Quality of life, depressive symptoms and stress in patients with end-stage renal disease: a comparison of renal replacement therapy modalities

Abstract

Aims: Patients with end-stage renal disease (ESRD) face various physical and mental limitations resulting from different renal replacement therapy (RRT) modalities. Renal transplantation (Tx) is considered as the treatment that impacts most on health-related quality of life (HRQOL). This study aimed to analyze and compare the HRQOL, depressive symptoms and stress in patients undergoing hemodialysis (HD), peritoneal dialysis (PD) and Tx.Methods: A single-center cross-sectional sample of 32 HD patients, 22 PD patients and 147 Tx patients participated in our questionnaire survey. Measurements for this study included the MOS 36-Item Short-Form Health Survey (SF-36), the Beck Depression Inventory (BDI) and the Perceived Stress Scale 14 (PSS-14). Multivariate regression models, including a linear regression model and an ordinal logistic regression model, were employed to analyze health differences among patients undergoing HD, PD and Tx.Results: Tx patients showed better results of PCS (P=0.002) and PSS-14 (P=0.046), compared to HD patients. There was no significant difference among three different RRT modalities regarding the scores of MCS, while the Tx group significantly suffered from milder depressive symptoms than the other two groups (P<0.001). The scores of PCS were associated with age, and the scores of PSS-14 were associated with RRT modality, education level and type of insurance. The variables associated with severity of depressive symptoms were occupation status and RRT modality.Conclusions: Tx patients had better HRQOL and psychological well-being. RRT modality, education level and type of insurance were significant factors of psychological well-being of ESRD patients. Multiple measures performed to examine the psychological well-being of ESRD patients need to be developed.