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      Impact of Baseline Health-Related Quality of Life Scores on Survival of Incident Patients on Peritoneal Dialysis: A Cohort Study

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          Abstract

          Introduction: In an attempt to decrease mortality in patients with end-stage renal disease, an increase in the lifetime of these patients without much focus on health-related quality of life (HRQOL) was pursued for a long period of time. However, lately, an improvement in the quality of this extended lifetime has focused on both the physical as well as the social and emotional aspects, as these parameters may be associated with clinical outcomes in end-stage renal disease patients. Aim: To evaluate the impact of self-determined HRQOL at admission on survival of incident peritoneal dialysis (PD) patients. Patients and Methods: A total of 1,624 incident Brazilian PD patients participating in a multicenter prospective cohort study (BRAZPD) were evaluated. HRQOL was assessed using the SF-36, divided into mental and physical components. Cox proportional regression analysis was used to determine the influence ofHRQOL (mental and physical components) on mortality. Multivariate Cox proportional hazards analyses were used to adjust gradually for more potential explanatory variables: first for demographic variables, followed by additional adjustment for socioeconomic, clinical and laboratory variables. The significance level in all analyses was set at p < 0.05. All analyses were carried out with SPSS 17.0. Results: Incident PD patients presented with low HRQOL scores on admission to therapy. Even after correction for sociodemographic variables, comorbidities, PD modality and laboratory parameters, HRQOL (both the mental and the physical components) remained a predictor [HR: 0.97 (CI: 0.95-0.98); HR: 0.97 (CI: 0.96-0.99), respectively] of survival. Conclusion: On admission to therapy, patients presenting with low HRQOL scores for both the mental and the physical components were associated with a higher mortality. These results suggest that early and timely intervention measures to improve the QOL of these patients are important.

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          Qualidade de vida de pessoas com doença renal crônica em tratamento hemodialítico

          Marielza R. Ismael Martins, Cláudia Bernardi Cesarino (2005)
          Este estudo descritivo objetiva avaliar a qualidade de vida de pessoas em tratamento de hemodiálise (HD) e identificar as atividades cotidianas que podem comprometer sua qualidade de vida. Foram pesquisadas 125 pessoas com insuficiência renal crônica (IRC) em tratamento de hemodiálise, mediante o Questionário Genérico de Qualidade de Vida SF-36 e as atividades cotidianas por uma entrevista semi-estruturada. Os dados foram submetidos à análise estatística, com nível de significância de 5%. Os resultados evidenciaram prejuízo na qualidade de vida, demonstrando menores escores nos domínios dos aspectos físicos, emocionais e vitalidade. Verificou-se correlação negativa entre tempo de HD e componente físico (r = - 0,75). As atividades corporais e recreativas foram as mais comprometidas tanto na amostra global quanto na estratificada por sexo. Observou-se correlação negativa entre tempo de HD e as atividades cotidianas: trabalho, atividades domésticas e atividades práticas.
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            Quality of life on chronic dialysis: comparison between haemodialysis and peritoneal dialysis.

            Jean-Blaise Wasserfallen, Georges Halabi, Patrick Saudan … (2004)
            Quality of life (QOL) assessment in patients on chronic haemodialysis (HD) or peritoneal dialysis (PD) has only rarely been carried out with the generic Euroqol-5D questionnaire. All chronic HD and PD patients in the 19 centres of western Switzerland were requested to fill in the validated Euroqol-5D generic QOL questionnaire, assessing health status in five dimensions and on a visual analogue scale, allowing computation of a predicted QOL value, to be compared with the value measured on the visual analogue scale. Of the 558 questionnaires distributed to chronic HD patients, 455 were returned (response rate 82%). Fifty of 64 PD patients (78%) returned the questionnaire. The two groups were similar in age, gender and duration of dialysis treatment. Mean QOL was rated at 60+/-18% for HD and 61+/-19% for PD, for a mean predicted QOL value of 62+/-30 and 58+/-32% respectively. Results of the five dimensions were similar in both groups, except for a greater restriction in usual activities for PD patients (P = 0.007). The highest scores were recorded for self-care, with 71% HD and 74% PD patients reporting no limitation, and the lowest scores for usual activities, with 14% HD and 23% PD patients reporting severe limitation. Experiencing pain/discomfort (for HD and PD) or anxiety/depression (for PD) had the highest impact on QOL. QOL was equally diminished in HD and PD patients. The questionnaire was well accepted and performed well. Improvement could be achievable in both groups if pain/discomfort and anxiety/depression could be more effectively treated.
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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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                Author and article information

                Journal
                Journal ID (publisher-id): NEF
                Journal ID (nlm-ta): Nephron
                Journal ID (doi): 10.1159/issn.1660-8151
                Title: Nephron
                Publisher: S. Karger AG
                ISSN (Print): 1660-8151
                ISSN (Electronic): 2235-3186
                Publication date Subscription-year: 2015
                Publication date (Print): February 2015
                Publication date (Electronic): 28 January 2015
                Volume: 129
                Issue: 2
                Pages: 97-103
                Affiliations
                aInterdisciplinary Program of Studies, Research, and Treatment in Nephrology and bDepartment of Medicine, Federal University of Juiz de Fora, Juiz de Fora, cDepartment of Medicine, Federal University of Sergipe, Aracaju, dDepartment of Medicine, Federal University of Bahia, Salvador, and eCenter of Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil; fDepartment of Medicine, Yale University, New Haven, Conn., USA; gDivision of Renal Medicine, CLINTEC, Karolinska Institute, Stockholm, Sweden
                Author notes
                *Dr. Fabiane Rossi dos Santos Grincenkov, Fundação IMEPEN, Rua José Lourenço Kelmer, 1300/208-222, São Pedro, Juiz de Fora, MG 36036-330 (Brazil), E-Mail nataliafernandes02@gmail.com
                Author information
                https://orcid.org/0000-0003-0536-5327
                Article
                Publisher ID: 369139 Other ID: Nephron 2015;129:97-103
                DOI: 10.1159/000369139
                PubMed ID: 25633060
                SO-VID: 4de4f0cd-5a25-46db-8ddf-c047ec71e239
                Copyright © © 2015 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 11 February 2014
                Date accepted : 16 October 2014
                Page count
                Figures: 3, Tables: 3, References: 20, Pages: 7
                Categories
                Subject: Clinical Practice: Original Paper

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: SF-36,Peritoneal dialysis,Survival,Health-related quality of life scores
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: SF-36, Peritoneal dialysis, Survival, Health-related quality of life scores

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