 inhibitors on renal function. Patients with type 2 DM (>18 years old) prescribed hypoglycemic agents at Gifu Municipal Hospital for ≥3 months between March 2010 and April 2014 were included in the study. Renal function was evaluated as estimated the decline in 12-month glomerular filtration rate from the baseline in patients receiving and not receiving DPP-4 inhibitors. Patient data from the DPP-4 inhibitor-treated (501 patients, 58.6%) and untreated (354, 41.4%) groups were analyzed using multiple logistic regression analysis, as well as Cox proportional-hazards regression analysis (616, 55.6% and 491, 44.4%, for DPP-4 inhibitors-treated and untreated groups). Multiple logistic regression analysis indicated that DPP-4 inhibitors significantly lowered the estimated glomerular filtration rate (eGFR) decline [20% over 12 months; odds ratio (OR), 0.626; 95% confidence interval [CI], 0.409–0.958; P = 0.031]. Similar results were obtained using Cox proportional-hazards regression analysis (hazard ratio [HR], 0.707; 95% CI, 0.572–0.874; P = 0.001). These findings suggest that DPP-4 inhibitors suppress the decrease of estimated glomerular filtration rate in patients with type 2 DM and show a renoprotective effect.

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.

Factors affecting quality of life in patients on haemodialysis: a cross-sectional study from Palestine

BACKGROUND

Haemodialysis (HD) is a life-sustaining treatment for patients with end-stage renal disease (ESRD). HD can bring about significant impairment in health-related quality of life (HRQOL) and outcomes. Therefore, we sought to describe the patterns of HRQOL and determine the independent factors associated with poor HRQOL in Palestinian patients on HD.

METHODS

A multicenter cross-sectional study was performed from June 2014 to January 2015 using the EuroQOL-5 Dimensions instrument (EQ-5D-5L) for the assessment of HRQOL. ESRD patients undergoing HD in all dialysis centres in the West Bank of Palestine were approached and recruited for this study. Multiple linear regression was carried out to identify factors that were significantly associated with HRQOL.

RESULTS

Two hundred and sixty-seven patients were participated in the current study giving response rate of 96 %. Overall, 139 (52.1 %) were male, and the mean ± standard deviation age was 53.3 ± 16.2 years. The reported HRQOL as measured by mean EQ-5D-5L index value and Euro QOL visual analogue scale (EQ-VAS) score was 0.37 ± 0.44 and 59.38 ± 45.39, respectively. There was a moderate positive correlation between the EQ-VAS and the EQ-5D-5L index value (r = 0.42, p < 0.001). The results of multiple linear regression showed a significant negative association between HRQOL with age, total number of chronic co-morbid diseases and the total number of chronic medications. However, a significant positive association was found between HRQOL with male gender, university education level and patients who live in village.

CONCLUSION

Our results provided insight into a number of associations between patient variables and their HRQOL. Healthcare providers should be aware of low HRQOL among patients with no formal education, female gender, patient's residents of refugee camps, multiple co-morbid diseases, multiple chronic medications, and elderly patients to improve their quality of life.