Abstract
Abstract Background and Aims The number of elderly who suffers from end stage renal disease (ESRD) is increasing and hence the dialysis therapy rate. Although dialysis increases life span, the overall benefits to elderly patients is arguably unpredictable due to the multiple comorbidities and functional impairment. Health-related quality of life (HRQOL) has been an important key outcome in the decision-making yet to date, there is no available local data of the dialysis implications on the elderly. Therefore, we aim to study on the impact of dialysis initiation on HRQOL among elderly ESRD patients. Method This is a prospective, multi-centered study conducted from 2021 to 2022 among elderly patients (aged ≥65) who were initiated on maintenance dialysis therapy. Health-related quality of life (QOL) were assessed using Kidney Disease Quality of Life-36 (KDQOL-36) questionnaire within the first month of initiation (baseline) with a follow-up review performed after six months. Results The study included 29 patients with the oldest was 95 years old. 27 patients underwent haemodialysis (HD) and another 2 had peritoneal dialysis (PD). 12 (42%) of them required caregivers with 8 of them had limited mobilization. All of the patients had underlying comorbidities with 25 of them had 3 and more comorbidities. Majority of the patients (n=24) were diabetic with 13 of them had an underlying ischemic heart disease. Their mean baseline haemoglobin and albumin were 8.1 g/dL (±0.3) and 34.2 mmol/L (±1.3) respectively. Only 1 of the study patients was initiated HD via a fistula while the rest were using temporary catheter. At 6 months of follow-up, 5 of the patients died due to cardiovascular events, catheter-related sepsis and one of them resorted to palliative care due to exhausted conventional vascular access. 13 patients out of 22 remained on catheter for HD with 9 patients were still using temporary catheter. We observed improvement in all five domains of HRQOL assessed. The mean score of physical component summary was 33.00% (±10.58) at baseline and 41.22% (±9.54) after 6 months (P = .011). The mean scores for mental component at baseline and 6-month review were 45.53% (±14.78) and 52.95% (±10.57) respectively (p= 0.018). As for symptoms and problems domain, they initially scored 58.59% (±18.71) which increased to 76.61% (±16.05) after 6 months (P = .003). The scores for ‘burden of kidney disease’ and ‘effects of kidney disease’ domains were and 43.49% (±35.62) and 58.21% (±26.74) respectively at baseline with improvements to 58.85% (±31.81) (P = .026) and 76.04% (±24.65) (P = .008) after 6 months. Conclusion Our study showed that dialysis therapy results in significant overall improvement in HRQOL among elderly ESRD patients. The decision for dialysis among this group of patients is nonetheless a complex process with consideration made on individual basis followed by continuous evaluation of its effectiveness, incorporating HRQOL assessment tool in particular.
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