Quality Of Life In End-stage Renal Disease Patients Research Articles

The Moderating Role of Health Variables on the Association between Physical Exercise and Quality of Life in Patients with End-Stage Renal Disease.

Scientific evidence demonstrates the positive impact that physical exercise has on the quality of life (QOL) of patients with chronic kidney disease (CKD). However, no study has proposed a model investigating the effect physical exercise has on the QOL of end-stage renal disease (ESRD) patients, considering the most frequent associated diseases (diabetes/hypertension). The objectives were (1) to explore the relationship between physical exercise and the QOL of adults with ESRD, and (2) to examine the moderating and/or mediating role of relevant patient variables. This non-interventional study utilized an ex post facto retrospective data analysis design with a sample of 310 patients with ESRD through two validated questionnaires. The dependent variables were the QOL scale (KDQOL-SF), and the physical function dimension (EFFISICA). The independent variables were the regular practice of intense physical activity (DEPINTE) and the daily time (in hours) the patient is in a sedentary attitude (TiParado). The moderating variables were the clinical situation and associated diseases. The mediator variable used was the body mass index. Bivariate and multiple regression analyses were conducted. Findings suggest implementing intense physical activity in transplant recipients and programmes to avoid sedentary lifestyles in dialysis patients have a positive effect in the QOL of ESRD patients.

Correlation of Body Composition and Quality of Life in Maintenance Hemodialysis Patients

Background: Due to the occurrence of hemodialysis, the life expectancy of end-stage renal disease (ESRD) patients is lengthening. However, their quality of life (QoL) is decreasing. The QoL of ESRD patients is composed of physical component score (PCS), mental component score (MCS), and kidney-related component score (KDCS) components. Nutritional status is one of the influencing factors of QoL. It is unclear whether free fat mass (FFM) or fat mass contributes to the increase of QoL in ESRD patients. Objectives: This study aimed to identify the correlation between FFM percentage and the QoL of ESRD patients. Methods: This cross-sectional study was conducted in Hemodialysis Unit, Division of Kidney and Hypertension, Dr. Cipto Mangunkusumo General Hospital, Jakarta from June to July 2018. In this study, 102 subjects were included. Blood samples were collected for laboratory examination. FFM percentage was measured using bioimpedance analysis (BIA). Meanwhile, QoL was evaluated using KDQOL SF-36 version 1.3. Statistical analysis was done using Pearson correlation test. Analysis of QoL was done based on fat percentage using ANOVA test. Results: In this study, the overall KDQOL score was 47.86 ± 6.56 with PCS 40.97 ± 9.66, MCS 46.6 (22.05 - 59.95), and KDCS 55.98 ± 9.02. FFM percentage was 74.21 ± 1% with mean mass of 43.06 ± 8.16 kg. Statistical analysis showed no correlation between FFM percentage and overall KDQOL score (r 0.032, P 0.750). However, there was a significant correlation between PCS and FFM (r 0.223, P 0.024). Conclusions: There is a weak positive correlation between FFM in kg and the physical quality of end-stage kidney disease (ESKD) patients.

HEALTH RELATED QUALITY OF LIFE AMONG HAEMODIALYSIS AND KIDNEY TRANSPLANT RECIPIENTS FROM NEPAL: A CROSS SECTIONAL STUDY USING WHOQOL-BREF

Objective: Very less is known about health-related quality of life (HRQOL) among patients with kidney diseases in Nepal. This study examined HRQOL among haemodialysis and kidney transplant recipients in Nepal. Design and method: The Nepali version of World Health Organization Quality of Life Instruments -(WHOQOL-BREF) questionnaire was administered using face to face interviews among end stage renal disease (ESRD) patients, from two large national referral centers in Nepal. The differences in socio-demographic characteristics among ESRD patients were examined using the Chi-square test. The group differences in quality of life (QOL) were examined using the Mann-Whitney U test and Kruskal-Wallis tests. Results: Of the 161 participants, 92 (57.1%) were renal transplant recipients and 62 (42.9%) patients were on maintenance haemodialysis. Hypertension (70.9%) was the most common co-morbidity among ESRD patients. Haemodialysis patients scored significantly lower than the transplant recipients in all four domains as well as in overall perception of quality of life and general health. Ethnicity (p = 0.020), socio-economic status (p < 0.001), educational status (p < 0.001) and employment status (p = 0.009) were significantly associated with the overall QOL in ESRD patients. Across patient groups, educational status (p = 0.012) was positively associated with QOL in dialysis patients, while urban residence (p = 0.023), higher socio-economic status (p < 0.001), higher educational status (p = 0.004) and diabetes status (p = 0.010) were significantly associated with better QOL in transplant recipients. Conclusions: The overall QOL of the renal transplant recipients was higher than that of the patients on maintenance haemodialysis; this was true in all four domains of the WHOQOL-BREF. ESRD patients with low HRQOL could benefit from targeted risk modification intervention.

The impact of pain on the quality of life of patients with end-stage renal disease undergoing hemodialysis: a multicenter cross-sectional study from Palestine

BackgroundChronic kidney disease is considered as a global health problem. Hemodialysis (HD), following renal transplantation, is the most common form of renal replacement therapy. However, HD may impact the quality of life (QOL). Pain is a frequent complaint among this population that also affects their QOL. The purposes of this study were to assess pain and QOL among end-stage renal disease (ESRD) patients on HD and to examine their association.MethodsThis was a multicenter, cross-sectional study that occurred in Palestine between August and November 2018. Brief Pain Inventory and European Quality of Life scale 5 dimensions (EQ-5D) scale, including its European Quality of Life visual analogue scale (EQ-VAS) component, were used to assess pain and QOL, respectively.ResultsA total of 300 participants were included in the final study. The average age of the subjects was 54 ± 16 years. Their median EQ-5D score was 0.68 [0.54–0.88], whereas their median EQ-VAS score was 60 [40–75]. A statistically significant association of pain severity score with EQ-5D score was found (r = − 0.783, p < 0.001). The association between pain interference score and EQ-5D score was also found to be statistically significant (r = − 0.868, p < 0.001). Similarly, pain severity score was significantly assocsiated with EQ-VAS score (r = − 0.590, p < 0.001), the same as was the pain interference score (r = − 0.647, p < 0.001). Moreover, age, gender, BMI, employment, educational level, income level, dialysis vintage, previous kidney transplantation, and chronic medication use were all significantly correlated with QOL. Regression analysis showed that patients aged < 60 years (p < 0.001), those with lower pain severity scores (p = 0.003), and those with lower pain interference scores (p < 0.001) had significantly higher QOL scores.ConclusionsPain has a significant negative impact on QOL in ESRD patients undergoing HD. The subgroups that were at higher risk included elderly patients, females, those with higher BMI, those without a formal education, those unemployed, those living with low monthly income, smokers, those who have multiple comorbidities, and patients with longer dialysis vintage. Our findings provide reliable data for educators and clinicians working with HD patients.

Health related quality of life among haemodialysis and kidney transplant recipients from Nepal: a cross sectional study using WHOQOL-BREF

BackgroundVery less is known about health-related quality of life (HRQOL) among patients with kidney diseases in Nepal. This study examined HRQOL among haemodialysis and kidney transplant recipients in Nepal.MethodsThe Nepali version of World Health Organization Quality of Life Instruments -(WHOQOL-BREF) questionnaire was administered using face to face interviews among end stage renal disease (ESRD) patients, from two large national referral centers in Nepal. The differences in socio-demographic characteristics among ESRD patients were examined using the Chi-square test. The group differences in quality of life (QOL) were examined using the Mann-Whitney U test and Kruskal-Wallis tests.ResultsOf the 161 participants, 92 (57.1%) were renal transplant recipients and 69 (42.9%) patients were on maintenance haemodialysis. Hypertension (70.9%) was the most common co-morbidity among ESRD patients. Haemodialysis patients scored significantly lower than the transplant recipients in all four domains as well as in overall perception of quality of life and general health. Ethnicity (p = 0.020), socio-economic status (p < 0.001), educational status (p < 0.001) and employment status (p = 0.009) were significantly associated with the overall QOL in ESRD patients. Across patient groups, educational status (p = 0.012) was positively associated with QOL in dialysis patients, while urban residence (p = 0.023), higher socio-economic status (p < 0.001), higher educational status (p = 0.004) and diabetes status (p = 0.010) were significantly associated with better QOL in transplant recipients.ConclusionThe overall QOL of the renal transplant recipients was higher than that of the patients on maintenance haemodialysis; this was true in all four domains of the WHOQOL-BREF. ESRD patients with low HRQOL could benefit from targeted risk modification intervention.

Protocol of a mixed method, randomized controlled study to assess the efficacy of a psychosocial intervention to reduce fatigue in patients with End-Stage Renal Disease (ESRD).

BackgroundPatients with end-stage renal disease (ESRD) commonly suffer from severe fatigue, which strongly impacts their quality of life (QoL). Although fatigue is often attributed to disease- and treatment characteristics, research also shows that behavioural, psychological and social factors affect perceived fatigue in dialysis patients. Whereas studies on fatigue in other chronic patient groups suggest that psychological or psychosocial interventions are effective in reducing fatigue, such interventions are not yet available for ESRD patients on dialysis treatment. The objective of this study is to examine the efficacy of a psychosocial intervention for dialysis patients aimed at reducing fatigue (primary outcome) and improving QoL (secondary outcome). The intervention consists of counselling sessions led by a social worker. The implementation process and patients’ and social workers’ expectations and experiences with the intervention will also be evaluated.Methods/DesignThis study follows a mixed-methods design in which both quantitative and qualitative data will be collected. A multi-centre, randomised controlled trial (RCT) with repeated measures will be conducted to quantitatively assess the efficacy of the psychosocial intervention in reducing fatigue and improving QoL in ESRD patients. Additional secondary outcomes and medical parameters will be assessed. Outcomes will be compared to patients receiving usual care. A sample of 74 severely fatigued dialysis patients will be recruited from 10 dialysis centres. Patients will be randomly assigned to the intervention or control group. Outcomes will be assessed at baseline, post intervention/16 weeks, and at three and six-month follow-ups. A qualitative process evaluation will be conducted parallel to/following the effectiveness RCT. Interviews and focus groups will be conducted to gain insight into patients’ and social workers’ perspectives on outcomes and implementation procedures. Implementation fidelity will be assessed by audio-taped and written registrations. Participatory methods ensure the continuous input of experiential knowledge, improving the quality of study procedures and the applicability of outcomes.DiscussionThis is the first mixed method study (including an RCT and qualitative process evaluation) to examine the effect and implementation process of a psychosocial intervention on reducing fatigue and improving QoL in ESRD patients on dialysis treatment.Trial registrationNTR5366, The Netherlands National Trial Register (NTR), registered August 26, 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0277-8) contains supplementary material, which is available to authorized users.

Predictors of quality of life in patients with end-stage renal disease on hemodialysis.

BackgroundAssessment of quality of life (QOL) of end-stage renal disease (ESRD) patients (physical, mental, and social well-being) has become an essential tool to develop better plans of care. Objective of this study is to determine which demographic and biochemical parameters correlate with the QOL scores in patients with ESRD on hemodialysis (HD) using Kidney Disease QOL-36 surveys (KDQOL).MethodsA retrospective chart review of all ESRD patients who underwent HD at an outpatient center. The five components of the KDQOL were the primary end points of this study (burden of kidney disease, symptoms and problems, effects of kidney disease on daily life, mental component survey, and physical component survey). Scores were grouped into three categories (below average, average, and above average). In addition to demographics (age, sex, and race), the independent variables such as weight gain, number of years on dialysis, urea reduction ratio, calcium, phosphorus, parathyroid hormone, albumin, and hemoglobin in the serum were collected. Chi-square analysis for dependent variables and the nominal independent variables was used, and analysis of variance analysis was used for continuous independent variables. Ordinal regression using PLUM (polytomous universal model) method was used to weigh out possible effects of confounders.ResultsThe cohort size was 111 patients. Mean age was 61.8 (±15.5) years; there were more males than females (64.9% vs 35.1%), the mean time-on-dialysis at the time of the study was 4.3 (4.8) years. Approximately two-thirds of the responses on all five domains of the questionnaire ranked average when compared to the national numbers. The remainders were split between above average (20.6%) and below average (13.4%). In our cohort, no relationships were statistically significant between the five dependent variables of interest and the independent variables by chi-square- and t-test analyses. This was further confirmed by regression analysis. Of note, sex carried the strongest statistical significance (with a P-value of 0.16) as a predictor of “the burden of kidney disease on daily life” in ordinal regression.ConclusionPrior studies have shown variables such as serum phosphate level, intradialytic weight gain, and dialysis adequacy are associated with lower KDQOL scores; however, this was not evident in our analysis likely due to smaller sample size. Larger size studies are required to better understand the predictors of QOL in ESRD patients on HD.

Quality of life data from EQ-5D for evidence-based health service practice in dialysis care

Background Hemodialysis (HD) and peritoneal dialysis (PD) are therapeutic options for patients with end-stage-renal-disease (ESRD), if transplantation is not available. Mortality rates for HD and PD are similar, while PD is generally the less costly alternative. Percentage of HD and PD shows considerable variability between high income countries (for PD from 5-7% in Germany and Switzerland up to 19-24% in the UK and Scandinavia). Patient reported outcomes, such as quality of life (QOL), can provide complementary evidence for planning of patient oriented dialysis services. Profile instruments (e.g. SF36, KDQOL) show no consistent QOL differences between HD and PD. However, single index preference-based QOL measures (such as EQ-5D), may add new information and are useful for later health economic evaluations. We aimed to collect current evidence for QOL of ESRD patients as measured with EQ-5D.

Editorial comment: health-related quality of life in hemodialysis patients: an Iranian multi-center study.

Dear Editor, Psychosocial aspects of health have a significant impact on the clinical outcomes of patients with end stage renal disease (ESRD) on hemodialysis (HD) (1, 2). Quality of life (QOL) is a potentially modifiable risk factor for mortality in this patient population. Mapes et al. (3) previously showed that lower health related quality of life (HRQOL) scores are associated with higher hospitalizations and increased mortality in dialysis patients. The mental and physical component summary (MCS, PCS) scores and kidney disease composite summary (KDCS) score are frequently used to assess HRQOL throughout the world. However, there is limited data on the QOL of ESRD patients from the Middle East. Rostami et al. (4) recently performed a cross-sectional study designed to evaluate the perception of QOL in 6,930 chronic HD patients from Iran. This study is important, as it is the largest comprehensive data collection addressing HRQOL of HD patients in Iran. An Iranian adapted version of the kidney disease QOL short form version 1.3 (KDCS-SF1.3) questionnaire was used. This instrument was previously validated in general medical patients in Iran (5). They compared PCS, MCS and KDCS scores of their patients with 19 similar studies performed in America, Europe and Asia between 1996 and 2010. Patients with acute illnesses requiring hospitalization and vascular access failure requiring temporary catheter placement were excluded from the study. PCS and MCS scores were slightly higher than the overall results while KDCS was slightly lower than the overall results. A significant limitation of the study is that the majority of patients had a low literacy rate which could potentially skew the results of this questionnaire. The Iranian adapted version of the questionnaire was previously validated in healthy individuals in Tehran which may have higher literacy rate than the rest of the country (5). The study also did not have a control group of general medical patients to compare the results of the QOL scores. Dialysis adequacy as defined by a Kt/V between 1 and 1.2 was associated with a lower rate of hospitalization. As with many clinical variables, there is also a J-shaped relationship between URR and survival in HD patients (6). Adverse outcomes observed among patients with a higher URR and KT/V may reflect lower body mass and malnutrition which should prompt a nutritional status evaluation (7). Despite potential differences in culture and perceptions of QOL, this study suggests that the QOL of Iranian HD patients are similar to that of ESRD patients from other countries. Prospective studies are needed to better understand the impact of HD on the QOL of ESRD patients. Interventions to improve the QOL of ESRD patients around the world are urgently needed.

Quality of life in patients before and after kidney transplantation

The presented study was carried out to differentially assess the quality of life (QOL) of two patient groups with end-stage renal disease (ESRD) with regard to the replacement therapy (dialysis vs. transplantation) and healthy controls. Successfully transplanted patients (n = 149) and patients treated by dialysis (n = 149) on the waiting list for transplantation at the Transplant Center Essen, Germany were enrolled. Additionally, 149 healthy controls were enrolled by an accumulative process starting from employees of the University Hospital Essen. Members of these three groups were strictly matched by age and gender. Medical data were gained from the patient record, QOL was measured by a global inventory, the Munich Quality of Life Dimension List (MLDL), and two specific inventories, the Brief Symptom Inventory (BSI) and the Questionnaire for Social Support - Short Form (K-22). Transplanted patients and healthy controls reported similar QOL, which was significantly higher than in dialysis patients (p < 0.0001). This was particularly true for the physical and the psychological status, but not for the social situation. Both patient groups reported similar social support, which was significantly lower than in controls (p < 0.006). Both ESRD groups described higher satisfaction with social support than the healthy controls (p < 0.0001). Successful kidney transplantation not only improved distinct aspects of QOL, but even put the patients on par with healthy controls regarding physical, psychological and functional QOL. Lower social support and higher satisfaction with social support in both patient groups should be evaluated further. From a clinical viewpoint, the improvement of QOL due to transplantation is impressive, but more attention should be paid to the interpersonal relations of ESRD patients. International multicenter longitudinal studies to investigate QOL in ESRD patients under different treatment modalities are emphasized.

Quality of life in patients before and after kidney transplantation

The aim of the present study was to differentially determine quality of life (QOL) in patients with end-stage renal disease (ESRD) after successful kidney transplantation (RT, Group A) compared with ESRD patients on a waiting list for RT (Group B). and with healthy controls (Group C) because opinions vary as to which treatment modality can best assure ESRD patients a high QOL. Groups A, B and C each consisted of 149 persons, matched for age and gender. The Munich Quality of Life Dimensions List (MLDL) was used to measure global aspects of QOL. Distinct aspects of QOL were investigated by the Brief Symptom Inventory (BSI) and the Questionnaire for Social Support (K-22). Groups A and C reported similar QOL. Which was significantly higher than in group B (p < .0001). This was particularly true for the physical and psychological status and daily activities, but not for the social situation. Groups A and B reported similar social support, which was significantly, lower than in group C (p < 006). Both ESRD groups reported higher satisfaction with social support than healthy controls (p < .0001). Successful RT nor only improved distinct aspects of QOL in patients with ESRD, but even put them on par with healthy controls regarding physical and psychological QOL. Lower social support and higher satisfaction with social support in both groups of ESRD patients should be evaluated further. From a clinical viewpoint. the improvement of physical and psychological aspects of QOL in RT patients is impressive; but more attention should be paid to constantly low social support in this group of patients. International multi center longitudinal studies to investigate QOL in ESRD patients under different treatments am necessary.

Differences in quality of life among patients receiving dialysis replacement therapy at seven medical centers

The purpose of this study is to investigate the variations in quality of life (QOL) among patients with end-stage renal disease (ESRD) who are receiving replacement therapy in several dialysis centers. This observational study includes interviews with nurses and data extraction from medical charts for all 680 adults who had been on dialysis therapy for more than 4 weeks in seven dialysis centers. By using multivariate analysis, we generated a model to explain the variance in QOL as measured by the QL index score (developed by Spitzer et al., J Chronic Dis 1981; 34: 585–597) among patients pooled from all centers. The expected mean QL index score and 95% confidence interval were computed for each dialysis center. Centers with observed mean QL index scores outside of the expected confidence range were marked as possible outliers. We found the following patient attributes to be independently associated with QOL: age, education, occupation, and certain comorbidities (e.g., diabetes, stroke). After adjustment for case mix, we could identify four outlier centers. After further adjustment for albumin in serum, a possible process indicator, two centers were no longer considered as outliers. These findings indicate that the variance in QOL of ESRD patients at different centers is not entirely explained by known case-mix factors. Further research should explore whether such variations are related to dissimilarity in the process of care at different centers.