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

Abstract

Background: Assessment 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). Methods: A 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. Results: The 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. Conclusion: Prior 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.

Assessment of quality of life in patients undergoing hemodialysis using WHOQOL-BREF questionnaire: a multicenter study

“…5 Patients with CKD on MHD have to bear significant physical, psychological, and economic challenges. 6,7 Patients, along with their families, must change their lifestyles to adapt to the rigor and frequencies of hemodialysis sessions, which can be up to thrice a week. In addition, specific dietary regimens and associated health problems can adversely affect QOL of these patients.…”

“…Unlike in the past, when the sole concern was to prolong survival of patients with CKD, equal importance is now being given toward maintenance of QOL. 9,10 Several studies have shown that patients with CKD undergoing hemodialysis have a lower QOL than those undergoing peritoneal dialysis, 11 those with renal transplantation, 6,12 and the healthy individuals. 13,14 Assessment of QOL of patients with CKD not only helps to assess the quality of dialysis program but also is useful to guide nephrologists to develop better interventions and plans of care for the future.…”

“…This result is in line with studies by Saad et al and Gemmell et al In both of these studies, the investigators found no significant difference in QOL scores between males and females. 6,25 Nevertheless, several studies have reported a significant influence of gender on QOL. Sayin et al documented males to have worse QOL than females, whereas Valderrábano et al reported the opposite.…”

Kt/V: A Magical Formula for Dialysis Adequacy: A Critical Review

“…Dialysis adequacy is considered a predictor of patient mortality and primary outcomes (14). The patients undergoing dialysis with high adequacy live as long as those receiving kidney transplant (15,16).…”

Hemodialysis Adequacy Sacrificed for Business: A Qualitative Study

“…According to the findings of previous studies, dialysis adequacy is a predictor for mortality and morbidity in patients undergoing hemodialysis, and patients undergoing adequate dialysis have a lifespan equal to that of patients with renal transplant (3). On the other hand, inadequate hemodialysis increases the patient's need for more prolonged or frequent hemodialysis, reduces the quality of life, imposes additional treatment costs on the national health system, and promotes the risk of transmitting fatal infectious agents such as hepatitis B and C viruses and other blood contaminating agents among in patients (4,5).…”