Life In Peritoneal Dialysis Patients Research Articles

Daytime Sleepiness and Quality of Life in Peritoneal Dialysis Patients

We aimed to compare automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) therapy with regard to patients' excessive daytime sleepiness (EDS) and quality of life (QOL). EDS was assessed with the Epworth Sleepiness Scale (ESS) and QOL with the Medical Outcomes Study 36-Item Short Form (SF-36) health survey. We included 59 patients (CAPD/APD, 30/29; male/female, 33/26; age, 45.3±15.8 years; dialysis duration, 42.0±33.6 months). The CAPD and APD groups were similar with respect to factors that affected sleep quality (age, sex, duration of PD), smoking, alcohol intake, socioeconomic status, body mass index, comorbid disease, and various laboratory parameters. Although one patient (3.3%) treated with CAPD and four patients (13.8%) treated with APD experienced EDS, there was no significant differences in ESS scores between the CAPD and APD patients. There was no difference in the SF-36 total and subscale scores when APD patients were compared with CAPD patients. The independent predictors of ESS were the serum albumin level (β= -2.04, P<0.01), total SF-36 score (β= 0.08, P=0.02), social functioning score (β= -2.47, P=0.01), and role-emotional subscale score (β= -1.12, P=0.05). The incidence of EDS was slightly higher in APD patients, but it did not negatively affect daily activities or QOL.

Peritoneal dialysis: an underutilized modality

There have been differential changes in outcomes of patients treated with in-center hemodialysis and peritoneal dialysis. In light of these changes, providers and practices should reevaluate the utilization of peritoneal dialysis. Accumulating evidence confirms that the present distribution of dialysis modality in the United States does not reflect patient choice. Furthermore, in most recent cohorts, the 5-year adjusted survival of patients treated with hemodialysis and peritoneal dialysis is remarkably similar (35 and 33% respectively). Similar results have been reported from Canada, Australia, and New Zealand. Moreover, health-related quality of life of peritoneal dialysis patients are no different from that reported by those treated with nocturnal hemodialysis. Finally, an expansion of use of peritoneal dialysis for the treatment of end-stage renal disease makes economic sense for the taxpayers - the payors for dialysis services. The improvement in outcomes of peritoneal dialysis patients makes a compelling argument for the expansion of the use of the therapy for the treatment of end-stage renal disease in the United States. We think that 20-40% of patients can be treated with peritoneal dialysis. However, any expansion in use should be done gradually and should include training healthcare providers while continuously monitoring patient outcomes.

Health‐related quality of life in patients undergoing peritoneal dialysis: effects of a nurse‐led case management programme

This paper is a report of an examination of the effectiveness of a nurse-led case management programme in improving the quality of life of peritoneal dialysis patients in Hong Kong. Patients with end-stage renal failure need integrated health care to maintain a desirable quality of life. Studies suggest that transitional care using a nurse case management model has a positive effect for patients suffering from chronic diseases, but the results have not been conclusive. Eighty-five patients participated in the study in 2005, 43 in the study group and 42 in the control group. Patients in the control group received routine hospital discharge services. Study group patients received a comprehensive education programme prior to discharge and standardized, 6-week nurse-initiated telephone follow-up. Kidney disease quality of life was measured for each patient at three time intervals: before the intervention, at completion of the 6-week intervention and 6 weeks after completion of the programme. Repeated measures analysis of variance, general linear model was carried out. Statistically significant within-group effects were found for symptoms/problems, effects of kidney disease, sleep, role-physical, pain, emotional wellbeing and social function. Statistically significant interaction effects were demonstrated for staff encouragement, patient satisfaction, sleep and social function. The nurse-led case management programme can be applied effectively to patients receiving peritoneal dialysis. The new model of care is particularly useful for enhancing patients' wellbeing in the transition from hospital to home.

The effect of psychological intervention on anxiety, depression and quality of life in peritoneal dialysis patients

Objective To investigate the association of anxiety or depression and quality of life in peritoneal dialysis(PD) patients and use the corresponding psychological intervention to improve their quality of life(QoL).Methods 164 peritoneal dialysis patients' QoL were evaluated by the short form 36 health survey questionnaire (SF-36).Depression and anxiety were estimated by Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) respectively.All the patients were divided into anxiety or depression group and non-anxiety or depression group.QoL and quality of PD were compared between two groups.Patients of anxiety or depression group were divided randomly into psychological intervention group and non-anxiety or depression group. Patients of anxiety or depression group were treated with psychological intervention in addition to routine treatment. Patients of non- anxiety or depression group were treated only with routine treatment.QoL and quality of FD were recompared between two groups. Results Incidence of depression and anxiety was 21.95% and 41.46% respectively of patients with PD. Depression and anxiety scores were negatively correlated with 7 out of 8 scales SF-36 questionnaire. Two groups had significantly difference especially emotional well-being and role limitations caused by bodily pain and emotional problems(r=-0.310,-0.367,-0.409 especially,P<0.01).The anxiety or depression group' total score of SF-36 [(46.23±16.25) vs(73.69±19.17), P<0.01],subjective global assessment [(19.84±4.41)vs(57.34±6.14),P<0.01]and urea clearance divided by volume of distribution [(2.00±0.43)vs(3.76±0.35),P=0.000]were lower than non- anxiety or depression group.After treatment , anxiety or depression group' total score of SF-36[(70.96±20.86)vs (46.60±18.85),P<0.01],subjective synthesis nutrition evaluate and urea urea clearance divided by volume of distribution are higher than those of non- anxiety or depression group. Conclusion Incidence of anxiety or depression are high in PD patients,which have close association with quality of Life. Key words: Psychological interfere; Peritoneal dialysis; Depression; Anxiety; Quality of life

P.1.g.017 Self-esteem and quality of life in peritoneal dialysis patients

P.1.g.017 Self-esteem and quality of life in peritoneal dialysis patients

Do health causal attributions and coping strategies act as moderators of quality of life in peritoneal dialysis patients?

Objective The present study aimed at testing the relationships between health causal attribution and coping mechanisms with quality of life (QOL) in patients who have end-stage renal disease (ESRD) undergoing a peritoneal dialysis (PD) treatment. It was hypothesized that QOL should be negatively associated with the severity of the disease. Problem-focused coping, internal health-related locus of control (HRLOC) and medical power HRLOC were hypothesized as positive moderators preserving a better QOL, after controlling for the severity of the disease. Methods A total of 47 PD patients completed the Kidney Disease Quality of Life (KD-QOL) scale encompassing the Medical Outcomes Study Short-Form (MOS SF-36) self-administered questionnaire, the Multidimensional Health Locus of Control scale and the Ways of Coping Check-List (WCCL) scale. Results Low scores for all QOL scores were found except for pain dimension, as compared with scores available from a general French population. Globally, QOL was not related to the severity of the disease. Univariate analysis showed that the physical component score (PCS) of QOL was positively associated with internal HRLOC ( r=.35; P<.05), and negatively with medical power HRLOC ( r=−.36; P<.05). Multivariate analysis adjusting for age confirmed these results. Mental component score (MCS) was negatively associated with the use of emotion-focused coping and seeking social support ( r=−.45; P=.001 and r=−.30; P<.05, respectively), the first association persisting in multivariate analysis. Neither PCS nor MCS was linked to the use of problem-focused coping. Conclusion These results suggest that physical QOL is all the more preserved when patients are more convinced that their behaviour can influence their health condition and that psychological QOL is all the more impaired when health condition is perceived as less controllable, requiring emotion-focused coping (avoidance strategies). Health causal attributions and coping act respectively as moderators of physical and psychological components of QOL.

Quality of life in peritoneal dialysis patients: Decline over time and association with clinical outcomes

Quality of life (QoL) is increasingly well recognized as an important measure of treatment outcome. The aim of this study was to determine which key factors affect QoL, which aspects of QoL change over time, and if measurements of QoL were associated with clinical outcome in our peritoneal dialysis (PD) population. The results of 88 patients (70% of our PD population) enrolled in longitudinal studies of dialysis adequacy, nutrition, and quality of life were reviewed. The sample comprised Indo-Asian [N=35 (diabetic N=18)], and white Europeans [N=53 (diabetic N=18)] heritage. At enrollment (>3 months on PD) demographic data was recorded. At enrollment, and six-month intervals, the dialysis adequacy, nutritional status, QoL (using the KDQOL-SF instrument), hospital admissions, PD infections, and changes in treatment modality were recorded. Male gender, Asian ethnicity, and poor nutritional status as measured by Subjective Global Assessment were the most significant characteristics independently associated with worse overall QoL dimension scores (physical health, mental health, kidney disease issues, patient satisfaction). Comorbidity, months of renal replacement, social deprivation and serum albumin were related to some of the 19 health domains measured. QoL declined steadily during the two-year study period. The most significant changes were for the items general health symptoms/problems, burden of kidney disease, emotional well-being, and patient satisfaction. Increased hospital admissions were associated with a worse QoL. Quality of life declines in patients on PD over time. Certain aspects of QoL are especially poor in Asian and male patients. This study suggests that further research is necessary to determine the effects of interventions directed at enhancing emotional and social support.

Self-Assessed Quality of Life in Peritoneal Dialysis Patients

Background/Aims: Studies comparing quality of life (QOL) between peritoneal and hemodialysis patients have yielded inconsistent results. Physical (PCS) and mental component summary (MCS) scales of Short Form 36 (SF-36) health survey are highly validated measures of self-assessed QOL. We sought to evaluate these indices in PD patients: (1) as measures of QOL, (2) predictors of QOL, (3) to study change in QOL over time, and (4) to compare QOL in PD vs. hemodialysis patients. Methods: SF-36 questionnaires were administered every 3 months to patients over a 2-year period and PCS and MCS were calculated. Mean follow-up was 15.3 ± 6.6 months for PD and 14.5 ± 5.7 months for HD. Results: Average PCS in PD (31.8 ± 7.8) was lower than HD (36.9 ± 9.8) (p < 0.02), while MCS was similar in the groups (p = NS). The prevalence of depression was 26.1% in PD and 25.4% in HD patients (p = NS). Serum albumin was the only significant predictor of PCS among PD patients and explained much of the decrease in PCS in them. The number of hospitalizations and in-hospital days were significantly lower for PD compared to HD patients (p < 0.05). PCS as well as MCS remained stable in both groups throughout the observation period. Conclusion: Self-assessed physical function is diminished, while mental function is similar in PD compared to HD patients. When corrected for serum albumin, this difference is eliminated. Over time, QOL in patients treated with PD remained stable.

Quality of life in peritoneal dialysis patients.

In 49 patients receiving continuous ambulatory peritoneal dialysis, we assessed the relative influences of adequacy of dialysis (assessed by kinetic transfer/volume urea) and psychological symptoms (depression and anxiety) upon the patients' evaluation of their overall quality of life (QoL). Subjects completed self-rating forms for anxiety, depressive, and somatic symptoms, for discrete areas relevant to QoL, and for overall QoL; clinicians also rated QoL. Depressive symptoms proved a much stronger correlate of overall QoL than did the biochemical measure of dialysis adequacy, and they remained influential even after adjustment for anxiety, kinetic transfer/volume, and somatic symptoms. In contrast, the effects of kinetic transfer/volume, anxiety symptoms, and somatic symptoms dropped sharply when adjusted for the other variables. Because psychological (especially depressive) symptoms may be stronger determinants of patients' overall QoL than is adequacy of dialysis, assessing QoL and psychological status should be part of the care of end-stage renal disease patients.