Kidney Disease Quality Of Life Research Articles

The influence of mindfulness meditation combined with progressive muscle relaxation training on the clinical efficacy and quality of life of patients with sarcopenia receiving haemodialysis: a randomised controlled trial

ObjectiveTo study the effect of mindfulness meditation combined with progressive muscle relaxation training on the clinical efficacy and quality of life in patients with sarcopenia receiving maintenance haemodialysis (MHD).MethodsEligible patients with sarcopenia in our hospital were randomly assigned to a control group (n = 24) and an intervention group (n = 25). The control group received conventional dialysis treatment, while the intervention group underwent mindfulness meditation combined with progressive muscle relaxation training during the interdialysis period in addition to conventional dialysis treatment. The effect of the intervention was evaluated after 12 weeks.ResultsThere were no significant differences in the baseline values of various parameters between the two groups. Exercise capacity (sit-to-stand test,handgrip,time to 10 sit-ups) significantly improved in the intervention group after 12 weeks (32.68 ± 8.32 vs 26.50 ± 6.83; 37.42 ± 10.12 vs 28.12 ± 8.51; 19.8 ± 5.40 vs 25.29 ± 7.18) (p < 0.05). In terms of the kidney disease quality of life (KDQOLTM) score, all other dimensions except sexual function, social functioning, burden of kidney disease and work status dimensions showed significant improvement compared to the baseline (p < 0.05). In the control group, only the dialysis staff encouragement (DSE) and patient satisfaction (PS) dimensions showed slight improvements compared to the baseline (p > 0.05). When compared with the control group, the intervention group showed significant improvements in 10 dimensions of exercise capacity and KDQOLTM scores for physical function, role-physical, general health, energy, symptom/problem list, sleep, DSE, pain, cognitive function, emotional well-being and patient PS after 12 weeks (61.30 ± 5.38 vs 42.98 ± 5.73; 57.50 ± 3.55 vs 50.70 ± 3.62) (p < 0.05). Some inflammatory markers, such as the levels of interleukin-6 and high-sensitivity C-reactive protein (30.29 ± 2.96 vs 17.65 ± 3.22; 8.93 ± 0.99 vs 3.02 ± 0.34), showed a decrease during the intervention, while albumin and prealbumin levels were significantly increased compared with the baseline (30.62 ± 1.65 vs 35.60 ± 1.68; 0.32 ± 0.05 vs 0.44 ± 0.07) (p < 0.05).ConclusionCombined intervention training can improve the motor ability and quality of life of patients with sarcopenia within a short period of time.

Symptom profiles in patients receiving maintenance hemodialysis and their association with quality of life: a longitudinal study.

Many patients receiving maintenance hemodialysis experience one or multiple symptoms. Using a latent profile analysis to identify symptom profiles may provide insights for person-centered symptom management strategies. This is a longitudinal study based on data from patients receiving maintenance hemodialysis at three hospitals in Shanghai, China. Of the 448 patients who completed the surveys at baseline (T1), 309 completed the 12-month follow-up survey (T2). Symptoms and quality of life were measured by the Chinese version of Kidney Disease Quality of Life 36 Short Form. The optimal classification of symptoms was identified using latent profile analysis. Five symptom profiles were identified: High (9.2%), Fatigue and Gastrointestinal (7.1%), Fatigue and Skin (10.7%), Skin (23.2%), and Low (49.8%). The high-symptom profile and the-fatigue-and-skin-symptom profile were associated with a lower level of physical functioning, a higher burden of kidney disease, and more negative effects of kidney disease than the low symptom profile at T1 and T2. Multivariate regression analysis showed that the high-symptom profile predicted a poorer physical functioning at T2, and the-fatigue-and-skin-symptom profile predicted a poorer physical functioning and higher burden of kidney disease at T2. Patients receiving maintenance hemodialysis reported unique symptom experiences which could be classified into different profiles. Patients reporting an overall high level of symptoms or a high level of fatigue and skin symptoms were more likely to have a poorer quality of life.

Psychometric Evaluation of the Multidimensional Scale-Uremic Pruritus in Dialysis Patients (UP-Dial): Comparison in Hemodialysis and Peritoneal Dialysis Patients with Chronic Pruritus.

High-quality patient-reported outcome (PRO) measures for dialysis patients with chronic pruritus are urgently needed. However, no known, well-validated multidimensional tools have been investigated to measure pruritus symptoms in dialysis patients. To examine the psychometric properties of a multidimensional tool of chronic pruritus, the Uremic Pruritus in Dialysis (UP-Dial) 14-item, by comparing hemodialysis and peritoneal dialysis modality. This validation study used data from the Thai Renal Outcomes Research-Uremic Pruritus, a prospective, multicenter, longitudinal study. Data for this study were collected from February 1, 2019, to May 31, 2022. The adult sample of 226 hemodialysis and 327 peritoneal dialysis patients fulfilled the criteria of chronic pruritus based on the International Forum for the Study of Itch. Psychometric properties of the UP-Dial included validity and reliability, as measured across hemodialysis and peritoneal dialysis patients. Patients completed a set of anchor-based measurement tools, including global itching, Dermatology Life Quality Index (DLQI), EuroQoL-5 dimension-5 level (EQ-5D-5L), Kidney Disease Quality of Life-36 (KDQOL-36), Pittsburgh Sleep Quality Index (PSQI), global fatigue, Somatic Symptom Scale-8 (SSS-8), and Patient Health Questionnaire-9 (PHQ-9). From the patient's perspective, face validity was satisfactory for both dialysis samples. Psychometric analyses of the UP-Dial for each dialysis sample had good convergent validity. Spearman rho correlations indicate a positively strong correlation (0.73 to 0.74) with global itching, a positively moderate correlation (0.33 to 0.58) with DLQI, PSQI, global fatigue, SSS-8, and PHQ-9, and a negatively moderate correlation (-0.39 to -0.58) with EQ-5D-5L and KDQOL-36. The discriminant validity was satisfactory with a group of moderate and severe burden of pruritus for both dialysis samples. For scale reliability, the UP-Dial revealed excellent internal consistency (Cronbach's α = 0.89 and McDonald's ω = 0.90) and reproducibility (intraclass correlation: 0.84 to 0.85) for both dialysis samples. Regarding psychometric properties, no statistically significant differences between dialysis samples were observed (all P > 0.05). The findings reaffirm good measurement properties of the UP-Dial 14-items in hemodialysis and peritoneal dialysis patients with chronic pruritus. These suggest a transferability of the UP-Dial as a PRO measure in clinical trial and practice settings.

Psychological profile of Chinese peritoneal dialysis patients during the Omicron pandemic in 2022

ObjectiveThe aim of this study was to determine the psychological status of peritoneal dialysis (PD) patients who were blocked during the 2022 Omic Pandemic in Shanghai.MethodsThis was an observational and cross-sectional study. We selected 172 PD patients from the peritoneal dialysis center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, during the quarantine of the Omicron pandemic in Shanghai from April to May 2022. General data and biochemical indices were collected. The Kidney Disease Quality of Life (SF-36) questionnaire was used to evaluate the psychological state of the patients during the quarantine.ResultsAccording to the assessment of the SF-36 scale, the physiological and psychological health status of PD patients was better than that before quarantine (P < 0.05). According to the comparison of biochemical indices, the high-density lipoprotein, total cholesterol and body mass index (BMI) levels were lower in patients after quarantine than before quarantine, while the blood phosphorus, blood calcium and haemoglobin levels were greater after quarantine (P < 0.05). Logistic regression analysis revealed that health changes were positively correlated with age of penetration (years) (OR = 1.031, 95% CI = 1.005–1.058); however, physiological function was negatively correlated with sex (OR = 0.198, 95% CI = 0.044–0.899). Energy was significantly positively correlated with closed-loop time (OR = 1.063, 95% CI = 1.001–1.128) (P < 0.05). There were no significant differences in biochemical indices or quality of life between APD patients and non-APD patients (P > 0.05). According to the results of the abstract independent sample T test, when comparing the various dimensions of the SF-36 scale, for the dimensions of physiological function, pain and energy, the PD patients were better than the HD patients were (P < 0.05). Similarly, for the dimension of physiological function, the HD patients were better than the PD patients were (P < 0.05). During the quarantine period from April to May in Shanghai, the infection rate of PD patients was lower than usual (P < 0.05).ConclusionsDuring the Omicron pandemic in Shanghai in 2022, PD patients exhibited relatively stable psychological and physiological states and a low infection rate. Compared with HD patients, PD patients had better adaptability. Especially in the context of the COVID-19 pandemic, peritoneal dialysis has more advantages.

Health-related quality of life among patients undergoing hemodialysis in a tertiary center in South Kerala

IntroductionHealth-related quality of life is essential for evaluating treatment quality in chronic diseases, providing valuable patient perspectives for medical decisions. Chronic kidney disease and end-stage renal disease significantly affect Health-related quality of life. The study aimed to assess the Health-related quality of life and the factors affecting it in end-stage renal disease patients on maintenance hemodialysis. MethodsA cross-sectional study was conducted in a tertiary care center in Kerala from November 2021 to December 2022.A validated Kidney Disease Quality of Life in the local language Malayalam was used for data collection. Patients over the age of 18 who have end-stage renal disease and have been on maintenance dialysis for at least 3 months and agreed to participate were included in the study by consecutive sampling method. ResultsAmong the 124 patients studied, the physical component had the lowest mean score (38.11 ± 20.87), mental component displayed a higher score compared to the physical (47.33 ± 16.88), indicating moderate level of mental well-being. Kidney Disease Component Summary had the highest mean score (61.73 ± 9.42).Younger patients had better mental-health related quality of life, while age did not significantly affect physical or disease-specific health related quality of life. Gender differences appeared, with males reporting higher physical-health related quality of life. Discussion and conclusionThe study highlights the quality of life and its association with socio-personal variables. To enhance the well-being of end-stage renal disease patients in Kerala, public health initiatives should prioritize elderly females with limited education, tailoring interventions to address their specific issues.

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.

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.

Metabolites Associated With Uremic Symptoms in Patients With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Rationale & ObjectiveThe toxins contributing to uremic symptoms in patients with CKD are unknown. We sought to apply complementary statistical modeling approaches to data from untargeted plasma metabolomic profiling to identify solutes associated with uremic symptoms in patients with CKD. Study DesignCross-sectional. Setting & Participants1,761 Chronic Renal Insufficiency Cohort (CRIC) participants with CKD not on dialysis. PredictorsMeasurement of 448 known plasma metabolites. OutcomesThe uremic symptoms fatigue, anorexia, pruritus, nausea, paresthesia, and pain were assessed by single items on the Kidney Disease Quality of Life-36 (KDQOL) instrument. Analytical ApproachMultivariable adjusted linear regression, Lasso linear regression, and random forest models were used to identify metabolites associated with symptom severity. After adjustment for multiple comparisons, metabolites selected in at least two of the three modeling approaches were deemed “overall” significant. ResultsParticipant mean eGFR was 43 mL/min/1.73 m2, with 44% self-identifying as female and 41% Non-Hispanic Black. The prevalence of uremic symptoms ranged from 22 – 55%. We identified 17 metabolites for which a higher level was associated with greater severity of at least one uremic symptom, and 9 metabolites inversely associated with uremic symptom severity. Many of these metabolites demonstrated at least a moderate correlation with eGFR (Pearson’s r ≥ 0.5), and some were also associated with risk of developing kidney failure or death in multivariable adjusted Cox regression models. LimitationsLack of a second independent cohort for external validation of our findings. ConclusionsMetabolomic profiling was used to identify multiple solutes associated with uremic symptoms in adults with CKD, but future validation and mechanistic studies are needed.

The Association Between Intradialytic Symptom Clusters and Recovery Time in Patients Undergoing Maintenance Hemodialysis: An Exploratory Analysis.

Individuals receiving hemodialysis often experience concurrent symptoms during treatment and frequently report feeling unwell after dialysis. The degree to which intradialytic symptoms are related, and which specific symptoms may impair health-related quality of life (HRQoL) is uncertain. To explore intradialytic symptoms clusters, and the relationship between intradialytic symptom clusters with dialysis treatment recovery time and HRQoL. We conducted a post hoc analysis of a prospective cohort study of 118 prevalent patients receiving hemodialysis in two centers in Calgary, Alberta and Hamilton, Ontario, Canada. Adults receiving hemodialysis treatment for at least 3 months, not scheduled for a modality change within 6 weeks of study commencement, who could provide informed consent and were able to complete English questionnaires independently or with assistance. Participants self-reported the presence (1 = none to 5 = very much) of 10 symptoms during each dialysis treatment, the time it took to recover from each treatment, and weekly Kidney Disease Quality of Life 36-Item-Short Form (KDQoL-36) assessments. Principal component analysis identified clusters of intradialytic symptoms. Mixed-effects, ordinal and linear regression examined the association between symptom clusters and recovery time (categorized as 0, >0 to 2, >2 to 6, or >6 hours), and the physical component and mental component scores (PCS and MCS) of the KDQoL-36. One hundred sixteen participants completed 901 intradialytic symptom questionnaires. The most common symptom was lack of energy (56% of treatments). Two intradialytic symptom clusters explained 39% of the total variance of available symptom data. The first cluster included bone or joint pain, muscle cramps, muscle soreness, feeling nervous, and lack of energy. The second cluster included nausea/vomiting, diarrhea and chest pain, and headache. The first cluster (median score: -0.56, 25th to 75th percentile: -1.18 to 0.55) was independently associated with longer recovery time (odds ratio [OR] 1.62 per unit difference in score, 95% confidence interval [CI]: 1.23-2.12) and decreased PCS (-0.72 per unit difference in score, 95% CI: -1.29 to -0.15) and MCS scores (-0.82 per unit difference in score, 95% CI: -1.48 to -0.16), whereas the second cluster was not (OR 1.24, 95% CI: 0.97-1.58; PCS 0.19, 95% CI -0.46 to 0.83; MCS -0.72, 95% CI: -1.50 to 0.06). This was an exploratory analysis of a small data set from 2 centers. Further work is needed to externally validate these findings to confirm intradialytic symptom clusters and the generalizability of our findings. Intradialytic symptoms are correlated. The presence of select intradialytic symptoms may prolong the time it takes for a patient to recover from a dialysis treatment and impair HRQoL.

Abstract 18110: Assessing the Impact of a Multidisciplinary Cardio-Kidney Care Team on the Overall Care Satisfaction in Patients With Heart Failure With Reduced Ejection Fraction And Chronic Kidney Disease

Background: Patients with heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) experience fragmented care in the usual referral-based model given poor care coordination between subspecialists and primary care clinicians (PCCs). Multidisciplinary specialty care teams can improve care coordination, increase use of guideline-directed medical therapies (GDMT), and potentially increase patient satisfaction. Methods: We conducted a randomized controlled trial in a single-center tertiary care institution, enrolling patients with both HFrEF (ejection fraction &lt;50%) and CKD (stages 2-5, not on hemodialysis) over 6 months. The patients’ PCCs were randomized to either the control arm in which usual care was continued, or to the treatment arm where PCCs were supported by a virtually organized cardio-kidney team with a heart failure specialist and nephrologist. Treatment arm PCCs received recommendations from the cardio-kidney team via electronic medical record secure messaging sharing guidance on GDMT use, necessary lab tests, etc. Patients’ quality of life and symptoms were assessed at both baseline and 3 months via the Kidney Disease Quality of Life (KDQoL) survey and Kansas City Cardiomyopathy Questionnaire (KCCQ), respectively. Results: 95 patients had 3 month follow-up data (treatment n=47, control=48). The mean patient age was 67.4±10.8, and 61% were male. The majority (76%) were African American with mean EF of 35.5 ±11.0. The treatment group had higher reported and clinically significant (&gt;at least a 5-point change) improvement of KCCQ scores from baseline to 3 months (52%) compared to the control group (38%), however, this was not statistically significantly different (p=0.15). Meanwhile, the proportion of deterioration was 39% and 40% in the treatment and control groups, respectively. There were no significant differences in KDQOL scores between or within both groups when comparing the baseline to 3 month data. Conclusion: Implementing a multidisciplinary care team to support PCCs is a feasible intervention and at 3 months, there was an increase (although statistically insignificant) in KCCQ scores. A longer duration of follow-up may be better able to assess the effects of multidisciplinary care team models.

Translation and psychometric testing of Indonesian Version of Chronic Kidney Disease– Symptom Burden Index

Introduction: Chronic Kidney Disease Symptom Burden Index (CKD-SBI) is an instrument measuring symptom burden developed by Almutary and colleagues in 2015 to refine the identification of symptom burden in chronic kidney disease population. This instrument has not been tested for Indonesian language, thus, the aim of study was to translate and psychometrically testing the Indonesian version of CKD-SBI. Methods: This study design was cross-sectional study. The study methods were divided into translation and psychometric testing. The translation was conducted by adapting Guillemin and Beaton's guidelines. The psychometric properties determined 320 hemodialysis patients with several inclusion criteria such as above 18 years old, regularly receiving hemodialysis for more than 3 months. Patients with cognitive impairment, psychiatric patients, and in critical condition were excluded. Results: The item content validity index of the Indonesian version was 0.92, and the subscale content validity was 0.78. The instrument demonstrated convergent validity with the Kidney Disease Quality of Life. Excellent internal consistency was demonstrated based on a Cronbach’s alpha coefficient of .91 and a subscale ranging from 0.86 to 0.92. The confirmatory factor analysis showed that the five factors of English Version did not fit the Indonesian version. Conclusions: Translated Indonesian versions of CKD-SBI can be used as instruments to assess symptom burden among patients with hemodialysis. By assessing symptom burden, we hope nurses in the hospital are able to decide effective symptom management to increase the health-related quality of life among these populations.

Living well on haemodialysis: Feasibility and acceptability trial of an online Acceptance and Commitment Therapy (ACT) programme for people receiving kidney haemodialysis

BackgroundPeople receiving kidney haemodialysis need psychological support. ObjectivesTo assess feasibility and acceptability of a 4-week online video-based Acceptance and Commitment Therapy (ACT) programme for people receiving kidney haemodialysis. DesignSingle group before-and-after study. ParticipantsPeople with end-stage kidney disease currently receiving dialysis, who had received in-centre haemodialysis at least 90 days in the last two years. MeasuresRecruitment, retention and engagement (feasibility); weekly and post-programme feedback (acceptability); pre-intervention and 4-week follow-up (potential outcome measures): kidney disease quality of life (KDQOL-SF), psychological flexibility (Acceptance and Action Scale) and acceptance of illness (Acceptance of Illness Scale). ResultsThe study recruited 13 participants of whom 85% completed at least half the programme and 69% completed the whole programme. Health and medical treatment issues were the main known reasons for non-participation and drop-out. Of the 16 separate elements of the programme (four ‘story’ videos and 12 videos explaining ACT techniques), 13 were positively evaluated by at least 75% of participants. Of 11 aspects of the programme, 8 were positively evaluated by at least 75% of participants, and 89% found the programme easy to use, understood how it worked, found it easy to access, trusted the information, had no technical difficulties, and understood the activities. However, only 66.7% agreed the programme was interesting and only 62.5% agreed they enjoyed the programme. All responding participants indicated they would recommend the programme to people starting dialysis. The direction of change was positive for 17/21 potential outcome measures, with significant (p < 0.05) improvements in psychological flexibility and energy/fatigue. ConclusionsAn online video-based ACT intervention was feasible and acceptable for people receiving kidney haemodialysis and the results provide pilot data for a planned larger trial.

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.

Health inequity associated with financial hardship among patients with kidney failure.

Financial hardship is a common challenge among patients with kidney failure and may have negative health consequences. Therefore, financial status is regarded as an important determinant of health, and its impact needs to be investigated. This cross-sectional study aimed to identify the differences in patient-reported and clinical outcomes among kidney failure patients with different financial status. A total of 354 patients with kidney failure were recruited from March to June 2017 at two hospitals in Hong Kong. The Dialysis Symptoms Index and Kidney Disease Quality of Life-36 were used to evaluate patient-reported outcomes. Clinical outcomes were retrieved from medical records and assessed using the Karnofsky Performance Scale (functional status) and Charlson Comorbidity Index (comorbidity level). Patients were stratified using two dichotomised variables, employment status and income level, and their outcomes were compared using independent sample t-tests and Mann-Whitney U-tests. In this sample, the employment rate was 17.8% and the poverty rate was 61.2%. Compared with other patients, increased distress of specific symptoms and higher healthcare utilization, in terms of more emergency room visits and longer hospital stays, were found in patients with poorer financial status. Low-income patients reported a decreased mental quality of life. Financially underprivileged patients experienced health inequity in terms of impaired outcomes. Attention needs to be paid to these patients by providing financial assessments and interventions. Additional research is warranted to confirm these findings and understand the experience of financial hardship and health equity.

498-P: Prevalence and Impact on Quality of Life of Diabetic Retinopathy in African Americans with End-Stage Kidney Disease on Hemodialysis

Background: The prevalence, severity, and quality of life (QoL) impact of diabetic retinopathy (DR) among African Americans (AA) with end-stage-kidney disease (ESKD) receiving dialysis are unknown. Methods: We conducted a prospective cross-sectional study in 93 AA adults with type 1 (n=9) and type 2 (n=84) diabetes with ESKD on hemodialysis. The diagnosis of DR was based on a review of medical records and/or having a positive photograph with a portable hand-held device (Optomed Aurora retinal camera) reviewed by both artificial intelligence software (AEYE Health’s retinal screening system) and a retinal specialist. Visual acuity was assessed with the Snellen Chart. Associations with QoL (ascertained using kidney disease QoL and depression questionnaires), physical disability (ascertained using visual impairment questionnaire), and social determinants of health (SDoH) including personal and household income, marital status, health insurance, education, food insecurity, or employment status assessed by standardized questionnaires. Results: The overall prevalence of DR was 75%, with 33% of patients having mild, 9.6% moderate and 57.4% severe DR. A total of 43% had normal visual acuity, 45% had moderate and 12% severe visual impairment. We found high burden of disease, multiple SDoH challenges, and low QoL among all patients, with most unemployed or disabled, living below poverty line, mainly receiving public health insurance, reporting poor general health, and substantial time spent dealing with kidney disease interfered with daily and family activities. However, the presence of DR had no significant impact on physical health and QoL compared to subjects without DR. Conclusion: DR is present in 75% of AA patients with diabetes and ESKD on hemodialysis. ESKD has a significant burden on general health and QoL; however, DR has a minor additional impact on the overall physical health and QoL in people with ESKD and diabetes. Disclosure Z.E.Zabala: None. B.Moazzami: None. M.Egeolu: None. R.L.Caleon: None. A.Y.G.Gerges: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. R.G.Mccoy: Consultant; Emmi. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter.

#5622 DIALYSING THE ELDERLY: IMPACT ON THE PATIENTS’ HEALTH-RELATED QUALITY OF LIFE OUTCOME

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.

#4367 THE IMPACT OF QUALITY OF LIFE ON THE SURVIVAL IN THE ELDERLY END-STAGE RENAL DISEASE PATIENTS : A PROSPECTIVE MULTICENTER COHORT STUDY IN KOREA

Abstract Background and Aims Quality of life (QOL) are associated with mortality in dialysis patients. However, the impact of QOL index or score on elderly patients with end-stage renal disease (ESRD) is controversial. We analyzed the relationship between QOL items and survival in elderly ESRD patients. Method A total of 492 patients with ESKD aged &amp;gt; 65 who assessed for QOL items were included from a Korean nationwide prospective cohort study. QOL was evaluated using the Kidney Disease Quality of Life (KDQOL) instrument, and the effect of each QOL item on mortality was analyzed. Multivariable Cox regression analysis was performed to identify independent risk factors for death after adjusting for compounding factors. Results The low physical component scale (PCS) and short form-36 score were significantly associated with low survival rate (PCS: p&amp;lt;0.001 and short form-36: p = 0.017, respectively), while the mental component scale (MCS) and ESRD-targeted item score had no correlation with survival rate. Multivariable Cox regression analysis confirmed that only a high PCS score is associated with better survival (hazard ratio 0.71, 95% confidence intervals 0.52-0.97, P = 0.031). Linear regression analysis identified that age, sex, modified Charlson Comorbidity Index, albumin, and intact parathyroid hormone were factors to PCS. Among the four PCS components, only physical function score was significantly associated with mortality (p&amp;lt;0.001). Conclusion Among the KDQOL items, PCS was an independent risk factor for death in elderly ESRD patients. The higher physical function score of PCS components was associated with a better outcome, suggesting the importance of physical conditions in elderly dialysis patients.

#3081 ASSOCIATION OF URINE PROTEIN EXCRETION LEVELS, AS A MEASURE OF DISEASE ACTIVITY, AND QUALITY OF LIFE IN IGA NEPHROPATHY PATIENTS

Abstract Background and Aims Little is known about the quality of life (QoL) of patients with IgA nephropathy (IgAN). Understanding the relationship between disease activity (as measured by urine protein excretion [UPE]) and QoL could allow decision-makers to understand how treatments that improve UPE might improve patient QoL. Methods The 2021 United States subset of the Adelphi IgAN Disease Specific Programme™ was a point-in-time survey of 43 nephrologists (who completed structured forms for 305 IgAN patients) and 70 patients (who elected to complete patient surveys of the 305). This analysis utilised physician-reported data (patient demographics, disease characteristics, and current 24-hour UPE levels [categories: ≤0.5, &amp;gt;0.5 to ≤1, &amp;gt;1 to ≤2, &amp;gt;2 to ≤3.5, &amp;gt;3.5 grams/day]) and patient-reported data (symptoms, Kidney Disease Quality of Life [KDQOL] scores, and EQ-5D scores). The association between UPE and patient-reported symptoms was evaluated using chi-squared and Fisher's exact tests. The association between UPE and QoL (KDQOL, EQ-5D) was evaluated using generalized linear regression to adjust for age, sex, chronic kidney disease stage, corticosteroid use, and non-steroidal immunosuppressant use. Results The analytical dataset included 69 patients with UPE data (reported by 8 physicians) out of the 70 patients who completed the patient survey. Of these 69, data were complete for the symptoms (n=63), KDQOL (n=60), and EQ-5D (n=67). Patients were an average age of 43 years, an average BMI of 26.3, 49% male, 55% White, 23% Asian, 64% never smokers, 78% in full-time occupation, and 74% with commercial health insurance. The most prevalent comorbidities were hypertension (33%), hyperlipidemia (30%), and diabetes (11%). UPE was not associated with any demographic characteristics, regular dialysis, or kidney transplants. Among comorbidities, higher UPE was associated with a higher percentage of hyperlipidaemia (P = .03). Among medications for IgAN, higher UPE was associated with a higher percent use of diuretics (P = .046), sodium-glucose co-transporter 2 inhibitors (P = .002), corticosteroids (P = .0009), non-steroidal immunosuppressants (p&amp;lt;0.0001), and anti-depressants (P = .0009). Higher UPE was associated with a higher percentage of patient-reported aching joints (P = .04), self-awareness of high cholesterol (P = .001), tiredness (P = .005), swollen feet/ankles/legs (p&amp;lt;0.0001), sleep problems (P = .02), feeling sick (P = .0003), and tea-colored urine (P = .03). Higher UPE was associated with worse KDQOL scores (burden [p&amp;lt;0.0001], effects [P = .007], physical health [P = .002], and mental health [p&amp;lt;0.0001]). After adjustment (Table 1), higher UPE continued to be associated with worse KDQOL burden (P = .01) and mental health (P = .03) scores. Unadjusted and adjusted analyses (Table 2) indicated that higher UPE was associated with worse EQ-5D scores. Conclusion The results indicate that higher levels of disease activity (UPE) in IgAN are associated with increased symptom burden, worse kidney disease QoL, and worse overall QoL.

#5243 ASSESSING HEALTH-RELATED QUALITY OF LIFE IN HEMODIALYSIS PATIENTS IN A PUBLIC HOSPITAL IN TUNIS: A CROSS-SECTIONAL STUDY

Abstract Background and Aims There are not many studies evaluating the quality of life of patients with chronic and advanced kidney disease in North Africa. We assessed the health-related quality of life (HRQOL) of patients receiving hemodialysis in a public hospital in Tunis using the KDQOLTM-36 (Kidney Disease Quality of Life) survey, and we investigated its sociodemographic, clinical and biological correlation. Method A cross-sectional study design was used, and patients were recruited from a single hemodialysis center in the Charles Nicolle Hospital in Tunis. The KDQOLTM-36 questionnaire was given to patients aged 18 or above receiving in-center hemodialysis maintenance for at least three months to assess their physical and mental health, as well as the effect, burden, and symptoms of kidney disease. Patients with hepatitis, HIV, mental illnesses, and physical disabilities were not eligible for the study. Socio-demographic and clinical data were collected for all eligible patients. We then employed linear regression models to explore the factors associated with overall KDQOL and its various domains. Results Sixty-five patients were included. The mean age was 50.9 years old (23-79). The sex ratio was 1.16. The median quality of life score was 52.5 for overall HRQOL, 35,6 for the Physical Component Summary (PCS) score and 44.2 for the Mental Component Summary (MSC) score. Symptoms/problems, effect, and burden of kidney disease (KD) were scored 62.5, 59.38 and 37.5, respectively. There was a significant correlation between diabetic and non-diabetic patients in Symptoms (50.19 vs 65.04 p = 0.006), Effect (45.4 vs 57.87 p = 0.038), Burden of KD (7.38 vs 39.46 p = 0,001) and MCS (p&amp;lt;0,0001). Cardiovascular disease was associated with a higher burden of KD (p = 0.025). Higher age was associated with lower score in Symptoms (p = 0.032) and Burden (p = 0.035). Other correlations were between weight gain between sessions and MCS (p = 0.012), Hyponatremia with both symptoms (p = 0.016), effect (p = 0.029) and MCS (p = 0.017), Hypoalbuminemia with symptoms (p = 0.018), dilated left cavity in the transthoracic ultrasound with both effect(p = 0.047) and burden of KD (p = 0.023). There was no correlation found between gender, work status and hemoglobin level and quality of life. Conclusion The results of this study indicate that patients receiving hemodialysis have a low quality of life. The factors associated with overall quality of life were diabetes, cardiovascular disease, age, weight gain between dialysis sessions, hyponatremia, hypoalbuminemia, and dilated left cavity in transthoracic ultrasound. Those findings should be studied using a larger sample.

Effects of physical activity by the teach-back educational method on the physical ability and quality of life in hemodialysis patients: a clinical trial†

Abstract Objective To determine the effect of physical activity by using the teach-back educational method on hemodialysis patients’ quality of life (QOL) and physical ability. Methods This is a single-blind clinical trial study involving a control group. A total of 90 patients who admitted to the dialysis centers of Beheshti and Besat hospitals in Hamadan were selected using a convenience sampling method and were randomly assigned to intervention (n = 45) and control (n = 45) groups. Data were collected using a demographic information checklist, a kidney disease QOL questionnaire, and a 6-minute-walk distance (6MWD) checklist. The patients’ QOL questionnaire was completed, and the 6MWD was recorded before and at the end of the 2nd, 4th, 6th, 8th, and 12th weeks of the intervention. In the intervention group, the patients were taught to perform physical activities with Pilates stretches in different resistances using the teach-back educational method during dialysis sessions for 12 weeks. Data were analyzed by using the independent t-test and chi-square test using SPSS-22 software. Results Before the intervention, no differences were observed between the experimental and control groups in terms of demographic characteristics, QOL, and physical ability (P &gt; 0.05). The physical ability and QOL levels of patients exercising in the test group were higher than those in the control group after the intervention (P &lt; 0.05). Based on the results, the 2 groups significantly differed with regard to the scores of various dimensions of QOL and physical ability after the intervention (P &lt; 0.05). Conclusions Physical activity by using the teach-back method can effectively increase physical ability and improve QOL of hemodialysis patients. Therefore, the recommendations and inclusion of exercise in the dialysis care plan can effectively promote patients’ health.