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      A One-Year Trial of In-Center Daily Hemodialysis with an Emphasis on Quality of Life

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          Abstract

          Background/Aims: Hemodialysis is associated with acute changes in several physiologic factors. Previous studies have suggested significant clinical and quality of life (QOL) benefits of daily hemodialysis (DHD) compared with 3 times weekly hemodialysis (CHD). We conducted a prospective trial to evaluate the effects of switching chronic hemodialysis patients to in-center DHD for a 12-month period. Methods: There were no exclusion criteria. Patients received hemodialysis 6 times per week. The study set a standardized weekly Kt/V (stdKt/V) goal of 3.0. A broad array of clinical parameters was determined. QOL was assessed with multiple instruments. Results: Eleven subjects completed 12 months and 12 completed 6 months on DHD. Significant changes relative to baseline at 12 months of DHD included decreased BP and improvements in QOL parameters by multiple techniques. 100% of patients at 12 months wished to continue DHD. Conclusions: DHD offers advantages over CHD with respect to improved QOL and BP control.

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          Most cited references 2

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          Psychosocial variables, quality of life, and religious beliefs in ESRD patients treated with hemodialysis.

          Religious and spiritual aspects of quality of life (QOL) have not been fully assessed in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD), but psychosocial factors are associated with patient survival. To investigate interrelationships between religious beliefs and psychosocial and medical factors, we studied 53 HD patients. Psychosocial and medical variables included perception of importance of faith (spirituality), attendance at religious services (religious involvement), the Beck Depression Inventory, Illness Effects Questionnaire, Multidimensional Scale of Perceived Social Support, McGill QOL Questionnaire scores, Karnofsky scores, dialysis dose, and predialysis hemoglobin and albumin levels. Eighty-seven percent of participants were African-American. Men had higher depression scores, perceived lower social support, and had higher religious involvement scores than women. No other parameters differed between sexes. Perception of spirituality and religiosity did not correlate with age, Karnofsky score, dialysis dose, or hemoglobin or albumin level. Greater perception of spirituality and religiosity correlated with increased perception of social support and QOL and less negative perception of illness effects and depression. A one-question global QOL measure correlated with depression, life satisfaction, perception of burden of illness, social support, and satisfaction with nephrologist scores, but not with age or Karnofsky score. Religious beliefs are related to perception of depression, illness effects, social support, and QOL independently of medical aspects of illness. Religious beliefs may act as coping mechanisms for patients with ESRD. The relationship between religious beliefs and clinical outcomes should be investigated further in patients with ESRD. Copyright 2002 by the National Kidney Foundation, Inc.
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            Quality of life in peritoneal dialysis patients.

            In 49 patients receiving continuous ambulatory peritoneal dialysis, we assessed the relative influences of adequacy of dialysis (assessed by kinetic transfer/volume urea) and psychological symptoms (depression and anxiety) upon the patients' evaluation of their overall quality of life (QoL). Subjects completed self-rating forms for anxiety, depressive, and somatic symptoms, for discrete areas relevant to QoL, and for overall QoL; clinicians also rated QoL. Depressive symptoms proved a much stronger correlate of overall QoL than did the biochemical measure of dialysis adequacy, and they remained influential even after adjustment for anxiety, kinetic transfer/volume, and somatic symptoms. In contrast, the effects of kinetic transfer/volume, anxiety symptoms, and somatic symptoms dropped sharply when adjusted for the other variables. Because psychological (especially depressive) symptoms may be stronger determinants of patients' overall QoL than is adequacy of dialysis, assessing QoL and psychological status should be part of the care of end-stage renal disease patients.
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              Author and article information

              Journal
              BPU
              Blood Purif
              10.1159/issn.0253-5068
              Blood Purification
              S. Karger AG
              0253-5068
              1421-9735
              2004
              May 2004
              09 July 2004
              : 22
              : 3
              : 320-328
              Affiliations
              aNephrology/Internal Medicine, Hospital of St. Raphael, New Haven, Conn.; bRenal Research Institute, New York, N.Y.; cDepartment of Pain Medicine, Beth Israel Medical Center, New York, N.Y.; dNew Haven CAPD, New Haven, Conn., and eYale University School of Medicine, New Haven, Conn., USA
              Article
              79186 Blood Purif 2004;22:320–328
              10.1159/000079186
              15256799
              © 2004 S. Karger AG, Basel

              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.

              Page count
              Tables: 7, References: 27, Pages: 9
              Product
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/79186
              Categories
              Original Paper

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