Predictors of quality of life of hemodialysis patients in India

Abstract

Little is known about the quality of life and survival in the patients on maintenance hemodialysis (HD) in India. Poor nutrition and dialysis noncompliance is common. This study investigates the factors that affect the quality of life (QoL) in HD patients in India. This cross-sectional study included 78 patients on HD for ≥ two months. Demographic, nutritional, functional subjective global assessment and Kidney Disease Quality of Life (KDQOL-36) assessments were done. Predictors of QoL were assessed by regression analysis. The mean calorie and protein intake were 1245 ± 116.9 kcal and 0.86 ± 0.19 g/kg/day respectively. Male gender (OR = 9.68), serum parathyroid hormone PTH <150 pg/ml (OR = 0.03), age ≤65 years (OR = 1.25), no catheter use (OR = 1.9) and hospitalizations (OR = 0.11), were independent predictors of total score ≥50. Independent predictors of physical component summary (PCS) >25 were male gender (OR = 5.06) and urine output at start of dialysis (OR = 1.05). Independent predictors of mental component summary (MCS) ≥25 were male gender (OR = 11.02), serum PTH > 150 pg/ml (OR = 0.15), daily protein intake of >0.8 g/kg and caloric intake >20 K.cal/kg (OR = 10.8). Patients with urine output >1 liter per day had more hypotensive episodes during dialysis (r = 0.56, P = 0.045), more headaches (r = 0.63, P = 0.006) but that did not affect the PCS significantly. Low PTH (<150 pg/ml) (OR = 1.29), multiple access failures (OR = 3.36) and total score ≤50 (OR = 0.09) were independently associated with increased hospitalization. Males, patients with serum PTH >150 pg/ml and those not on catheter had better total score. Though patients with higher urine output had better PCS, those with output >1 liter had higher incidence of hypotension and dialysis-related headache. Protein-energy malnutrition affected the MCS significantly. Dialysis noncompliance seen in one-fourth of the population did not affect the scores significantly.

Assessment of health-related quality of life and its determinants in patients with chronic kidney disease

“…[2456] We observed a significant decline in KDCS with increasing severity of CKD. Among individual domains, work status scores were affected to a greater degree.…”

“…There is minimal literature on HRQoL in CKD patients from low and middle-income countries, including India. [345678910111213] A few issues unique to the developing world which could potentially affect the HRQoL include age, economic status, literacy level, loss of employment, and gender bias. Apart from the disease and its complications, socioeconomic and cultural environment of the patients also play a major role in determining HRQoL.…”

“…There is only limited data on HRQoL in CKD from Indian subcontinent. [456910111213] Most of the Indian studies are limited to patients having advanced CKD or end stage renal disease (ESRD). Considering the social and cultural diversity in India, there can be significant differences in HRQoL and its determinants across the country.…”

The most frequent diagnosis on patients undergoing hemodialysis

“…This result is in concurrence with research conducted by Veerappan et al, which found that urine elimination disorder was common in chronic kidney failure patients who experienced interdialytic weight gain (IDWG) and whose urine output influenced their quality of life. 17 Patients who had less interdialytic weight gain had a higher quality of life, as did patients who had a higher volume of urine.…”

The Effects of Sundanese Kacapi Suling “Ayun Ambing” Music Therapy to The Level of Anxiety on Chronic Renal Failure Patient Undergoing Hemodialysis

“…On the other hand, according to Leghari et al (2015), the anxiety comes due to personality reasons, an A-type person will be more likely to experience anxiety than a B-type person. Veerapan, Arvind, and Ilayabharthi (2012) claim that other causes include change of self concept, self-control loss, and fear of future due to illness complication, and fizzling of work performance. This is also similar to Zachariah and Gopalkrishnan's arguments (2012), claiming that the anxiety experienced by these patients are caused by asthma, pain around the fistulae area, anxiety of the illness condition and of whether the illness cannot be cured, and fear of death.…”