Quality of life in male hemodialysis patients. Role of erectile dysfunction.

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Abstract

Health-related quality of life (QOL) is affected in hemodialysis patients (HD). A number of factors such as age, anemia, and comorbidity had been implicated in decreased QOL. Erectile dysfunction (ED) is a frequent and potentially treatable complication in HD patients. In this cross-sectional study, we aimed to evaluate the possible relation between the QOL and ED in HD patients.

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Quality of life in peritoneal dialysis patients: decline over time and association with clinical outcomes.

Anne Bakewell, Rob M Higgins, Mair E Edmunds (2002)

Quality of life (QoL) is increasingly well recognized as an important measure of treatment outcome. The aim of this study was to determine which key factors affect QoL, which aspects of QoL change over time, and if measurements of QoL were associated with clinical outcome in our peritoneal dialysis (PD) population. The results of 88 patients (70% of our PD population) enrolled in longitudinal studies of dialysis adequacy, nutrition, and quality of life were reviewed. The sample comprised Indo-Asian [N=35 (diabetic N=18)], and white Europeans [N=53 (diabetic N=18)] heritage. At enrollment (>3 months on PD) demographic data was recorded. At enrollment, and six-month intervals, the dialysis adequacy, nutritional status, QoL (using the KDQOL-SF instrument), hospital admissions, PD infections, and changes in treatment modality were recorded. Male gender, Asian ethnicity, and poor nutritional status as measured by Subjective Global Assessment were the most significant characteristics independently associated with worse overall QoL dimension scores (physical health, mental health, kidney disease issues, patient satisfaction). Comorbidity, months of renal replacement, social deprivation and serum albumin were related to some of the 19 health domains measured. QoL declined steadily during the two-year study period. The most significant changes were for the items general health symptoms/problems, burden of kidney disease, emotional well-being, and patient satisfaction. Increased hospital admissions were associated with a worse QoL. Quality of life declines in patients on PD over time. Certain aspects of QoL are especially poor in Asian and male patients. This study suggests that further research is necessary to determine the effects of interventions directed at enhancing emotional and social support.

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Predictive Value of Functional Status for Mortality in Patients on Maintenance Hemodialysis

Onyekachi Ifudu, Henry R. Paul, Peter Homel … (1998)

In patients receiving maintenance hemodialysis, laboratory indices (such as serum albumin concentration) are predominantly utilized to assess well-being, while measures of functional status are rarely applied. However, the serum albumin concentration declines with advancing age, and the mean age of patients starting maintenance hemodialysis is now over 63 years. Using a 14-level modified Karnofsky activity scale, we measured baseline functional status in 522 randomly selected hemodialysis patients and prospectively monitored them for 3 years to determine the predictive value of our modified Karnofsky score for mortality. At onset of study, serum albumin and creatinine concentrations as well as hematocrit were measured and the comorbid conditions documented. At baseline, the 522 subjects (270 women and 252 men) included 327 blacks (63%), 154 whites (29%), 31 Hispanics (6%), and 10 Asians (2%) of mean age 59 ± (SD) 15 years. The mean duration of end-stage renal disease was 4 ± 3.6 years, and the mean serum albumin concentration was 3.7 ± 0.4 g/dl. 166 (32%) of the patients died during the observation period. Cox regression analysis revealed inverse relations between mortality and both our modified Karnofsky score (p = 0.0001) and serum albumin concentration (p = 0.001). The predictive value of a low modified Karnofsky score for mortality persisted after analysis of subjects stratified according to serum albumin concentration (<4 g/dl, n = 382, p = 0.0001 vs. ≥4 g/dl, n = 140, p = 0.008). With a modified Karnofsky score (<70 vs. ≥70), the relative risk of death during the 3-year follow-up period was 1.44 (95% confidence interval 1.236, 1.675; p < 0.0001). Forward stepwise Cox regression analysis showed that advanced age (p = 0.0005), white race (p = 0.0009), diabetes mellitus (p = 0.01), and a low serum albumin concentration (p = 0.003) were independently associated with an increased risk of mortality during follow-up after adjustment for other factors. A modified Karnofsky score (p = 0.14) did not predict survival in the Cox model when other independent variables were included. We conclude that in patients with end-stage renal disease sustained on maintenance hemodialysis, a poor functional status (measured on a modified Karnofsky activity scale) is associated with early mortality. Periodic measurement of modified Karnofsky score is a simple, low-cost, and reliable means of identifying patients on dialysis at risk for early death.