Abstract
Aims
Our aim was to compare health-related quality of life (HRQOL) between end-stage renal disease (ESRD) patients and the Hong Kong general population to identify how the mode of dialysis and other factors were associated with HRQOL.
Methods
We conducted a cross-sectional study involving 253 hemodialysis (HD) patients and 103 peritoneal dialysis (PD) patients recruited in 2014–2015. Their HRQOL was evaluated using Kidney Disease and Quality of Life-36 (KDQOL-36) sub-scale scores and the Short Form-6 Dimensions (SF-6D) health preference score. One-way analysis of variance was used to analyze the difference in mean KDQOL-36 and SF-6D scores among PD patients, HD patients, and an exact age- and sex-matched general population. Multiple linear regressions were conducted to evaluate factors associated with the KDQOL-36 and SF-6D scores.
Results
The physical HRQOL of ESRD patients on dialysis was worse than that of the age- and sex-matched general population (38.4 vs. 49.6), but mental HRQOL was similar (50.7 vs. 52.0). After adjusting for all baseline characteristics, male subjects was associated with higher physical component summary (PCS), SF-6D, and symptom scores. A higher level of education (secondary or tertiary) was associated with higher mental component summary (MCS), SF-6D, symptom, and effects scores. Patients who were female, younger, married, and less educated and had a history of cardiovascular disease (CVD) and did not achieve target hemoglobin and albumin levels were associated with poorer HRQOL outcomes.
Conclusions
HD was associated with a greater negative impact of ESRD on daily lives than was PD, which may be a consideration when deciding on the dialysis modality for first-line renal replacement therapy. To improve HRQOL among patients on maintenance dialysis, more attention should be paid to those with demographic risk factors, preventing CVD, and meeting clinical dialysis outcome targets such as hemoglobin and albumin levels.
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References
Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260–72.
International Diabetes Federation. IDF Diabetes Atlas, 7 ed. Brussels; 2015.
Kwong VW, Li PK. Peritoneal dialysis in Asia. Kidney Dis (Basel). 2015;1(3):147–56.
Fukuhara S, Yamazaki S, Hayashino Y, Green J. Measuring health-related quality of life in patients with end-stage renal disease: why and how. Nat Clin Pract Nephrol. 2007;3(7):352–3.
Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev. 1999;15(3):205–18.
Mapes DL, Lopes AA, Satayathum S, Mccullough KP, Goodkin DA, Locatelli F, et al. Health-related quality of life as a predictor of mortality and hospitalization: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int. 2003;64(1):339–49.
Paniagua R, Amato D, Vonesh E, Guo A, Mujais S. Health-related quality of life predicts outcomes but is not affected by peritoneal clearance: the ADEMEX trial. Kidney Int. 2005;67(3):1093–104.
Harris S, Lamping DL, Brown EA, Constantinovici N. Clinical outcomes and quality of life in elderly patients on peritoneal dialysis versus hemodialysis. Perit Dial Int. 2002;22(4):463–70.
Sayin A, Mutluay R, Sindel S. Quality of life in hemodialysis, peritoneal dialysis, and transplantation patients. Transpl Proc. 2007;39(10):3047–53.
Molsted S, Prescott L, Heaf J, Eidemak I. Assessment and clinical aspects of health-related quality of life in dialysis patients and patients with chronic kidney disease. Nephron Clin Pract. 2007;106(1):c24–33.
Wu AW, Fink NE, Marsh-Manzi JV, Meyer KB, Finkelstein FO, Chapman MM, et al. Changes in quality of life during hemodialysis and peritoneal dialysis treatment: generic and disease specific measures. J Am Soc Nephrol. 2004;15(3):743–53.
Diaz-Buxo JA, Lowrie EG, Lew NL, Zhang H, Lazarus JM. Quality-of-life evaluation using Short Form 36: comparison in hemodialysis and peritoneal dialysis patients. Am J Kidney Dis. 2000;35(2):293–300.
Wan EY, Chen JY, Choi EP, Wong CK, Chan AK, Chan KH, et al. Patterns of health-related quality of life and associated factors in Chinese patients undergoing haemodialysis. Health Qual Life Outcome. 2015;13(1):1.
Bleyer AJ, Hylander B, Sudo H, Nomoto Y, de la Torre E, Chen RA, et al. An international study of patient compliance with hemodialysis. JAMA. 1999;281(13):1211–3.
Fukuhara S, Lopes AA, Bragg-Gresham JL, Kurokawa K, Mapes DL, Akizawa T, et al. Health-related quality of life among dialysis patients on three continents: the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2003;64(5):1903–10.
Lam CLK, Wong CKH, Lam ETP, Lo YY. Population norm of Chinese (HK) SF-12 health survey_version 2 of Chinese adults in Hong Kong. HK Pract. 2010;32:77–86.
Wong CK, Lam CL, Poon JT, Kwong DL. Clinical correlates of health preference and generic health-related quality of life in patients with colorectal neoplasms. PLoS One. 2013;8(3):e58341.
Choi EP, Lam CL, Chin WY. The health-related quality of life of Chinese patients with lower urinary tract symptoms in primary care. Qual Life Res. 2014;23(10):2723–33.
Joshi VD, Mooppil N, Lim JF. Validation of the kidney disease quality of life-short form: a cross-sectional study of a dialysis-targeted health measure in Singapore. BMC Nephrol. 2010;11(1):36.
Chen JY, Choi EP, Wan EY, Chan AK, Tsang JP, Chan KH, et al. Validation of the disease-specific components of the kidney disease quality of life-36 (KDQOL-36) in Chinese patients undergoing maintenance dialysis. PLoS One. 2016;11(5):e0155188.
Ware JE, Kosinski M, Turner-Bowker DM, Gandek B. How to score version 2 of the SF-12 health survey (with a supplement documenting version 1). Boston, Massachusetts: QualityMetric Incorporated; 2002.
Hays RD, Kallich JD, Mapes DL, Coons SJ, Amin N, Carter W, et al. Kidney disease quality of life short form (KDQOL-SFTM), version 1.2: a manual for use and scoring. Santa Monica: RAND; 1997.
Brazier JE, Roberts J. The estimation of a preference-based measure of health from the SF-12. Med Care. 2004;42(9):851–9.
McGhee SM, Brazier J, Lam CLK, Wong LC, Chau J, Cheung A, et al. Quality-adjusted life years: population-specific measurement of the quality component. Hong Kong Med J. 2011;17(Suppl 6):17–21.
Lam CL, Brazier J, McGhee SM. Valuation of the SF-6D health states is feasible, acceptable, reliable, and valid in a chinese population. Value Health. 2008;11(2):295–303.
Gotch FA, Sargent JA. A mechanistic analysis of the National Cooperative Dialysis Study (NCDS). Kidney Int. 1985;28(3):526–34.
Gilmore J. KDOQI clinical practice guidelines and clinical practice recommendations-2006 updates. Nephrol Nurs J. 2006;33(5):487.
NKF. DOQI guidelines: clinical practice guidelines and clinical practice recommendations. 2006 Updates. Hemodialysis adequacy, peritoneal dialysis adequacy and vascular access. New York: The National Kidney Foundation; 2006. p. 2006.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1988.
Valderrábano F, Jofre R, López-Gómez JM. Quality of life in end-stage renal disease patients. Am J Kidney Dis. 2001;38(3):443–64.
Murtagh FE, Addington-Hall J, Higginson IJ. The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis. 2007;14(1):82–99.
Polaschek N. The experience of living on dialysis: a literature review. Nephrol Nurs J. 2003;30(3):303.
Gilbar O, Or-Han K, Plivazky N. Mental adjustment, coping strategies, and psychological distress among end-stage renal disease patients. J Psychosom Res. 2005;58(6):471–6.
Sprangers MA, Schwartz CE. Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med. 1999;48(11):1507–15.
Gerogianni SK, Babatsikou FP. Psychological aspects in chronic renal failure. Health Sci J. 2014;8(2):205–214.
Leung CB, Cheung WL, Li PKT. Renal registry in Hong Kong—the first 20 years. Kidney Int Suppl. 2015;5(1):33–8.
Harris LE, Luft FC, Rudy DW, Tierney WM. Clinical correlates of functional status in patients with chronic renal insufficiency. Am J Kidney Dis. 1993;21(2):161–6.
Chiang C-K, Peng Y-S, Chiang S-S, Yang C-S, He Y-H, Hung K-Y, et al. Health-related quality of life of hemodialysis patients in Taiwan: a multicenter study. Blood Purif. 2005;22(6):490–8.
Coelho-Marques F, Wagner M, De Figueiredo CP, d’Avila D. Quality of life and sexuality in chronic dialysis female patients. Int J Impot Res. 2006;18(6):539–43.
Gil CJ, García CM, Foronda J, Borrego J, Sánchez PM, Pérez PB, et al. Health-related quality of life in elderly patients in haemodialysis. Nefrologia. 2002;23(6):528–37.
Vazquez I, Valderrabano F, Fort I, Jofre R, López-Gómez J, Moreno F, et al. Differences in health-related quality of life between male and female hemodialysis patients. Nefrologia. 2003;24(2):167–78.
Lam C, Wong C, Lam E, Lo Y, Huang W. Population norm of Chinese (HK) SF-12 health survey-version 2 of Chinese adults in Hong Kong. Hong Kong Pract. 2010;32(2):77–86.
Ashing-Giwa KT, Lim J-W. Examining the impact of socioeconomic status and socioecologic stress on physical and mental health quality of life among breast cancer survivors. Oncol Nurs Forum. 2009;36(1):79–88.
Kaptein AA, van Dijk S, Broadbent E, Falzon L, Thong M, Dekker FW. Behavioural research in patients with end-stage renal disease: a review and research agenda. Patient Educ Counsel. 2010;81(1):23–9.
Evans RW, Rader B, Manninen DL. The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. JAMA. 1990;263(6):825–30.
Moreno F, Gomez JL, Sanz-Guajardo D, Jofre R, Valderrabano F. Quality of life in dialysis patients. A Spanish multicentre study. Nephrol Dial Transpl. 1996;11(Suppl 2):125–9.
Iliescu EA, Coo H, McMurray MH, Meers CL, Quinn MM, Singer MA, et al. Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol Dial Transpl. 2003;18(1):126–32.
Jafar T, Islam M, Poulter N. Chronic kidney disease in the developing world. N Engl J Med. 2006;354(10):998–9.
Julius M, Hawthorne VM, Carpentier-Alting P, Kneisley J, Wolfe RA, Port FK. Independence in activities of daily living for end-stage renal disease patients: biomedical and demographic correlates. Am J Kidney Dis. 1989;13(1):61–9.
Vazquez I, Valderrábano F, Jofre R, Fort J, López-Gómez JM, Moreno F, et al. Psychosocial factors and quality of life in young hemodialysis patients with low comorbidity. J Nephrol. 2003;16(6):886–94.
Unruh M, Benz R, Greene T, Yan G, Beddhu S, Devita M, et al. Effects of hemodialysis dose and membrane flux on health-related quality of life in the HEMO study. Kidney Int. 2004;66(1):355–66.
Acknowledgements
The authors thank the HD-PPP program teams, all cluster representatives, and the Statistics and Workforce Planning Department of the Hospital Authority of Hong Kong for working with our team in this study. Sincere gratitude is expressed to all community HD centers and renal unit in-charge as well as their most helpful clinic staff who made our data collection successful.
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J.Y.C. and C.L.K.L. were responsible for the study design, obtaining funding, overall supervision, interpretation of data, and critical revision of the manuscript. E.Y.F.W. was the project manager and led the acquisition of data, statistical analysis, and interpretation of the results and critical revision of the manuscript. E.P.H.C. and A.K.C.C. contributed to the statistical analysis, interpretation of the results, and drafting the manuscript. K.H.Y.C and J.P.Y.T. assisted in the data interpretation and drafting the manuscript. All authors reviewed and approved the final manuscript.
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This study has received funding support from by the Health and Health Services Research Fund, Food and Health Bureau, HKSAR Commissioned Research on Enhancing Primary Care Study (Ref. No. EPC-HKU-2). The funding agencies had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflict of interest
J.Y.C., E.Y.F.W., E.P.H.C., A.K.C.C., K.H.Y.C., J.P.Y.T. and C.L.K.L. have no conflicts of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Chen, J.Y., Wan, E.Y.F., Choi, E.P.H. et al. The Health-Related Quality of Life of Chinese Patients on Hemodialysis and Peritoneal Dialysis. Patient 10, 799–808 (2017). https://doi.org/10.1007/s40271-017-0256-6
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DOI: https://doi.org/10.1007/s40271-017-0256-6