Health-Related Quality of Life in Home Dialysis Patients Compared to In-Center Hemodialysis Patients: A Systematic Review and Meta-analysis

Abstract

Rationale & Objective Dialysis patients judge health-related quality of life (HRQoL) as an essential outcome. Remarkably, little is known about HRQoL differences between home dialysis and in-center hemodialysis (HD) patients worldwide. Study Design Systematic review and meta-analysis. Setting & Study Populations Search strategies were performed on the Cochrane Library, Pubmed, and EMBASE databases between 2007 and 2019. Home dialysis was defined as both peritoneal dialysis and home HD. Selection Criteria for Studies Randomized controlled trials and observational studies that compared HRQoL in home dialysis patients versus in-center HD patients. Data Extraction The data extracted by 2 authors included HRQoL scores of different questionnaires, dialysis modality, and subcontinent. Analytical Approach Data were pooled using a random-effects model and results were expressed as standardized mean difference (SMD) with 95% CIs. Heterogeneity was explored using subgroup analyses. Results Forty-six articles reporting on 41 study populations were identified. Most studies were cross-sectional in design (90%), conducted on peritoneal dialysis patients (95%), and used the 12-item or 36-item Short-Form Health Survey questionnaires (83%). More than half the studies showed moderate or high risk of bias. Pooled analysis of 4,158 home dialysis patients and 7,854 in-center HD patients showed marginally better physical HRQoL scores in home dialysis patients compared with in-center HD patients (SMD, 0.14; 95% CI, 0.04 to 0.24), although heterogeneity was high ( I 2 >80%). In a subgroup analysis, Western European home dialysis patients had higher physical HRQoL scores (SMD, 0.39; 95% CI, 0.17 to 0.61), while home dialysis patients from Latin America had lower physical scores (SMD, −0.20; 95% CI, −0.28 to −0.12). Mental HRQoL showed no difference in all analyses. Limitations No randomized controlled trials were found and high heterogeneity among studies existed. Conclusions Although pooled data showed marginally better physical HRQoL for home dialysis patients, the quality of design of the included studies was poor. Large prospective studies with adequate adjustments for confounders are necessary to establish whether home dialysis results in better HRQoL. Trial Registration PROSPERO 95985.

Health Outcomes and Cost Considerations of Assisted Peritoneal Dialysis: A Narrative Review

“…For home dialysis in general, a systematic review and meta-analysis looking at 46 publications, pooling together 4,158 home dialysis and 7,854 in-centre HD patients from 40 distinct patient populations was conducted [2]. They found no overall difference in either physical or mental health-related QoL (that is, a patient’s perception of one’s own physical or mental well-being, respectively).…”

“…Peritoneal dialysis (PD) is a significantly underutilized renal replacement therapy (RRT) in many regions. As compared to in-center hemodialysis (HD), self-care PD boasts at least similar medical outcomes [1], improved physical health-related quality of life (QoL) [2], and increased satisfaction with their treatment [3]. Self-care PD is also more cost-effective than in-center HD [4], and in aggregate, consensus among surveyed nephrologists is that at least 40% of patients requiring RRT should be on some form of PD [3].…”

Impact of malnutrition on health-related quality of life in persons receiving dialysis: a prospective study

“…In persons receiving HD, 24-hour dietary recalls included information from a dialysis day, a non-dialysis day and a weekend day, while in persons performing PD, dietary Accepted manuscript recalls obtained information from two weekdays and one weekend day. We used the software Dietplan 7 (Forestfield Software Limited, West Sussex, United Kingdom) to calculate the average intake of calories, protein and fat.…”

Couples Coping With the Serious Illness of One of the Partners

“…The risks of depression are regularly highlighted in the international literature, both at a medical level and in the field of health psychology. There are numerous references in this field (some recent ones being Bonenkamp et al, 2020;Nair et al, 2020;Schouten et al, 2020 etc.). These studies seek to establish scales (of depression and anxiety in particular) and relevant and operative measures, particularly for preventive purposes, or to provide a comparative analysis of the treatments proposed (hemodialysis in the center or at home, peritoneal dialysis, before and after a transplant, etc.…”