Quality of life in patients on chronic dialysis in South Africa: a comparative mixed methods study

Elliot K Tannor,M Razeen Davids,Elize Archer,Kenneth Kapembwa,Susan C Van Schalkwyk

doi:10.1186/s12882-016-0425-1

Elliot K Tannor, M Razeen Davids + Show 3 more

Open Access

https://doi.org/10.1186/s12882-016-0425-1

Copy DOI

Journal: BMC Nephrology	Publication Date: Jan 5, 2017
Citations: 48	License type: open-access

Affiliation: Stellenbosch University, Tygerberg Hospital

Abstract

BackgroundThe 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).MethodsWe 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.ResultsA 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.ConclusionsPD 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.

Highlights

The increasing prevalence of treated end-stage renal disease and low transplant rates in Africa leads to longer durations on dialysis
Continuous ambulatory peritoneal dialysis (CAPD) using a twin-bag system is the sole form of PD, with the majority of PD patients performing four 2-litre exchanges per day
We found no difference in the overall quality of life between HD and PD patients as measured by Kidney Disease Quality of Life (KDQOL) 1.3 scoring

Summary

Introduction

The increasing prevalence of treated end-stage renal disease and low transplant rates in Africa leads to longer durations on dialysis. We investigated the QOL of patients on chronic haemodialysis (HD) and peritoneal dialysis (PD). End-stage renal disease (ESRD) is a serious complication of CKD and requires renal replacement therapy (RRT) in the form of haemodialysis (HD), peritoneal dialysis (PD) or transplantation as the mainstay of treatment. Of the more than 1.8 million patients worldwide on dialysis, less than 5% are in Africa where access to RRT is dependent on very limited government support [4, 5]. The dialysis rates across Africa are less than 20 per million population (pmp) as compared to a global prevalence of 223 pmp. According to recent registry data 71.8% of patients receiving RRT are on HD and 13.5% on PD [7]

Methods

Results

Discussion

Conclusion