Kidney Disease Quality Of Life-Short Form Research Articles

The Influence of Emotional Intelligence on Quality of Life in Patients Undergoing Chronic Hemodialysis Focused on Age and Gender.

Emotional intelligence is a health predictor as it has an effect on quality of life, given that it affects a person's capacity to use and regulate emotions and consequently has an influence on their physical and mental condition. The aim of this study is to analyze emotional intelligence, quality of life, and associated correlation factors in patients undergoing chronic hemodialysis, differentiating age and gender differences. A multicenter study of one hundred and thirty-eight hemodialysis patients was conducted using a quantitative, observational, and cross-sectional design. A battery of questionnaires, including Trait Meta-Mood Scale (TMMS-24), Kidney Disease Quality of Life-Short Form (KDQOL-SF), and an ad hoc sociodemographic questionnaire, were administered. The Chi-squared test, the Student's t-test, and one-way ANOVA were used to compare categorical, independent, and continuous variables, respectively. A linear regression model was used to compare variables associated with quality of life. Gender differences existed when assessing the three dimensions of emotional intelligence: ranked by order, the highest scores in males were in clarity, repair, and attention. However, in females, the highest scores were in repair, clarity, and attention. Males had higher scores than females in emotional roles (p = 0.045). Younger participants had better scores in all physical functions (p = 0.001) and vitality (p = 0.038). Participants who had a higher level of education presented better physical function (p = 0.027) and higher scores in emotional wellbeing (p = 0.036). Finally, in females, emotional attention (p = 0.046) and repair (p = 0.000) were strongly associated with general health perception. The assessment of emotional intelligence considering gender differences in patients undergoing chronic hemodialysis can be an indicator of quality of life, including for use in health interventions.

Psychometric properties of the Kidney Disease Quality of Life short form 36 (KDQOL-36) scale for the assessment of quality of life in Colombian patients with chronic kidney disease on dialysis.

Considering the importance of incorporating quality of life (QoL) construct during the health care of patients with stage 5 chronic kidney disease (CKD) on dialysis, it is necessary to have evidence on the clinimetric properties of the instruments used for its measurement. This study aimed to establish the clinimetric properties of the Kidney Disease Quality of Life Short Form 36 (KDQOL-36) scale in patients with stage 5 CKD on dialysis in Colombia. A scale validation study was conducted using the classical test theory methodology. The statistical analysis included exploratory factor analysis (EFA) and confirmatory (CFA) techniques performed on two independent subsamples; concurrent criterion validity assessments; internal consistency using four different coefficients; test-retest reliability; and sensitivity to change using mixed model for repeated measures. The KDQOL-36 scale was applied to 506 patients with a diagnosis of stage 5 CKD on dialysis, attended in five renal units in Colombia. The EFA endorsed the three-factor structure of the scale, and the CFA showed an adequate fit of both the original and empirical models. Spearman's correlation coefficient values ≥0.50 were found between the domains of the CKD-specific core of the KDQOL-36 scale and the KDQ. Cronbach's alpha, McDonald's omega, Greatest lower bound (GLB), and Guttman's lambda coefficients were ≥0.89, indicating a high degree of consistency. A high level of concordance correlation was found between the two moments of application of the instrument, with values for Lin's concordance correlation coefficient ≥0.7. The application of the instrument after experiencing an event that could modify the quality of life showed statistically significant differences in the scores obtained. The KDQOL-36 scale is an adequate instrument for measuring QoL in Colombian patients with stage 5 CKD on dialysis.

Hemodialysis-induced chronodisruption and chronotype distribution in patients with chronic kidney disease

ABSTRACT Changes in circadian rhythms have been observed in patients with chronic kidney disease (CKD), and evidence suggests that these changes can have a negative impact on health. This study aimed to investigate the existence of hemodialysis-induced chronodisruption, the chronotype distribution, and their association with sleep quality and quality of life (QoL). This was a cross-sectional study that enrolled 165 patients (mean age: 51.1 ± 12.5 y, 60.6% male) undergoing hemodialysis from three local units. The following instruments were used: the Morning-Eveningness Questionnaire (MEQ); a modified version of the Munich Chronotype Questionnaire (MCQT) to estimate hemodialysis-induced chronodisruption (HIC); the Kidney Disease QoL Short Form (KDQOL-SF); the Epworth Sleepiness Scale (ESS); the Pittsburgh Sleep Quality Index (PSQI) and the 10–Cognitive Screener (10-CS). HIC was present in 40.6% of CKD patients. Morning chronotype was prevalent in CKD patients (69%) compared to evening-type (17.1%) and significantly different from a paired sample from the general population (p < 0.001). HIC and chronotype were associated with different domains of QoL but not with sleep quality. This study suggests that there is a HIC and that morning chronotype is associated with CKD patients undergoing hemodialysis, with implications for QoL.

Effect of psychosocial interventions for depression in adults with chronic kidney disease: a systematic review and meta-analysis

BackgroundPeople with chronic kidney disease (CKD) treated with dialysis are frequently affected by depression. Psychotherapy has been reported to decrease depressive symptoms in various chronic diseases and is a potential treatment option for depression. We aimed to perform a systematic review and meta-analysis to evaluate the effect of psychotherapy on depression in adults with CKD.MethodsWe searched MEDLINE, Embase, Web of Science, and Cochrane for published studies up to October 31, 2023. Two investigators independently reviewed the included studies and extracted relevant data. Randomized controlled trials (RCTs) assessing the impact of interventions that provide psychological, emotional, or social support without the use of pharmacological substances on depressive symptoms in people with CKD were included and summarized. Scores on different tools for depressive assessment and quality of life were pooled.ResultsA total of 19 RCTs published between 2004 and 2023 were included and analyzed. The weighted mean difference (WMD) for all included studies with regard to depression was − 2.32 (95%CI=-3.83, -0.80, P = 0.003). The WMD for Beck Depression Inventory (BDI) score of depression was − 3.27 (95%CI=-7.81, 1.27, P = 0.158) with significant heterogeneity (I2 = 95.1%). Significant WMD was detected for the Hospital Anxiety and Depression Scale (HADS) tool: WMD=-1.90, 95%CI=-2.91, -0.90, P < 0.001. The WMD for all included studies regarding quality of life was 1.21 (95%CI=-0.51, 2.93, P = 0.168). The WMD for Kidney Disease Quality of Life Short Form (KDQOL-SF) score was 4.55 (95%CI = 0.50, 8.60, P = 0.028). The WMD for SF-36 score was 0.02 (95%CI=-10.33, 10.36, P = 0.998). Significant difference on outcomes of S-PRT scale was observed (WMD = 2.42, 95%CI = 1.07, 3.76, P < 0.001).ConclusionsPsychosocial interventions probably reduce the depression level among CKD patients. Preliminary evidence suggests that psychosocial interventions might be beneficial for the quality of life in CKD patients. Our results provide medical facilities with an evidence-based basis for establishing psychosocial interventions in kidney care settings.

Is health-related quality of life trajectory associated with dialysis modality choice in advanced chronic kidney disease?

Patients with advanced chronic kidney disease have lower health-related quality of life (HRQOL) than the general population. There is uncertainty regarding patterns of HRQOL changes before dialysis initiation. This study aimed to characterise HRQOL trajectory and assess its potential association with intended dialysis modality. This prospective single-centre cohort study followed adults with an estimated glomerular filtration rate ≤15 mL/min/1.73 m2 for one year. Patients were allocated into one of two groups based on their intended treatment modality, 'home dialysis' (peritoneal dialysis or home haemodialysis (HD)) and 'other' (in-centre HD or conservative care). Follow-up was for up to 1 year or earlier if initiated on kidney replacement therapy or died. Kidney Disease Quality of Life - Short Form (KDQOL-SF) was completed every 6 months. Predictors of changes in KDQOL-SF components were modelled using mixed effect multivariable linear regressions. One hundred and nine patients were included. At baseline, crude physical composite summary (PCS) (45 ± 10 vs. 39 ± 8) was higher in patients choosing home dialysis (n = 41), while mental composite summary (MCS) was similar in both groups. After adjustment, patients choosing home dialysis had an increase in MCS (B = 8.4 per year, p = 0.007) compared to those selecting in-centre HD/conservative care. This translates into an annual increase in MSC by 3 points for the 'home dialysis' group, compared to an annual decline by 5.4 points in the 'other' group. There was no difference in PCS trajectory through time. Patients choosing home dialysis had improved MCS over time compared to those not selecting home dialysis. More work is needed to determine how differences in processes of care and/or unmeasured patient characteristics modulate this association.

A Prospective Observational Study to Assess Medication Adherence and Health Related Quality of Life in Chronic Kidney Disease Patients in a Tertiary Care Hospital

Chronic Kidney Disease(CKD) patients belong to the group of subjects with large burden of daily pill intake. Failure of adherence to these medications can lead to increased morbidity, mortality, cost, and burden on health care system. Therefore, good medication adherence is important to obtain desired therapeutic outcome which in turn improves the quality of life.&#x0D; The objective of this study is to assess medication adherence and health related quality of life in CKD patients.&#x0D; A prospective observational study was conducted for 6 months at Indiana Hospital and Heart Institute, Mangalore. Total 100 participants diagnosed with CKD were enrolled for the study. Permission from the Ethical Committee was taken and informed consent was obtained from the study subjects before initiating the study. Demographic, clinical and treatment details were collected in a specially designed data collection forms. Patient’s adherence to the medication was assessed with the help of Brief Medication Questionnaire (BMQ) and patient’s quality of life was assessed using Kidney Disease Quality of Life Short Form (KDQOL-SF). The data was expressed using descriptive statistics and analyzed using Chi square test, Mann Whitney test, and Spearman Correlation Statistics.&#x0D; Out of 100 patients enrolled in the study, 63 were male and 37 were female. The average number of medicines taken in a day by each patient was 10. 12% of the study population was completely adherent to the drug therapy. BMQ had 3 domains in which 39% of the patients were adherent and 61% were non adherent to the Regimen screen, 68% were adherent and 32% were non adherent to the Belief screen, and 31% were adherent and 69% were non adherent to the Recall screen. High cost of medicine (69%), Complex dosing schedule (68%), and Unaware about seriousness of condition or use of medicine (63%) were most common reasons for Non-adherence. Using KDQOL questionnaire, mean scores for Dialysis staff encouragement (96.25±9.31) and Quality of social interaction (87.86±17.48) were high whereas Physical role (4.75±16.92) and Emotional role (13.03±31.44) were found to be low.&#x0D; These results indicate that non adherence to medications leads to deteriorating quality of life and high therapeutic complexity.

Automated Digital Counseling Program (ODYSSEE-Kidney Health): A Pilot Study on Health-Related Quality of Life.

In-person counselling programs promote self-care behaviour and health-related quality of life (HRQoL). ODYSSEE Kidney Health (ODYSSEE-KH) is an automated, scalable, digital counselling program for patients with CKD. This open-label, single-arm pilot study tested the efficacy potential of ODYSSEE-KH to improve HRQoL in patients with CKD. Adults with categories G3b to 5D CKD were recruited from nephrology clinics in Toronto, Canada. Patients (n=29) received access to ODYSSEE-KH in conjunction with usual care. Generalized linear models and pairwise comparisons of mean change scores were conducted to assess the primary outcome: Mental Component Score (MCS) of the Kidney Disease Quality of Life - Short Form (KDQoL-SF) instrument. Secondary outcomes included: MCS mental health scale, 36-item KDQoL-SF, Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire for depression (PHQ-9), Enhancing Recovery in Coronary Heart Disease Social Support Instrument (ESSI), and 3-item Revised UCLA Loneliness (RULS-3) scale. Mean age was 53.5 years (SD=18.3); 35% women; 56% White; 93% completed ≥ post-secondary education; patients came from the Multi-Care Kidney Clinic (n=9), the Home Peritoneal Dialysis Unit (n=12), and the Home Hemodialysis Unit (n=8); and 24 participants completed the 4-month end of study questionnaires. Outcomes were assessed according to tertiles of program logon minutes: median (range) = 67 (62-108), 212 (119-355), and 500 (359-1573) minutes. Patients in the highest tertile of engagement showed significant improvements on the MCS vs. the moderate tertile group (p = 0.01). Significant dose-response associations were observed for MCS Mental Health (p<0.05), KDQoL Burden on Kidney Disease (p<0.01), KDQoL Effect of Kidney Disease on Everyday Life (p<0.01), aggregated KDQoL summary (p<0.05), GAD-7 (p<0.01), PHQ-9 (p<0.05), ENRICHD-SSI (p<0.01), and RULS-3 (p<0.01). ODYSSEE-KH demonstrated feasibility as an automated, scalable, digital self-care program for patients with CKD. There is evidence of efficacy potential to improve HRQoL. Further evaluation with a larger sample is warranted.

#4292 PATIENT-REPORTED MENTAL HEALTH PROBLEMS, SUICIDE IDEATION, AND CLINICAL OUTCOMES IN ADULTS WITH NON-DIALYSIS CKD: RESULTS OF THE KNOW-CKD STUDY

Abstract Background and Aims Mental health is important for health and well-being at every stage of life and disease. Mental health problems are common and bothersome in chronic kidney disease (CKD). Mental health problems of CKD are poorly understood and evaluated. To address the importance of mental health in CKD, we analyzed a prospective cohort database from prospective CKD cohort. Method We analyzed 1897 participants from the KNOW-CKD cohort. We evaluated 4 items as indicators of patient-reported mental health: sleep duration, perceived stress, depressive symptoms, and suicidal ideation. To facilitate interpretation of the mental health problems in CKD, we measure a scaled effect size (ES) for the Kidney Disease Quality of Life Short Form (KDQOL-SF) differences among the groups of mental health problems. We investigated the association between patient-reported mental health problems and clinical outcomes of incident end-stage kidney disease (ESKD) all-cause death in non-dialysis CKD. Results The mean age was 53 ± 12 years and 62% were male. The participants had mental health problems of inadequate sleep duration (17.4%), subject distress (27.3%), experience of depression (13.2%), and suicide ideation (16.8%), but had not well taken care (psychiatric counselling 1.9%, antidepressant therapy 2.8%). The 4 item indicators of mental health showed large effect size between-groups KDQOL mental component summary (ES = 1.67). In the fully adjusted Cox proportional model, poor mental health (≥2 mental health problems) was associated with high risk of ESKD [HR = 1.46; 95% CI (1.18∼1.08)] and death [HR = 1.55; 95% CI (1.04∼2.32)] compared to good mental health (no mental health problems). Among 4 item indicators of patient-reported mental health, suicide ideation was the most predictive indicator of clinical outcomes. Conclusion Mental health problem is common and undertreated in CKD. Poor mental health is associated with high risk of ESKD and death in non-dialysis CKD and the single question of suicide ideation is significantly associated with high risk of ESKD and death. It suggests that the evaluation and management of mental health problem is important to the clinical outcomes in CKD.

Comparison of quality of life in patients with advanced chronic kidney disease undergoing haemodialysis, peritoneal dialysis and conservative management in Johannesburg, South Africa: a cross-sectional, descriptive study

IntroductionMental health and quality of life are under-appreciated clinical targets which affect patient and modality survival. Lack of dialysis availability in the resource-constrained public health sector in South Africa results in assignment to treatment modalities without regard to effects on these parameters. We assessed the effect of dialysis modality, demographic and laboratory parameters on mental health and quality of life measurements.MethodsSize-matched cohorts were recruited from patients on haemodialysis (HD), peritoneal dialysis (PD), and patients on conservative management (CM) between September 2020 and March 2021. Responses to the Hospital Anxiety and Depression Scale (HADS) and Kidney Disease Quality of Life Short Form 36 (KDQOL-SF36) questionnaires and demographic and baseline laboratory parameters were compared between modalities. Multivariate linear regression was used to evaluate independent effect of baseline characteristics on HADS and KDQOL-SF36 scores between treatment groups where significant difference was observed.ResultsAnxiety, depression, and reduced KDQOL measures were widespread amongst respondents. Dialyzed patients reported higher anxiety and depression scores than those on CM (p = 0.040 and p = 0.028). Physical composite (PCS), role–physical (RP), vitality (VS), and emotional well-being (EWB) KDQOL-SF36 scores were poorer in dialyzed patients (p < 0.001 for all). PCS (p = 0.005), pain (p = 0.030), vitality (p = 0.005), and social functioning KDQOL scores were poorer in PD compared to HD; HADS anxiety (p < 0.001) and KDQOL-SF36 EWB scores (p < 0.001) were better in PD. PD patients were more likely to be employed (p = 0.008). Increasing haemoglobin concentration reduced anxiety (p < 0.001) and depression scores (p = 0.004), and improved PCS (p < 0.001), and pain scores (p < 0.001). Higher serum albumin improved PCS (p < 0.001) and vitality (p < 0.001) scores.ConclusionAdvanced chronic kidney disease increases anxiety and depression and limits quality of life. PD improves mental health and emotional wellbeing and preserves the ability to undertake economic activity but limits social functioning and causes greater physical discomfort. Targeting haemoglobin may ameliorate modality effects on mental health and quality of life.

Reliability and validity of the Patient Generated Index (PGI) in patients with chronic kidney disease (CKD) on dialysis, a new approach to quality of life

Purpose To evaluate the test-retest reliability and validity of the Patient Generated Index (PGI) in individuals with Chronic Kidney Disease (CDK) undergoing hemodialysis. Methods Through a non-experimental study with repeated measures, PGI was applied twice to assess internal consistency and test-retest reliability. Correlations with the Kidney Disease Quality of Life Short Form (KDQOL-SF), the Human Activity Profile (HAP) questionnaire, the Social Participation Scale, and the Glittre ADL Test were used. Results 91 individuals with CKD were evaluated. There was high reliability for the PGI (ICC= 0.97) PGI correlated with KQDOL – SF in Functional Capacity r = 0.38 (p < 0.001), Emotional Well-Being r = 0.31 (p = 0.003), Social Aspect r = 0.22 (p = 0.036), Emotional Function r = 0.22 (p = 0.038) and Effect of Kidney Disease r = 0.21 (p = 0.042), and Physical scores r = 0.24 (p = 0.021)), Mental r = 0.21 (p = 0.05) and General r = 0.22 (p = 0.037) summarized. There was a significant correlation between PGI and HAP r = 0.40 (p < 0.001) and the Social Participation Scale r = −0.36 (p < 0.001). There was no correlation between the PGI and Glittre ADL scores r = 0.12 (p = 0.247). Conclusion In adults receiving hemodialysis, the PGI proved to be an accurate and reliable instrument for the assessment of the quality of life from the perspective of the patient. IMPLICATIONS FOR REHABILITATION Although hemodialysis treatment is associated with increased survival and symptom control, there is a significant change in the patient’s lifestyle. In order to provide a more focused view of the individual, the Patient Generated Index (PGI) was created to evaluate the quality of life. PGI is reliable and correlates with KQDOL – SF and the Social Participation Scale in this population.

Quality of life of patients undergoing haemodialysis at Edward Francis Small Teaching Hospital, The Gambia

Background: Renal Replacement Therapies (RRTs) like haemodialysis only partially correct the symptoms experienced by a patient but provoke additional changes in his/her lifestyle. These changes can affect the Quality of life (QOL) of the patients. Therefore, the purpose of this study was to measure the quality of life of patients undergoing haemodialysis at the Edward Francis Small Teaching Hospital (EFSTH), The Gambia Method: A cross-sectional study design was used. The Kidney Disease Quality of Life –Short Form (KDQOL-SF) questionnaire was adapted and used to collect data from 44 participants undergoing haemodialysis at the time of data collection. The data was analyzed using SPSS version 20 and t-test and Analysis of variance (ANOVA) were used to determine the difference in the quality of life, among the patients in relation to their demographic variables. Results: The finding showed that the majority of the patients were female 30(68.2%) and the mean age was 43.3 years ranging from 20- 80 years. Hypertension was the major cause of renal failure (n=27; 61.4%) of the patients. The patients had a poor quality of life with a mean score of 34. 8%. Independent t-test shows that the Physical Composite Score (PCS), Mental Composite Score (MCS), and Kidney Disease Composite Score (KDCS) were all higher in males compared to females, with PCS being significant at a p-value of 0.007 and KDCS at a P-value of 0.01. The MCS was significantly higher among the unmarried patients at a p-value of 0.022 as well as for diabetes and hypertension compared to unknown causes of Kidney Conclusion: The low PCS, MCS, and KDCS among the patients receiving haemodialysis treatment in EFSTH indicate poor quality of life. Therefore, more efforts need to be done to improve the quality of life for these patients.

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

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 usingArabic translated, adapted, and validated version of the Kidney Disease Quality of Life Short-Form 36 (KDQOL-36). We carriedout 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. 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). 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.

Can residual kidney function affect quality of life and cognitive function in hemodialysis patients?

BackgroundResidual kidney function (RKF) may provide many benefits to patients on permanent renal replacement therapy that are reflected in better control of biochemical parameters. In hemodialysis patients, quality of life (QOL) and cognitive function are often impaired. This study aimed to assess the predictors of RKF and its impact on QOL and cognitive function in chronic hemodialysis patients.Patients and methodsThe study involved seventy-eight patients suffering from end-stage renal disease on regular hemodialysis. The patients were divided into two groups according to the presence or absence of RKF (24-hour urine volume ≥ 100 ml). Beside basic laboratory investigations, all patients were subjected to Kidney Disease Quality of Life-Short Form (KDQOL-SF) version 1.3 for assessing the quality of life and Montreal cognitive assessment (MoCA) score for assessing cognitive function.ResultsThere was a significantly higher score for KDQOL domains and MoCA score in patients with RKF compared to patients without RKF. There was a significant positive correlation between RKF and both of MoCA score and the physical composite score (PCS) of QOL. Moreover, there were statistically significant positive correlations between the MoCA score and both PCS and mental composite score (MCS). On multivariate analysis, hemodialysis duration was the only predictor for RKF; whereas age was a significant predictor for PCS; and MoCA score could be significantly predicted by the measured RKF and patients’ age.ConclusionHD patients with maintained RKF had better QOL and cognitive function. The duration of HD and the age of the patients were found to be related to RKF and PCS in this study. RKF was associated with the cognitive performance of hemodialysis patients.

Improvement in Quality of Life via Catheter Ablation for Atrial Fibrillation in Patients Undergoing Hemodialysis Therapy

BackgroundAtrial fibrillation (AF) is the most common arrhythmia in patients undergoing hemodialysis (HD); AF lowers quality of life (QoL) and increases the risk of dialysis-related complications. The present study aimed to evaluate the effectiveness of AF ablation on the QoL in patients undergoing HD. MethodsNineteen patients undergoing HD (14 men, age 68 ± 8 years; 15 with paroxysmal AF) who underwent catheter ablation (CA) of AF were enrolled in the study. The Kidney Disease Quality of Life Short Form (KDQOL-SF) was assessed to evaluate the QoL of the HD patients at baseline and 6 months after the ablation. Ablation outcomes and procedural complications were evaluated and compared to those of 1053 consecutive non-HD patients who underwent AF ablation. ResultsThe KDQOL-SF of the HD patients 6 months after the ablation showed an improvement in physical functioning (54 ± 23 to 68 ± 28, P < 0.01), general health perceptions (38 ± 17 to 48 ± 15, P < 0.01), and symptoms/problems (75 ± 21 to 84 ± 13, P = 0.02), compared to baseline. For intradialytic symptoms, dyspnea during HD significantly improved after the CA in the HD patients without AF recurrence (43% to 7%, P = 0.04), whereas the atrial tachyarrhythmias and hypotension during HD remained unchanged. During the follow-up period of 17 ± 13 months after the last procedure, the incidence of being arrhythmia-free was similar (HD patients, 79% vs non-HD patients, 86%, log-rank P = 0.82). No life-threatening complications occurred in any of the patients. ConclusionsCA of AF improves QoL in patients undergoing chronic HD therapy.

Role of malnutrition inflammation score and interleukin-6 on quality of life of regular hemodialysis patients

Background: Malnutrition, systemic inflammation, and atherosclerosis known as MIA syndrome occurs in patients who have undergone regular hemodialysis (HD) and can lower their quality of life (QoL). Current study aimed to determine the interrelation of malnutrition and inflammation to QoL. Methods: A cross-sectional analytic study was conducted in our hemodialysis installation. We performed Malnutrition Inflammation Score (MIS) and measure serum IL-6 to determine malnutrition and inflammation conditions in regular HD patients and utilized ‘Kidney Disease Quality of Life-Short Form (KDQOL-SF) to assess QoL MIS. IL-6 cut-off point were determined by the Receiver Operating Curves (ROC) then we performed linear regression to analyze the relationship level of MIS and IL-6 with level of QoL. We also used path analysis to prove the mechanism model of MIS and IL-6 to QoL on regular HD patients. Results: This study consisted of 60 regular HD patients, 40 (66.7%) of men with mean age of 51.8 years and 78 months average of dialysis vintage. Good QoL was obtained ≥60 overall health (above the median value) and high level of MIS was obtained ≥5 with 75% sensitivity and 21.8% specificity, while high IL-6 level were ≥47.21 pg/mL, with 62.2% sensitivity and specificity of 78.3%. This study found the prevalence of protein-energy wasting (PEW) in regular HD patients was 81.7% by using high level of MIS. MIS were significantly correlated to IL-6 (r = 0.376, p = 0.003) however high level of MIS were uncorrelated to poor QoL. The mechanism of the interrelation of MIS, IL-6, and QoL showed on path analysis that MIS was 15% directly correlated to QoL, however, IL-6 indirectly correlated to QoL on regular hemodialysis patients. Conclusion: MIS and IL-6 were correlated to QoL and MIS also correlated to IL-6. Malnutrition inflammatory score directly affected QoL but IL-6 indirectly affected QoL in regular HD patients.

The association between sense of coherence and quality of life: a cross-sectional study in a sample of patients on hemodialysis

BackgroundPatients on hemodialysis universally experience detriments in their general quality of life (QOL). Sense of coherence (SOC) is a long-standing factor that affects QOL. Nevertheless, the association between SOC and QOL in patients on hemodialysis was seldom investigated. Our research aims to study this association in a sample of Lebanese adult patients on hemodialysis.MethodsIn this cross-sectional study, SOC was measured using the short version of the “Orientation of Life" scale (SOC-13). QOL was assessed using the Kidney Disease Quality of Life- Short Form (KDQOL-SF). The association between SOC and QOL and its submodalities was first explored using Pearson Correlation and multivariate linear regression analyses, controlling for sociodemographic variables and medical variables.Results157 patients on hemodialysis (mean(SD) age: 62.1(13.81) years; 58.6% males) were included. Mean QOL score was 51.65 and that of SOC was 48.06. SOC was strongly corrected with the total QOL (r = 0.832; p value < 0.001), as well as its physical functioning (r = 0.767; p value < 0.001), emotional functioning (r = 0.757; p value < 0.001), cognitive functioning (r = 0.740; p value < 0.001), and social functioning (r = 0.773; p value < 0.001) submodailties. SOC was moderately correlated with professional functioning submodality of QOL (r = 0.618; p value < 0.001), but not correlated with the satisfaction with the quality of care (r = 0.052; p = 0.520). Within the regression models accounting for sociodemographic and medical variables, SOC was significantly associated with the total QOL (unstandardized B = 0.803; 95% CI 0.714, 0.893), physical functioning (unstandardized B = 0.761; standardized B = 0.763; 95% CI 0.661, 0.861), emotional functioning (unstandardized B = 1.205; standardized B = 0.757; 95% CI 1.037, 1.372), professional functioning (unstandardized B = 1.142; standardized B = 0.498; 95% CI 0.843, 1.442), cognitive functioning (unstandardized B = 1.239; standardized B = 0.739; 95% CI 1.058, 1.420), and social functioning (unstandardized B = 0.912; standardized B = 0.768; 95% CI 0.790, 1.034).ConclusionsIn a sample of adult patients on hemodialysis, SOC was positively significantly associated with QOL and its submodalities, expect the satisfaction with the quality of care. The confirmation of the general hypothesis that relates the SOC with the QOL encourages more salutogenic research among this patient population.

Burden of kidney disease among patients with peritoneal dialysis versus conventional in-centre haemodialysis: A randomised, non-inferiority trial.

Little is known about the impact of haemodialysis (HD) and peritoneal dialysis (PD) on health-related quality of life (HRQoL). We compared HRQoL between conventional in-centre HD and home-based PD in 1082 newly diagnosed kidney failure patients. This was an open-label, randomised, non-inferiority trial of adult patients with a diagnosis of end-stage kidney disease (estimated glomerular filtration rate ≤ 15 mL/min/1.73 m2) requiring maintenance dialysis from 36 sites in China randomised 1:1 to receive PD or conventional in-centre HD. The primary outcome was the 'Burden of Kidney Disease' assessed using the Kidney Disease Quality of Life-Short Form (KDQoL-SF) survey over 48 weeks and the main secondary outcomes were the remaining scales of KDQoL-SF and all-cause mortality. The effect of PD versus HD on the primary outcome was compared by their geometric mean (GM) ratio, and non-inferiority was defined by the lower bound of a one-sided 95% confidence interval (CI) >0.9. A total of 725 subjects completed the trial per protocol (395 PD and 330 HD, mean age 49.8 (standard deviation (SD) 14.4) years, 41.4% women). For the primary outcome, the mean (SD) change in 'Burden of Kidney Disease' over 48 weeks was 2.61 (1.27) in PD group and 2.58 (1.35) in HD group, and the GM ratio (95% CI) was 1.059 (0.908-1.234), exceeding the limit for non-inferiority. For the secondary outcomes, the PD and HD groups were similar in all scales. There were 17 and 31 deaths in PD and HD groups, respectively. Patients receiving PD had more adverse events, adverse event leading to hospitalisation and serious adverse events compared to those allocated to HD, but adverse events leading to death and discontinuation of the trial were not different between PD and HD. In this trial, PD may be non-inferior to HD on the 'Burden of Kidney Disease' among Chinese kidney failure patients who are of younger age and have lower comorbidity after 48 weeks' follow-up.

Validation of the functional assessment of anorexia/cachexia therapy instrument to assess quality of life in maintenance hemodialysis patients with cachexia.

Many patients on maintenance hemodialysis (MHD) eventually suffer from cachexia. The Functional Assessment of Anorexia/Cachexia Therapy (FAACT) is a tool used to evaluate the quality of life of patients with cachexia related to various diseases, but its suitability for use in MHD patients has yet to be verified. This study aimed to explore the validation of the FAACT in MHD patients by conducting reliability and validity tests. Qualified MHD patients were selected to complete the FAACT and Kidney Disease Quality of Life Short Form 36 (KDQOL-36) questionnaires, and their demographic data and biochemical test results were collected from electronic medical records. Next, the Cronbach's alpha coefficient, paired sample t test and ICC were used to analyze the scale consistency. Additionally, the association between the KDQOL-36 and FAACT was analyzed using Bland-Altman plots and Pearson correlation analysis. Finally, the patients were divided into groups to evaluate discriminant validity. A total of 299 patients were included in this study. The Cronbach's alpha coefficients of the FAACT and its anorexia-cachexia subscale (ACS) were 0.904 and 0.842, respectively, and their ICC exceeded 0.90. The correlation coefficients between the FAACT and its items ranged from 0.146 to 0.631, and the correlation coefficients between the FAACT and KDQOL-36 dimensions ranged from 0.446 to 0.617. The Bland-Altman plots between the FAACT and KDQOL-36 showed that only 3.3% of the points were outside the 95% limits of agreement. The effects of cachexia status (present or absent) on FAACT and ACS scores had effect sizes of 0.54 (P< 0.001) and 0.60 (P< 0.001), respectively. The FAACT and ACS also significantly discriminated between patients with and without inflammation (P< 0.001). The FAACT and ACS have acceptable reliability and validity in MHD patients and are suitable for measuring the quality of life of MHD patients with cachexia.

The relationship between the perception of chronic disease care and health-related quality of life in adults with chronic kidney disease.

In this study, it was aimed to determine the chronic disease care assessments and health-related quality of life (HRQoL) levels in adults with chronic kidney disease (CKD) undergoing hemodialysis and to reveal the relationship between chronic disease care assessment and HRQoL. A single-center cross-sectional design has been used. Data were collected from 105 adults with CKD, who undergoing hemodialysis. Patient Evaluation Chronic Illness Care (PACIC) scale and Kidney Disease Quality of Life Short Form-36 (KDQOL-36) were used to obtain data. The mean scale scores of PACIC were low (2.66 ± 0.891). Although participants achieved high HRQoL scores on the symptoms subdimension of the KDQoL-36 scale, they got low scores on the subdimensions of mental health, physical health, and burden of disease. Participants' HRQoL is affected significantly by gender, age, educational level, working status, income, and presence of comorbidity (especially diabetes), diagnosis time of CKD, and hemodialysis time at the hospital (p < 0.05). A positive and statistically significant relationship was found between PACIC and subdimensions of KDQoL-36 (p < 0.05). The results can be a guide for improving the quality of chronic disease care in healthcare institutions. To improve this, patients' evaluations on this issue should be taken into account.

MO841EFFICACY OF PHYSICAL EXERCISE IN PERITONEAL DIALYSIS PATIENTS: A SECONDARY ANALYSIS OF THE EXCITE TRIAL

Abstract Background and Aims Although physical activity has been documented to be effective in many categories of high-risk patients and more recently also in dialysis patients, there are no studies specifically focused on Peritoneal Dialysis (PD) patients. The peculiarity of this treatment modality for uremia is that it is carried out at the patient's home while the vast majority of physical exercise in dialysis patients is carried out during the hemodialysis (HD) session, then they are not applicable for PD patients. The Excite trial (JASN 2017; 28:1259-1268) is a home-based, individualized, low-intensity exercise program. In this multicenter, randomized clinical trial, the EXerCise Introduction To Enhance performance in dialysis patients trial (EXCITE), we aimed to investigate whether this home exercise program improves the degree of fitness and quality of life in patients with CKD-5D (Hemodialysis and Peritoneal Dialysis patients). The EXCITE home based clinical trial, is the first and may be the only one, involving peritoneal dialysis patients and this is of unique importance for the scientific community. Method We performed a secondary analysis of 35 peritoneal dialysis (PD) patients (age: 64±11 years; 74% males; 17% diabetics) who participated to the Exercise Introduction to Enhance Performance in Dialysis (EXCITE) trial, a 6-month randomized, multicenter trial testing whether a simple, personalized walking exercise program at home, managed by dialysis staff, improves functional status in adult patients on dialysis. The main study outcomes included change in physical performance at 6 months, assessed by the 6-minute walking test (6MWD) and the five times sit-to-stand test (STS), and in quality of life, assessed by the Kidney Disease Quality of Life Short Form (KDQOL-SF) questionnaire. Data are summarised as median and interquartile range (IQR). Results Out of 35 PD patients, 14 resulted to be allocated to the active arm and the remaining 21 to the control arm of the trial, and all completed the 6-month active phase of the trial. At baseline, the two groups did not differ as for age, gender, smoking, diabetes, and NYHA class (p ranging from 0.41 to 1.00) as well as for baseline values of 6MWD (active group, median 344 m, IQR: 307-440 m versus control group, median 302 m, IQR: 263-425m, P=0.12) and STS test (active group, median 18.2, IQR: 17.1-18.8 sec versus control group, median 20.2, IQR 16.2-27.1, P=0.25). During the 6 month period, there was a 34.0 m median increase of 6MWD (IQR: from 16.3 to 61.3 m) in the active group and only a modest increase of the same test in the control group (median: 14.0 m; IQR: from -39.5 to 38.5 m) and the between arms difference was statistically significant (P=0.034). No between arms difference was found in the STS test change (P=0.70). At 6 months, the quality of social interaction in the kidney disease component of the KDQOL-SF remained stable in patients of the active arm (median change from baseline: 0.0, IQR: from -5.0 to 17.5) whereas it decreased in patients in the control arm (median change from baseline: -5.8, IQR: from – 20.0 to -1.3) (between-arms difference, P=0.032). Conclusion The results of this multicentre trial involving PD patients show that a simple, personalized, home-based, low-intensity exercise program is feasible in PD patients and it may improve physical performance and quality of life in this high risk category of patients.