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Chae YJ, Kim HS. Effects of a mobile application on improving self-management of adult patients receiving peritoneal dialysis: A randomized controlled trial. Jpn J Nurs Sci 2024; 21:e12555. [PMID: 37589209 DOI: 10.1111/jjns.12555] [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: 02/18/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/18/2023]
Abstract
AIM This study aimed to develop a mobile application for improving self-management and to evaluate its effects in adult patients on peritoneal dialysis (PD). METHODS This randomized controlled trial was registered with the Korean Clinical Research Information Service Registry (KCT0007267) and conducted at a tertiary hospital. A self-management mobile application (SMA) was developed based on social cognitive theory and the ADDIE (analysis, design, development, implementation, and evaluation) model. The SMA includes information about disease management; self-recording of data on diet, exercise, medication, and health behavior; and healthcare providers' support and feedback. Participants aged 19-65 years were randomly allocated to the intervention group (n = 27) using the SMA for 10 weeks, and the control group (n = 26) receiving usual care. PD-related knowledge and self-efficacy, PD-related health behavior, biomarkers, and health-related quality of life (HRQoL) were surveyed pretest/posttest and analyzed using SPSS 23.0. RESULTS Compared to the controls, the intervention group showed significant improvement in PD-related knowledge and health behavior, albumin, and hemoglobin. HRQoL domains of symptoms/problems of kidney disease and disease impact on daily activity were improved in the intervention group. CONCLUSION The SMA is an effective intervention for enhancing health behaviors as well as improving the HRQoL of patients with PD. Without any limitations on time or location, patients with PD can easily use the SMA to monitor their health conditions, efficiently manage their disease, and perform PD-related behaviors. Nurses can implement high-quality tailored healthcare by using patients' lifelog data from the SMA.
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Affiliation(s)
- Yoon Jung Chae
- College of Nursing, Jesus University, Jeonju, South Korea
| | - Hee Sun Kim
- College of Nursing·Research Institute of Nursing Science, Jeonbuk National University, Jeonju, South Korea
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Liu L, Pang J, Xu J, Liu LN, Liao MY, Huang QX, Li YL. Impact of initial dialysis modality on the survival of patients with ESRD: a propensity-score-matched study. BMC Nephrol 2023; 24:313. [PMID: 37884871 PMCID: PMC10601298 DOI: 10.1186/s12882-023-03312-0] [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: 01/15/2023] [Accepted: 08/29/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Studies comparing the survival of hemodialysis (HD) and peritoneal dialysis (PD) patients are controversial. This study evaluated the impact of initial dialysis modality on the survival of patients with end-stage renal disease (ESRD) in a matched-pair cohort. METHODS A retrospective cohort study was performed on ESRD patients who initiated renal replacement treatment between January 1, 2010, and December 31, 2018. Propensity score matching was applied to balance the baseline conditions, and multivariate Cox regression analysis was applied to compare mortality between HD and PD patients and evaluate correlations between mortality and various baseline characteristics. Subgroup analysis was performed with respect to diabetes status. RESULTS There were 739 patients in our center in the Chinese National Renal Data System (CNRDS) between 2010 and 2018. Of these, 125 PD patients were matched with 125 HD patients. The 1-, 2-, and 3-year survival rates were 96.5%, 90.7%, and 82.5%, respectively, in the HD group and 99.5%, 97.8%, and 92.5%, respectively, in the PD group (log-rank P < 0.001). Among the propensity score-matched cohorts, no significant differences in Kaplan-Meier curves were observed between the two groups (log-rank P = 0.514). Age at dialysis initiation, CCI, congestive heart failure and cerebrovascular disease were risk factors in the multivariable-adjusted model. In subgroups defined by diabetes status, the Kaplan‒Meier survival curve showed that PD survival was significantly higher than that of HD (log-rank P = 0.022). CONCLUSIONS HD and PD were not significantly different regarding the survival of patients with ESRD. PD was associated with better survival in diabetic ESRD patients.
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Affiliation(s)
- Li Liu
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, 3rd Kangxin Road, Zhongshan, 528400 China
| | - Jie Pang
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, 3rd Kangxin Road, Zhongshan, 528400 China
| | - Juan Xu
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, 3rd Kangxin Road, Zhongshan, 528400 China
| | - Lin-na Liu
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, 3rd Kangxin Road, Zhongshan, 528400 China
| | - Man-yu Liao
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, 3rd Kangxin Road, Zhongshan, 528400 China
| | - Qing-xiu Huang
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, 3rd Kangxin Road, Zhongshan, 528400 China
| | - Yan-lin Li
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, 3rd Kangxin Road, Zhongshan, 528400 China
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Warli SM, Alamsyah MT, Nasution AT, Kadar DD, Siregar GP, Prapiska FF. The Assessment of Male Erectile Dysfunction Characteristics in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Using the International Index of Erectile Function (IIEF-5) Combined with Hospital Anxiety and Depression Scales. Int J Nephrol Renovasc Dis 2023; 16:155-161. [PMID: 37180487 PMCID: PMC10167996 DOI: 10.2147/ijnrd.s402540] [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: 02/01/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023] Open
Abstract
Purpose To determine the differences in mean scores of erectile dysfunctions (EDs) assessed by the International Index of Erectile Function (IIEF-5) questionnaire between patients with chronic kidney disease (CKD) undergoing hemodialysis and patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods This is an analytic observational study with a cross-sectional design that was conducted from June to December 2022 at the Urology Center of Haji Adam Malik General Hospital and Rasyida Kidney Specialized Hospital. The sample of this study were male CKD-patients who underwent regular hemodialysis (HD) and who underwent CAPD, and met the inclusion and exclusion criteria. Psychological disorders experienced during therapy session are considered as risk factors and assessed via the Hospital Anxiety and Depression Scale (HADS). These disorders assessment was used to evaluate the severity of the patients' anxiety and depressive symptoms. Statistical data analysis was carried out. Results Both groups had HADS-A and HADS-D scores with an average <7, classified as normal anxiety and depression. Most of the patients in the HD group had mild-to-moderate ED (28.6%), while in the CAPD group had mild severity of ED (38.1%). There were no significant differences in severity of ED between patients undergoing HD and CAPD (p > 0.05). However, there was a significant difference in ED scores (IIEF-5) between patients undergoing HD and those with CAPD (p < 0.05), in which patients in the CAPD group had a higher IIEF-5 score. In addition, there was a significant positive correlation with moderate strength (p<0.001; r=0.494) between anxiety disorders and ED disorders in patients undergoing HD and CAPD, whereas there is no significant correlation between depressive disorders and ED conditions (p > 0.05). Conclusion There was a significant difference in IIEF-5 scores between patients undergoing HD and CAPD.
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Affiliation(s)
- Syah Mirsya Warli
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
- Department of Urology, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan, Indonesia
| | - Mohammad Taufiq Alamsyah
- Department of Urology, Faculty of Medicine, Universitas Indonesia - Haji Adam Malik General Hospital, Medan, Indonesia
| | - Alwi Thamrin Nasution
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Dhirajaya Dharma Kadar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Ginanda Putra Siregar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Fauriski Febrian Prapiska
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
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Yin C, Zhang X, Zhu J, Yuan Z, Wang T, Wang X. Comparison of hospitalization cause and risk factors between patients undergoing hemodialysis and peritoneal dialysis. Medicine (Baltimore) 2022; 101:e31186. [PMID: 36482565 PMCID: PMC9726322 DOI: 10.1097/md.0000000000031186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This retrospective study was designed to compare the cause of hospitalization and influencing factors between patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Baseline data and laboratory parameters of 192 dialysis patients (92 HD patients and 100 PD patients) were compared. Quantitative parameters with normal distribution were assessed using independent t-test or analysis of variance (ANOVA). Quantitative parameters with non-normal distribution were assessed by non-parametric test. Qualitative data were statistically compared using χ2 test. The number of patients with urban employee medical insurance (88 HD patients and 60 PD patients) and rural cooperative medical care (12 HD patients and 40 PD patients) significantly differed (P < .01). The hospitalization rate of PD patients was significantly higher than that of HD counterparts. The average length of hospital stay of PD patients was 10 days, remarkably longer than 8 days of HD patients (P < .01). The primary cause of hospitalization for HD patients was infection-related complications, followed by cardiovascular, cerebrovascular complications and dialysis access disorders. The primary cause of hospitalization for PD patients was infection-related complications, followed by dialysis access disorders, cardiovascular, and gastrointestinal complications. Compared with the HD group, the levels of hemoglobin, serum albumin, alkaline phosphatase, intact parathyroid hormone were significantly decreased, whereas serum urea nitrogen, serum creatinine, phosphorus levels and cardiothoracic ratio were remarkably increased in the PD group (all P < .01). The hospitalization rate of PD patients is relatively higher, and the length of hospital stay is longer. Extensive attention and efforts should be delivered to enhance the understanding of disease and lower the risk of complications for patients.
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Affiliation(s)
- Caixia Yin
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
| | - Xiumei Zhang
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
| | - Jiang Zhu
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
| | - Zijing Yuan
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
| | - Tao Wang
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
| | - Xixi Wang
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
- * Correspondence: Xixi Wang, Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu 211100, China (e-mail: )
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Eslampour S, Hajirezaei S, Sagheb MM, Ezatzadegan Jahromi S, Mohammadi M. A Comparison of Relation between Resilience, Locus of Control, Quality of Relationship and Pain Intensity with Dialysis Adequacy in Patients with Peritoneal and Hemodialysis. IRANIAN JOURNAL OF PSYCHIATRY 2022; 17:428-435. [PMID: 36817804 PMCID: PMC9922353 DOI: 10.18502/ijps.v17i4.10692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 08/29/2021] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
Objective: Mental health in people with chronic diseases undergoes many changes due to conflict with the pain caused by the disease, which can have a reciprocal effect on the course and quality of the patient's treatment. The goal of the present study is to compare the correlation between locus of control, relationship quality, pain intensity and resilience with dialysis adequacy and laboratory indicators in peritoneal dialysis and hemodialysis patients. Method : This causal-comparative study was conducted on 30 hemodialysis (HD) and 30 peritoneal dialysis (PD) patients through the convenience sampling method. The data was collected using Pierce Quality Relationship Inventory (QRI), Conner-Davidson Resilience Scale (CD-RISC), Rotter's Locus of Control Scale (RLOC), and Von Korff's Chronic Pain Grade Scale (CPGS), and experimental data collected through blood and urine sampling and analyzed with Fisher's test and multivariate analysis of variance. Results: Conclusion of the Fisher test evinced that there was a significant difference between quality of relationships with parents and amount of Potassium (K), Phosphorus (P) and Parathyroid Hormone (PTH) as well between quality of relationships with friends and amount of Creatinine (Cr), and between the intensity of pain with K and Albumin (Alb) in patients with PD and HD (P < 0.05, P < 0.01). Conclusion of analysis of variance showed that the mean scores of quality of relationships with friends, K, Blood Urea Nitrogen (BUN), Cr, Alb and PTH in the PD group were significantly lower than the mean scores of HD patients (P < 0.05, P < 0.01). Also, mean of dialysis adequacy in patients with PD was significantly higher (P < 0.01). Conclusion: Based on findings, in order to increase dialysis adequacy of patients, along with medical interventions, psychological variables and mental health improvement of patients should also be considered.
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Affiliation(s)
| | - Shahram Hajirezaei
- Deptartment of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Sagheb
- Nephrology-Urology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Ezatzadegan Jahromi
- Nephrology-Urology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Mohammadi
- Islamic Azad University, Shiraz Branch, Shiraz, Iran.,Corresponding Author: Address: Islamic Azad University, Shiraz Branch, Shiraz, Fars, Iran, Postal Code: 7198774731. Tel: 98-71 36191311, Fax: 98-71 36410059,
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Elias MA, Van Damme W, Wouters E. Accessibility and quality of haemodialysis services in an urban setting in South India: a qualitative multiperspective study. BMJ Open 2022; 12:e052525. [PMID: 35131824 PMCID: PMC8823140 DOI: 10.1136/bmjopen-2021-052525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the accessibility and quality of existing haemodialysis services in an urban setting. SETTING The study was conducted in Bangalore city, India. PARTICIPANTS A total of 28 stakeholders including 2 nephrologists, 7 duty doctors, 13 dialysis technicians and 6 patients on long-term haemodialysis were selected from 20 dialysis centres in Bangalore city. DESIGN AND METHODS Qualitative study using in-depth interviews. A thematic analysis was done using the Availability, Accessibility, Acceptability and Quality Framework of WHO and the Bruce's Quality of Care Framework. RESULTS The study found several gaps with regard to the access and quality of existing services for patients with end-stage kidney disease (ESKD). The charges for dialysis sessions across settings displayed a wide variance. Patients often started dialysis services in private and later shifted to government and non-governmental organisations-run centres and reduced the number of weekly dialysis sessions due to financial constraints. Most standalone dialysis centres did not have the facilities to manage any emergencies. Most centres did not admit patients with hepatitis or HIV. The quality of care in dialysis centres seemed to be variable and most centres were managed solely by dialysis technicians. There were no psychosocial interventions available to the patients irrespective of the settings. Cost-cutting practices such as employing underqualified technicians, reusing dialysis equipment and using substandard water for dialysis were common. CONCLUSION The study highlights the need for more financial and personnel investments in ESKD care in India to ensure optimal care for the growing patient population. The study points towards the need for comprehensive management practices, including diet counselling and psychosocial support. While there are comprehensive guidelines on the establishment and management of dialysis services, more policy attention needs to be on effective implementation of these, to ensure better accessibility and quality of existing services.
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Affiliation(s)
- Maya Annie Elias
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Wim Van Damme
- Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerp, Belgium
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Sanchez S, Teelucksingh S, Ali R, Bailey H, Legall G. Quality of Life and Health Status Among Patients Receiving Renal Replacement Therapy in Trinidad and Tobago, West Indies. Int J Nephrol Renovasc Dis 2021; 14:173-192. [PMID: 34135618 PMCID: PMC8199923 DOI: 10.2147/ijnrd.s302157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The determinants of quality of life for patients on renal replacement therapy vary across the world. The aim of this study is to determine the quality of life of patients on renal replacement therapy in Trinidad and Tobago and predictors thereof. PATIENTS AND METHODS This cross-sectional study took place over a 1-year period. Data were obtained from 530 out of 1383 patients meeting inclusion criteria (100 transplants, 80 peritoneal dialyses, 350 hemodialyses) using the survey instruments. Stratified random sampling with proportional allocation was used to select patients at hemodialysis centres. The Kidney Disease Quality of Life questionnaire (KDQOL-36), EuroQol and demographic questionnaires were administered via face-to-face interviews. SPSS24, STATA14 and MINITAB18 were used for descriptive and inferential data analysis. RESULTS Of the 530 patients, 52.5% were male, 37.5% were in the 56-65 years age group and 51.3% were of Indo-Trinbagonian descent. Hypertension (25.5%) and type 2 diabetes mellitus (62.0%) were reported as the main causes of kidney disease in the dialysis group. In the transplant category, chronic glomerulonephritis (45%) was the main aetiology of kidney disease. The KDQOL-36 domain scores and significantly associated variables included modality of renal replacement, Charlson's Comorbidity Index, ethnicity, income and employment status. Transplant patients had higher mean subcomponent Kidney Disease Quality of Life scores and performed better in the EuroQol than patients on dialysis. Patients on peritoneal dialysis had a better quality of life than hemodialysis patients. Among patients on hemodialysis, an arteriovenous fistula significantly impacted their quality of life. CONCLUSION Renal transplant recipients enjoy the best quality of life and health state among patients on renal replacement therapy in Trinidad and Tobago. Increasing patients' access to renal transplantation or peritoneal dialysis will markedly improve health status for the number of years of renal replacement therapy.
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Affiliation(s)
- Sharlene Sanchez
- Department of Medicine, North Central Regional Health Authority, Arima General Hospital, Arima, Trinidad and Tobago, West Indies
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
| | - Ronan Ali
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
| | - Henry Bailey
- Department of Economics, University of the West Indies, St Augustine, Trinidad and Tobago, West Indies
| | - George Legall
- Department of Natural Sciences, University of the West Indies, St Augustine, Trinidad and Tobago, West Indies
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Health-related quality of life associated with risk of death in Brazilian dialysis patients: an eight-year cohort. Qual Life Res 2021; 30:1595-1604. [PMID: 33454887 DOI: 10.1007/s11136-020-02734-9] [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] [Accepted: 12/06/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Despite the advancements in renal replacement therapy, patients with end-stage renal disease face several limitations, with significant impacts on health-related quality of life (HRQoL) and mortality. This study aims to examine associations between quality of life and risk of death in Brazilian patients who underwent dialysis therapy between 2007 and 2015. METHODS Observational, prospective, non-concurrent cohort study of patients who underwent dialysis therapy at the Brazilian Public Health System (SUS) and were followed up for 8 years. Semi-structured questionnaires interrogating socioeconomic and demographic characteristics, as well as HRQoL measures (36 Item Short-Form Health Survey, SF-36), were employed. The Cox proportional risk model was used to investigate associations between HRQoL and risk of death. RESULTS Our sample comprised 1162 patients; of these, 884 were on hemodialysis (HD) and 278 on peritoneal dialysis (PD). Among the HD patients, death was associated with the physical (HR: 0.993; 95% CI: 0.989-0.997) and physical summary component (HR: 0.994; 95% CI: 0.989-0.999) domains of HRQoL. Regarding the PD patients, death was associated with the bodily pain (HR: 0.994; 95% CI: 0.990-0.998), mental health (HR: 0.094; 95% CI: 0.990-0.998), emotional problems (HR: 0.993; 95% CI: 0.987-0.998), social functioning (HR: 1.012; 95% CI: 1.002-1.023), physical problems (HR: 0.992; 95% CI: 0.986-0.998) and mental summary component (HR: 0.989; 95% CI: 0.981-0.997) domains of HRQoL. CONCLUSIONS Our data suggest that early and timely intervention measures aiming to enhance the HRQoL of dialysis patients are an essential component of professional practice and may contribute to improving the management of factors associated with dialysis patients' mortality.
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Lipid status association with 25-hydroxy vitamin D: Cross sectional study of end stage renal disease patients. J Med Biochem 2020; 39:309-317. [PMID: 33269019 DOI: 10.2478/jomb-2019-0032] [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] [Received: 04/08/2019] [Accepted: 05/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background Some observational studies indicate an association of 25-hydroxy vitamin D (25(OH)D) insufficiency and atherogenic cholesterol concentrations. The aim of this study was to investigate relationship between 25(OH)D concentrations and lipid parameters in end stage renal disease (ESRD) patients, separately for predialysis, hemodialysis and peritoneal dialysis patients. Methods We have adjusted 25(OH)D concentrations for seasonal variability with cosinor analysis, and performed all further analysis using these corrected 25(OH)D concentrations. Concentrations of 25(OH)D and the lipid parameters were determined in 214 ESRD patients and 50 control group participants. The analysis included the measurement of 25(OH)D by HPLC, apolipoprotein (Apo) AI, ApoB and Lp(a) by nephelometry, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) by spectrophotometry and manually calculated ApoB/ApoAI and LDL-C/HDL-C ratio. Results ESRD patients with adjusted 25(OH)D concentrations of 50 nmol/L had significantly higher TC (P = 0.005) and ApoAI (P = 0.049). Significantly higher HDLC (P = 0.011) and ApoAI (P = 0.020) were found in hemodialysis patients with the 25(OH)D concentrations of 50 nmol/L. The other analyzed lipid parameters differed significantly between predialysis, hemodialysis and peritoneal dialysis patients with 25(OH)D concentrations of < 50 nmol/L. Conclusions Our study indicate the significant relationship between 25(OH)D repletion and optimal concentrations of lipid parameters in ESRD patients. Further research is necessary to explain whether joint evaluation of vitamin D status and lipid abnormalities could improve cardiovascular outcome in ESRD patients.
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Yao X, Lei W, Shi N, Lin W, Du X, Zhang P, Chen J. Impact of initial dialysis modality on the survival of patients with ESRD in eastern China: a propensity-matched study. BMC Nephrol 2020; 21:310. [PMID: 32727426 PMCID: PMC7389640 DOI: 10.1186/s12882-020-01909-3] [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: 04/18/2019] [Accepted: 06/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background There are conflicting research results about the survival differences between hemodialysis(HD) and peritoneal dialysis (PD). The present study estimated the survival and the relative mortality hazard for incident HD and PD patients with end stage renal disease (ESRD) in eastern China. Methods This study examined a cohort of patients with ESRD who initiated dialysis therapy in Zhejiang province between Jan of 2010 and Dec of 2014, followed up until the end of 2015. PD patients were matched in a 1:1 fashion with HD patients, and Kaplan–Meier analysis was used to explore the survival of them. The Cox proportional hazard regression model was applied to identify the factors that predict survival by treatment modality. Subgroup analyses were conducted by stratifying patients according to gender, age, causes of ESRD and comorbidities. Results Among a total of 22,379 enrolled patients (17,029 HD patients and 5350 PD patients), 5350 matched pairs were identified, and followed for a median of 29 months (3 ~ 72 months). Kaplan-Meier survival curve revealed that overall mortality rate was significantly higher in HD patients than in PD patients (log-rank test, P < 0.001), after adjusting by gender, age, primary causes of ESRD and comorbidities. HD was consistently associated with an increased risk for morality compared with PD in the matched cohort (adjusted hazard ratio (AHR): 1.140, 95%CI: 1.023 ~ 1.271). In subgroup analyses, male, younger patients, or nondiabetic patients aged less than 65 years after adjustment of covariates, initiating with PD was associated with a significantly lower mortality compared with HD. In the multivariate Cox proportional risks model, age, diabetic nephropathy (DN), other/unknown causes of ESRD, and patients with a history of cardiovascular disease or cancer showed statistical significance in explaining survival of incident ESRD patients. Conclusions ESRD patients who initiated dialysis with PD yielded superior survival rates compared to HD. Increased use of PD as initial dialysis modality in ESRD patients could be encouraged in Chinese population.
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Affiliation(s)
- Xi Yao
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.,Key Laboratory Of Nephropathy, Hangzhou, Zhejiang, China
| | - Wenhua Lei
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.,Key Laboratory Of Nephropathy, Hangzhou, Zhejiang, China
| | - Nan Shi
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.,Key Laboratory Of Nephropathy, Hangzhou, Zhejiang, China
| | - Weiqiang Lin
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.,Key Laboratory Of Nephropathy, Hangzhou, Zhejiang, China
| | - Xiaoying Du
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.,Key Laboratory Of Nephropathy, Hangzhou, Zhejiang, China
| | - Ping Zhang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China. .,Key Laboratory Of Nephropathy, Hangzhou, Zhejiang, China.
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China. .,Key Laboratory Of Nephropathy, Hangzhou, Zhejiang, China.
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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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12
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Križan Smojver B, Altabas K, Knotek M, Bašić Jukić N, Aurer A. Periodontal inflamed surface area in patients on haemodialysis and peritoneal dialysis: a Croatian cross-sectional study. BMC Oral Health 2020; 20:95. [PMID: 32245460 PMCID: PMC7118952 DOI: 10.1186/s12903-020-01086-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 03/25/2020] [Indexed: 01/10/2023] Open
Abstract
Background The decision to initiate dialysis treatment via haemodialysis (HD) or peritoneal dialysis (PD) often involves the consideration of complex factors and remains a matter of debate. The purpose of this study was to quantify the inflammatory burden that periodontitis causes in dialysis patients and to examine whether patients on PD and HD differ in terms of the periodontal inflamed surface area (PISA), which can be helpful for selecting the most appropriate dialysis modality. Methods A cross-sectional study was performed on 58 consecutive patients on HD and 31 consecutive patients on PD. PISA was calculated using measurements of the clinical attachment level, recession and bleeding on probing. We performed the primary analysis using multivariable robust regression. Results Patients on PD had a 746 mm2 (93%) lower mean PISA than patients on HD after adjustment for 20 possible confounders, including the duration of dialysis. The type of dialysis was independently correlated with the PISA (semipartial correlation: − 0.50; p = 0.017; false discovery rate < 5%). After adjusting for confounding factors, the correlation between the duration and type of dialysis was not significant (F (2,44) = 0.01; p = 0.994; η2 = 0.00). Differences in the PISA between patients who had undergone dialysis for less than a year, 2–3 years or ≥ 3 years were not significantly different in either of the two dialysis groups. Conclusions PISA levels in Croatian patients on dialysis indicate a high need for periodontal treatment. PD is associated with a smaller PISA independent of many sociodemographic, lifestyle, laboratory and clinical factors. The duration of dialysis does not influence PISA levels. Trial registration ISRCTN17887630. A clinical study to investigate gum infection in patients undergoing kidney dialysis.
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Affiliation(s)
- Bojana Križan Smojver
- Department of Endodontics with Restorative Dentistry, Oral Medicine and Periodontology, Dental Clinic Zagreb, Perkovčeva ulica 3, 10000, Zagreb, Croatia.
| | - Karmela Altabas
- Clinic of Internal Medicine, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Mladen Knotek
- Clinic of Internal Medicine, University Hospital Center Merkur, Zajčeva ulica, 10000, Zagreb, Croatia
| | - Nikolina Bašić Jukić
- Clinic of Internal Medicine, University Hospital Center Zagreb, Kišpatićeva ulica 12, 10000, Zagreb, Croatia
| | - Andrej Aurer
- Department of Periodontology, School of Dental Medicine, University of Zagreb, Gundulićeva ulica 5, 10000, Zagreb, Croatia
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Bonenkamp AA, van Eck van der Sluijs A, Hoekstra T, Verhaar MC, van Ittersum FJ, Abrahams AC, van Jaarsveld BC. Health-Related Quality of Life in Home Dialysis Patients Compared to In-Center Hemodialysis Patients: A Systematic Review and Meta-analysis. Kidney Med 2020; 2:139-154. [PMID: 32734235 PMCID: PMC7380444 DOI: 10.1016/j.xkme.2019.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE & OBJECTIVE Dialysis patients judge health-related quality of life (HRQoL) as an essential outcome. Remarkably, little is known about HRQoL differences between home dialysis and in-center hemodialysis (HD) patients worldwide. STUDY DESIGN Systematic review and meta-analysis. SETTING & STUDY POPULATIONS Search strategies were performed on the Cochrane Library, Pubmed, and EMBASE databases between 2007 and 2019. Home dialysis was defined as both peritoneal dialysis and home HD. SELECTION CRITERIA FOR STUDIES Randomized controlled trials and observational studies that compared HRQoL in home dialysis patients versus in-center HD patients. DATA EXTRACTION The data extracted by 2 authors included HRQoL scores of different questionnaires, dialysis modality, and subcontinent. ANALYTICAL APPROACH Data were pooled using a random-effects model and results were expressed as standardized mean difference (SMD) with 95% CIs. Heterogeneity was explored using subgroup analyses. RESULTS Forty-six articles reporting on 41 study populations were identified. Most studies were cross-sectional in design (90%), conducted on peritoneal dialysis patients (95%), and used the 12-item or 36-item Short-Form Health Survey questionnaires (83%). More than half the studies showed moderate or high risk of bias. Pooled analysis of 4,158 home dialysis patients and 7,854 in-center HD patients showed marginally better physical HRQoL scores in home dialysis patients compared with in-center HD patients (SMD, 0.14; 95% CI, 0.04 to 0.24), although heterogeneity was high (I 2>80%). In a subgroup analysis, Western European home dialysis patients had higher physical HRQoL scores (SMD, 0.39; 95% CI, 0.17 to 0.61), while home dialysis patients from Latin America had lower physical scores (SMD, -0.20; 95% CI, -0.28 to -0.12). Mental HRQoL showed no difference in all analyses. LIMITATIONS No randomized controlled trials were found and high heterogeneity among studies existed. CONCLUSIONS Although pooled data showed marginally better physical HRQoL for home dialysis patients, the quality of design of the included studies was poor. Large prospective studies with adequate adjustments for confounders are necessary to establish whether home dialysis results in better HRQoL. TRIAL REGISTRATION PROSPERO 95985.
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Affiliation(s)
- Anna A. Bonenkamp
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | | | - Tiny Hoekstra
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frans J. van Ittersum
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Alferso C. Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Brigit C. van Jaarsveld
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
- Diapriva Dialysis Center, Amsterdam, the Netherlands
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14
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Pagels AA, Stendahl M, Evans M. Patient-reported outcome measures as a new application in the Swedish Renal Registry: health-related quality of life through RAND-36. Clin Kidney J 2019; 13:442-449. [PMID: 32699625 PMCID: PMC7367131 DOI: 10.1093/ckj/sfz084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/02/2019] [Indexed: 02/06/2023] Open
Abstract
Background Although patient-reported outcome measures (PROMs) are gaining increased interest in developing health care quality and are a useful tool in person-centered care, their use in routine care is still limited. The aim of this study is to describe the implementation and initial results of PROMs via the Swedish Renal Registry (SRR) on a national level. Methods After testing and piloting the electronic PROM application, nationwide measures were carried out in 2017 for completing the RAND-36 questionnaire online or by paper in a wide range of chronic kidney disease (CKD) patients (Stages 3–5, dialysis and transplantation) through the SRR. Cross-sectional results during the first year were analyzed by descriptive statistics and stratified by treatment modality. Results A total of 1378 patients from 26 of 68 renal units (39%) completed the questionnaire. The response rate for all participating hemodialysis units was 38.9%. The CKD patients had an impaired health profile compared with a Swedish general population, especially regarding physical functions and assessed general health (GH). Transplanted patients had the highest scores, whereas patients on dialysis treatment had the lowest scores. The youngest age group assessed their physical function higher and experienced fewer physical limitations and less bodily pain than the other age groups but assessed their GH and vitality (VT) relatively low. The oldest age group demonstrated the lowest health profile but rated their mental health higher than the other age groups. The older the patient, the smaller the difference compared with persons of the same age in the general population. Conclusions Nationwide, routine collection of PROMs is feasible in Sweden. However, greater emphasis is needed on motivating clinical staff to embrace the tool and its possibilities in executing person-centered care. CKD patients demonstrate impaired health-related quality of life, especially regarding limitations related to physical problems, GH and VT/energy/fatigue.
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Affiliation(s)
- Agneta A Pagels
- Department of Endocrinology & Nephrology, Karolinska University Hospital, Stockholm, Sweden.,Swedish Renal Registry, Jönköping County Hospital, Jönköping, Sweden
| | - Maria Stendahl
- Swedish Renal Registry, Jönköping County Hospital, Jönköping, Sweden.,Department of Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Marie Evans
- Department of Endocrinology & Nephrology, Karolinska University Hospital, Stockholm, Sweden.,Swedish Renal Registry, Jönköping County Hospital, Jönköping, Sweden.,Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Renal Unit, Stockholm, Sweden
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15
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Surendra NK, Abdul Manaf MR, Hooi LS, Bavanandan S, Mohamad Nor FS, Shah Firdaus Khan S, Ong LM, Abdul Gafor AH. Health related quality of life of dialysis patients in Malaysia: Haemodialysis versus continuous ambulatory peritoneal dialysis. BMC Nephrol 2019; 20:151. [PMID: 31039745 PMCID: PMC6492391 DOI: 10.1186/s12882-019-1326-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health related quality of life (HRQOL) is an important predictor of clinical outcomes for End Stage Renal Disease (ESRD) patients and to establish quality adjusted life years (QALYs) for economic evaluation studies. This study aims to measure the health utilities and to identify socio-demographic and clinical factors associated with HRQOL for haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) in Malaysia. METHODS A total of 141 patients (77 HD and 64 CAPD) from 1 federal and four state hospitals participated in this cross-sectional study. Patients were randomly selected from the National Renal Registry (NRR) using a stratified random sampling. The EQ-5D-3 L questionnaire was used to measure HRQOL. Variables investigated include dialysis modalities, sociodemographic characteristics, co-morbidities and biochemical markers. Utilities are measured on an ordinal scale of 0-1, where 1 indicates full health and 0 indicates death. RESULTS The mean utility scores were 0.854 ± 0.181 and 0.905 ± 0.124 (p > 0.05) and the mean Visual Analogue Scale (VAS) scores were 76.2 ± 12.90 and 77.1 ± 10.26 (p > 0.05) for HD and CAPD patients respectively. There was a significant difference in problems reported between HD (35.1%) and CAPD (15.6%) on usual activities dimension (p = 0.009). The proportion of patients having problems in the pain/discomfort domain in both modalities was high (34.0%). Haemoglobin (< 10 g/dL) (p = 0.003), number of co-morbidities ≥3 (p = 0.004) and wheelchair-bound status (p < 0.001) were significant predictors of poor HRQOL. CONCLUSIONS The present cross-sectional study shows that CAPD patients have a higher utility index score than HD patients but this was not statistically significant. The utilities index score may be used to calculate QALYs.
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Affiliation(s)
- Naren Kumar Surendra
- Department of Community Health, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Cheras Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Community Health, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Cheras Malaysia
| | - Lai Seong Hooi
- Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor Malaysia
| | | | | | | | - Loke Meng Ong
- Hospital Pulau Pinang, Residency Road, 10990 Penang, Malaysia
| | - Abdul Halim Abdul Gafor
- Nephrology Unit, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
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16
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Pei M, Aguiar R, Pagels AA, Heimbürger O, Stenvinkel P, Bárány P, Medin C, Jacobson SH, Hylander B, Lindholm B, Qureshi AR. Health-related quality of life as predictor of mortality in end-stage renal disease patients: an observational study. BMC Nephrol 2019; 20:144. [PMID: 31035977 PMCID: PMC6489294 DOI: 10.1186/s12882-019-1318-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/29/2019] [Indexed: 02/08/2023] Open
Abstract
Background Health-related quality of life (HRQoL) is an important component of patient-centered outcomes and a useful parameter for monitoring quality of care. We assessed HRQoL, its determinants, and associations with mortality in patients with end-stage renal disease (ESRD). Methods Short Form-36 was used to assess HRQoL, its domain components, and physical (PCS) and mental (MCS) composite summary scores in altogether 400 (338 incident and 62 prevalent) dialysis patients with median age 64 years, 37% women, 24% diabetes mellitus (DM), 49% cardiovascular disease (CVD), and median estimated glomerular filtration rate (eGFR) of 5.3 (3.0–9.4) ml/min/1.732. Results were analyzed separately for 338 incident patients starting on hemodialysis (HD; 68%) or peritoneal dialysis (PD; 32%), and 62 prevalent PD patients. Mortality risk was analyzed during up to 60 months (median 28 months). Results Linear multivariate regression analysis showed that in incident dialysis patients, 1-SD higher PCS associated negatively with 1-SD higher age, DM and CVD, and positively with 1-SD higher hemoglobin and sodium (adjusted r2 = 0.17). In 62 prevalent PD patients, 1-SD higher PCS was negatively associated with 1-SD higher age. MCS was not associated to any of the investigated factors. Multivariate Cox regression analysis showed that in incident dialysis patients, 1-SD increase of PCS associated with lower all-cause mortality, hazard ratio 0.65 (95% confidence interval 0.52–0.81), after adjustments for age, sex, DM, CVD, plasma albumin, C-reactive protein and eGFR whereas 1-SD lower MCS did not associate with mortality. In PD patients, neither PCS nor MCS associated with mortality. Conclusions MCS did not associate with any of the investigated clinical factors, whereas lower PCS associated with higher age, CVD, DM, and lower hemoglobin and sodium levels. MCS was not associated with mortality, whereas lower PCS associated with increased mortality risk. These results suggest that HRQoL - in addition to its role as patient-centered outcome - matters also for hard clinical outcomes in ESRD patients. Our knowledge about factors influencing MCS in ESRD patients is limited and should motivate further studies. Electronic supplementary material The online version of this article (10.1186/s12882-019-1318-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming Pei
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden.,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Rute Aguiar
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden.,Department of Nephrology, Hospital Espírito Santo, Évora, Portugal
| | - Agneta A Pagels
- Department of Nephrology, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Olof Heimbürger
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Peter Stenvinkel
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Peter Bárány
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Charlotte Medin
- Department of Nephrology, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Stefan H Jacobson
- Department of Clinical Sciences, Division of Nephrology, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Britta Hylander
- Department of Nephrology, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Bengt Lindholm
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden.
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17
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Tannor EK, Archer E, Kapembwa K, van Schalkwyk SC, Davids MR. Quality of life in patients on chronic dialysis in South Africa: a comparative mixed methods study. BMC Nephrol 2017; 18:4. [PMID: 28056851 PMCID: PMC5217650 DOI: 10.1186/s12882-016-0425-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/20/2016] [Indexed: 11/21/2022] Open
Abstract
Background The increasing prevalence of treated end-stage renal disease and low transplant rates in Africa leads to longer durations on dialysis. Dialysis should not only be aimed at prolonging lives but also improve quality of life (QOL). Using mixed methods, we investigated the QOL of patients on chronic haemodialysis (HD) and peritoneal dialysis (PD). Methods We conducted a cross-sectional study at Tygerberg Hospital in Cape Town, South Africa. All the PD patients were being treated with continuous ambulatory peritoneal dialysis. The KDQOL-SF 1.3 questionnaire was used for the quantitative phase of the study. Thereafter, focus-group interviews were conducted by an experienced facilitator in groups of HD and PD patients. Electronic recordings were transcribed verbatim and analysed manually to identify emerging themes. Results A total of 106 patients completed questionnaires and 36 of them participated in the focus group interviews. There was no difference between PD and HD patients in the overall KDQOL-SF scores. PD patients scored lower with regard to symptoms (P = 0.005), energy/fatigue (P = 0.025) and sleep (P = 0.023) but scored higher for work status (P = 0.005) and dialysis staff encouragement (P = 0.019) than those on HD. Symptoms and complications were verbalised more in the PD patients, with fear of peritonitis keeping some housebound. PD patients were more limited by their treatment modality which impacted on body image, sexual function and social interaction but there were less dietary and occupational limitations. Patients on each modality acknowledged the support received from family and dialysis staff but highlighted the lack of support from government. PD patients had little opportunity for interaction with one another and therefore enjoyed less support from fellow patients. Conclusions PD patients experienced a heavier symptom burden and greater limitations related to their dialysis modality, especially with regards to social functioning. The mixed-methods approach helped to identify several issues affecting quality of life which are amenable to intervention. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0425-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elliot K Tannor
- Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Elize Archer
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - Kenneth Kapembwa
- Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Susan C van Schalkwyk
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - M Razeen Davids
- Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
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Manavalan M, Majumdar A, Harichandra Kumar KT, Priyamvada PS. Assessment of health-related quality of life and its determinants in patients with chronic kidney disease. Indian J Nephrol 2017; 27:37-43. [PMID: 28182041 PMCID: PMC5255988 DOI: 10.4103/0971-4065.179205] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Health-related quality of life is an important, yet neglected aspect of chronic kidney disease (CKD) care. We evaluated the quality of life and its determinants across CKD 3 to 5D using a kidney disease specific tool (Kidney Disease Quality of Life-SF™) in an underprivileged, predominantly rural population with high rates of illiteracy and unemployment. The scores of individual domains were summarized to three composite scores – physical composite summary (PCS), mental composite summary (MCS), and kidney disease component summary score (KDCS). A total number of 204 participants were recruited from nephrology outpatient clinics. About 68.1% of participants were males. The mean age of the study population was 49.14 ± 13.63 years. There was a high proportion of illiteracy (36.3%) and unemployment (80.9%). KDCS showed a significant decline (P = 0.01) from CKD 3 to CKD 5D whereas MCS and PCS showed a nonsignificant decrease. There was no difference in KDCS, PCS, or MCS scores between patients treated by hemodialysis and CAPD. Illiteracy and unemployment were associated with significantly lower KDCS, PCS, and MCS scores. Age ≥50 years was associated with poor PCS (29.49 ± 8.20 vs. 34.17 ± 9.99; P < 0.001). Hemoglobin <10 g/dL was associated with poor KDCS (58.93 ± 13.09 vs. 65.55 ± 13.38; P < 0.001) and PCS (29.56 ± 8.13 vs. 33.37 ± 9.82; P < 0.001). The presence of comorbidities such as diabetes and hypertension had no impact on the composite scores. KDCS, MCS, or PCS scores did not vary among patients having high serum phosphorus (≥4.5 mg/dL), low albumin (<3.5 g/dL), and elevated parathyroid hormone (≥150 pg/ml). On multiple linear regression analysis, the predictors of KDCS were unemployment (P < 0.001) and illiteracy (P = 0.03). Unemployment (P < 0.001) and age (P < 0.001) were predictors of PCS whereas literacy level (P < 0.001) was predictive of MCS.
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Affiliation(s)
- M Manavalan
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - A Majumdar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - K T Harichandra Kumar
- Department of Biometrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - P S Priyamvada
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Zyoud SH, Daraghmeh DN, Mezyed DO, Khdeir RL, Sawafta MN, Ayaseh NA, Tabeeb GH, Sweileh WM, Awang R, Al-Jabi SW. Factors affecting quality of life in patients on haemodialysis: a cross-sectional study from Palestine. BMC Nephrol 2016; 17:44. [PMID: 27117687 PMCID: PMC4847206 DOI: 10.1186/s12882-016-0257-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 04/22/2016] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Sa’ed H. Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, 11800 Malaysia
| | - Dala N. Daraghmeh
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Diana O. Mezyed
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Razan L. Khdeir
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mayas N. Sawafta
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nora A. Ayaseh
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Ghada H. Tabeeb
- PharmD program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Waleed M. Sweileh
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Rahmat Awang
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, 11800 Malaysia
| | - Samah W. Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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