Quality of Life Research

, Volume 25, Issue 2, pp 373–384 | Cite as

Quality of life and emotional distress in patients and burden in caregivers: a comparison between assisted peritoneal dialysis and self-care peritoneal dialysis

  • K. Griva
  • C. S. Goh
  • W. C. A. Kang
  • Z. L. Yu
  • M. C. Chan
  • S. Y. Wu
  • T. Krishnasamy
  • M. Foo



Assisted peritoneal dialysis (PD) involving caregivers allows more patients to get started on home-based dialysis with good clinical outcomes, but evidence on patient-reported and caregiver-reported outcomes is lacking. This study aimed to compare assisted PD versus self-care PD on quality of life (QoL) and psychosocial outcomes for patients and caregivers. The effect of PD modality [automated PD (APD); continuous ambulatory PD (CAPD)] in relation to self-care or assisted care was also examined.


A cross-sectional sample of 231 PD patients [142 self-care (57 APD/85 CAPD) and 89 assisted care PD (45 APD/44 CAPD)], 72 caregivers of assisted PD patients and 39 family members of self-care PD patients completed the Kidney Disease Quality of Life Short Form (KDQOL-SF), World Health Organisation Quality of Life Instrument-brief and the Hospital Anxiety and Depression Scale. Caregivers and family members completed the Lay Care-Giving for Adults Receiving Dialysis questionnaire and Zarit Burden Interview.


Case-mix-adjusted comparisons indicated comparable QoL in all dimensions with the exception of physical SF-12 (p = .001) and the KDQOL effects of kidney disease in favour of self-care PD. Levels of anxiety (9.72 ± 4.90; 8.25 ± 5.22) and depression (8.63 ± 3.80; 6.35 ± 4.76) were equivalent in assisted PD and self-care PD, respectively. Assisted PD caregivers reported more task-orientated duties (p = .007), yet levels of perceived burden were equal to those reported by family members of self-care PD.


Our findings of mostly comparable patient and caregiver outcomes in assisted PD and self-care PD suggest that caregiver burden and QoL should not be a barrier to using assisted PD.


Assisted peritoneal dialysis Burden Caregiver Quality of life Self-care peritoneal dialysis 



The study was funded by grants from NUS cross-faculty research Fund and NUS Academic Research Fund (start-up) [FY2007-FRC5-006] and conducted with the help and support of staff of the specialist PD clinics in Singapore General Hospital. The authors would also like to thank all patients, family members and Dr. Tonia Griva for their support for this study.

Compliance with ethical standards

Conflict of interest

None to declare.


  1. 1.
    Choong, H. L. (2012). Eighth report of the Singapore Renal Registry. Singapore: Health Promotion Board.Google Scholar
  2. 2.
    Perico, N., & Remuzzi, G. (2012). Chronic kidney disease: a research and public health priority. Nephrology, Dialysis, Transplantation, 27(Suppl 3), iii19–iii26.CrossRefPubMedGoogle Scholar
  3. 3.
    ESRD Patients in 2011: A Global Perspective. (2012). Fresenius Medical Care.Google Scholar
  4. 4.
    ERA-EDTA Registry Annual Report 2007. (2009). Netherlands: European Renal Association—European Dialysis and Transplantation Association.Google Scholar
  5. 5.
    Dimkovic, N., Aggarwal, V., Khan, S., Chu, M., Bargman, J., & Oreopoulos, D. G. (2009). Assisted peritoneal dialysis: What is it and who does it involve? Advances in peritoneal dialysis. Conference on Peritoneal Dialysis, 25, 165–170.Google Scholar
  6. 6.
    Li, P. K.-T., Law, M. C., Chow, K. M., Leung, C.-B., Kwan, B. C.-H., Chung, K. Y., & Szeto, C.-C. (2007). Good patient and technique survival in elderly patients on continuous ambulatory peritoneal dialysis. Peritoneal Dialysis International, 27(Supplement 2), S196–S201.PubMedGoogle Scholar
  7. 7.
    Laplante, S., Krepel, H., Simons, B., Nijhoff, A., van Liere, R., & Simons, M. (2013). Offering assisted peritoneal dialysis is a cost-effective alternative to the current care pathway in frail elderly Dutch patients. International Journal of Healthcare Management, 6(1), 27–36.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Pang, M. (2013, 8 April). NKF steps up home-dialysis drive. The Straits Times, p. B1.Google Scholar
  9. 9.
    Oliver, M., Quinn, R., Richardson, E., Kiss, A., Lamping, D., & Manns, B. (2007). Home care assistance and the utilization of peritoneal dialysis. Kidney International, 71(7), 673–678.CrossRefPubMedGoogle Scholar
  10. 10.
    Jofre, R., López-Gómez, J. M., & Valderrábano, F. (2000). Quality of life for patient groups. Kidney International, 57, S121–S130.CrossRefGoogle Scholar
  11. 11.
    Bakewell, A. B., Higgins, R. M., & Edmunds, M. E. (2002). Quality of life in peritoneal dialysis patients: Decline over time and association with clinical outcomes. Kidney International, 61(1), 239–248.CrossRefPubMedGoogle Scholar
  12. 12.
    Lowrie, E. G., Curtin, R. B., LePain, N., & Schatell, D. (2003). Medical outcomes study short form-36: A consistent and powerful predictor of morbidity and mortality in dialysis patients. American Journal of Kidney Diseases, 41(6), 1286–1292.CrossRefPubMedGoogle Scholar
  13. 13.
    Brownbridge, G., & Fielding, D. M. (1994). Psychosocial adjustment and adherence to dialysis treatment regimes. Pediatric Nephrology, 8(6), 744–749.CrossRefPubMedGoogle Scholar
  14. 14.
    Cukor, D., Rosenthal, D. S., Jindal, R. M., Brown, C. D., & Kimmel, P. L. (2009). Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney International, 75(11), 1223–1229.CrossRefPubMedGoogle Scholar
  15. 15.
    Lopes, A. A., Bragg, J., Young, E., Goodkin, D., Mapes, D., Combe, C., et al. (2002). Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. Kidney International, 62(1), 199–207.CrossRefPubMedGoogle Scholar
  16. 16.
    Einwohner, R., Bernardini, J., Fried, L., & Piraino, B. (2004). The effect of depressive symptoms on survival in peritoneal dialysis patients. Peritoneal Dialysis International, 24(3), 256–263.PubMedGoogle Scholar
  17. 17.
    Cukor, D., Ver Halen, N., & Fruchter, Y. (2013). Anxiety and quality of life in ESRD. Seminars in Dialysis, 26(3), 265–268.CrossRefPubMedGoogle Scholar
  18. 18.
    Belasco, A., Barbosa, D., Bettencourt, A. R., Diccini, S., & Sesso, R. (2006). Quality of life of family caregivers of elderly patients on hemodialysis and peritoneal dialysis. American Journal of Kidney Diseases, 48(6), 955–963.CrossRefPubMedGoogle Scholar
  19. 19.
    Belasco, A. G., & Sesso, R. (2002). Burden and quality of life of caregivers for hemodialysis patients. American Journal of Kidney Diseases, 39(4), 805–812.CrossRefPubMedGoogle Scholar
  20. 20.
    Dimkovic, N., & Oreopoulos, D. G. (2008). Assisted peritoneal dialysis as a method of choice for elderly with end-stage renal disease. International Urology and Nephrology, 40(4), 1143–1150.CrossRefPubMedGoogle Scholar
  21. 21.
    Yu, Z. L., Yeoh, L. Y., Seow, Y. Y., Luo, X. C., & Griva, K. (2012). Evaluation of adherence and depression among patients on peritoneal dialysis. Singapore Medical Journal, 53(7), 474–480.PubMedGoogle Scholar
  22. 22.
    Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of chronic diseases, 40(5), 373–383.CrossRefPubMedGoogle Scholar
  23. 23.
    Beddhu, S., Zeidel, M. L., Saul, M., Seddon, P., Samore, M. H., Stoddard, G. J., & Bruns, F. J. (2002). The effects of comorbid conditions on the outcomes of patients undergoing peritoneal dialysis. The American journal of medicine, 112(9), 696–701.CrossRefPubMedGoogle Scholar
  24. 24.
    Hays, R. D., Kallich, J. D., Mapes, D. L., Coons, S. J., Amin, N., Carter, W., & Kamberg, C. (1997). Kidney Disease Quality of Life Short Form (KDQOL-SFTM), Version 1. 2: A manual for use and scoring. Santa Monica, CA: Rand.Google Scholar
  25. 25.
    Thumboo, J., Fong, K.-Y., Machin, D., Chan, S.-P., Leong, K.-H., Feng, P.-H., et al. (2001). A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore. Quality of Life Research, 10(2), 175–188.CrossRefPubMedGoogle Scholar
  26. 26.
    Joshi, V. D., Mooppil, N., & Lim, J. F. (2010). Validation of the kidney disease quality of life-short form: A cross-sectional study of a dialysis-targeted health measure in Singapore. BMC Nephrology, 11, 36.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Jenkinson, C., Layte, R., Jenkinson, D., Lawrence, K., Petersen, S., Paice, C., & Stradling, J. (1997). A shorter form health survey: Can the SF-12 replicate results from the SF-36 in longitudinal studies? Journal of Public Health, 19(2), 179–186.CrossRefGoogle Scholar
  28. 28.
    Skevington, S. M., Lotfy, M., & O’Connell, K. A. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of Life Research, 13(2), 299–310.CrossRefPubMedGoogle Scholar
  29. 29.
    Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.CrossRefPubMedGoogle Scholar
  30. 30.
    Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale—A review of validation data and clinical results. Journal of Psychosomatic Research, 42(1), 17–41.CrossRefPubMedGoogle Scholar
  31. 31.
    Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52(2), 69–77.CrossRefPubMedGoogle Scholar
  32. 32.
    Snaith, R. P. (2003). The hospital anxiety and depression scale. Health Qual Life Outcomes, 1(1), 29.PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Horsburgh, M. E., Laing, G. P., Beanlands, H. J., Meng, A. X., & Harwood, L. (2008). A new measure of ‘lay’ care-giver activities. Kidney International, 74(2), 230–236.CrossRefPubMedGoogle Scholar
  34. 34.
    Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The Gerontologist, 20(6), 649–655.CrossRefPubMedGoogle Scholar
  35. 35.
    Seng, B. K., Luo, N., Ng, W. Y., Lim, J., Chionh, H. L., Goh, J., & Yap, P. (2010). Validity and reliability of the Zarit Burden Interview in assessing caregiving burden. Annals of the Academy of Medicine, Singapore, 39, 758–763.PubMedGoogle Scholar
  36. 36.
    Hébert, R., Bravo, G., & Préville, M. (2000). Reliability, validity and reference values of the Zarit Burden Interview for assessing informal caregivers of community-dwelling older persons with dementia. Canadian Journal on Aging/La Revue canadienne du vieillissement, 19(04), 494–507.CrossRefGoogle Scholar
  37. 37.
    Schreiner, A. S., Morimoto, T., Arai, Y., & Zarit, S. (2006). Assessing family caregiver’s mental health using a statistically derived cut-off score for the Zarit Burden Interview. Aging Ment Health, 10(2), 107–111.CrossRefPubMedGoogle Scholar
  38. 38.
    Corp, I. (2012). IBM SPSS Statistics for Windows (Version 21.0). Armonk, NY: IBM Corp.Google Scholar
  39. 39.
    Oliver, M., & Quinn, R. (2009). Assisted peritoneal dialysis in elderly persons, introduction to the American Society of Nephrology Geriatric Nephrology curriculum (Vol. Chapter 23): American Society of Nephrology.Google Scholar
  40. 40.
    Wellard, S. J., & Street, A. F. (1999). Family issues in home-based care. International Journal of Nursing practice, 5(3), 132–136.CrossRefPubMedGoogle Scholar
  41. 41.
    Cousineau, N., McDowell, I., Hotz, S., & Hébert, P. (2003). Measuring chronic patients’ feelings of being a burden to their caregivers: Development and preliminary validation of a scale. Medical Care, 41(1), 110–118.CrossRefPubMedGoogle Scholar
  42. 42.
    Yokoyama, Y., Suzukamo, Y., Hotta, O., Yamazaki, S., Kawaguchi, T., Hasegawa, T., et al. (2008). Dialysis staff encouragement and fluid control adherence in patients on hemodialysis. Nephrology Nursing Journal: Journal of the American Nephrology Nurses’ Association, 36(3), 289–297.Google Scholar
  43. 43.
    Fan, S. L.-S., Sathick, I., McKitty, K., & Punzalan, S. (2008). Quality of life of caregivers and patients on peritoneal dialysis. Nephrology, Dialysis, Transplantation, 23(5), 1713–1719.CrossRefPubMedGoogle Scholar
  44. 44.
    Mehta, K. K. (2006). A critical review of Singapore’s policies aimed at supporting families caring for older members. Journal of Aging & Social Policy, 18(3–4), 43–57.CrossRefGoogle Scholar
  45. 45.
    Guney, I., Solak, Y., Atalay, H., Yazici, R., Altintepe, L., Kara, F., et al. (2010). Comparison of effects of automated peritoneal dialysis and continuous ambulatory peritoneal dialysis on health-related quality of life, sleep quality, and depression. Hemodialysis International, 14(4), 515–522.CrossRefPubMedGoogle Scholar
  46. 46.
    Michels, W. M., van Dijk, S., Verduijn, M., le Cessie, S., Boeschoten, E. W., Dekker, F. W., & Krediet, R. T. (2011). Quality of life in automated and continuous ambulatory peritoneal dialysis. Peritoneal Dialysis International, 31(2), 138–147.PubMedGoogle Scholar
  47. 47.
    Bieber, S. D., Burkart, J., Golper, T. A., Teitelbaum, I., & Mehrotra, R. (2014). Comparative outcomes between continuous ambulatory and automated peritoneal dialysis: A narrative review. American Journal of Kidney Diseases, 63(6), 1027–1037.PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Povlsen, J. V., & Ivarsen, P. (2005). Assisted automated peritoneal dialysis (AAPD) for the functionally dependent and elderly patient. Peritoneal Dialysis International, 25(Suppl 3), S60–S63.PubMedGoogle Scholar
  49. 49.
    Verger, C., Duman, M., Durand, P.-Y., Veniez, G., Fabre, E., & Ryckelynck, J.-P. (2007). Influence of autonomy and type of home assistance on the prevention of peritonitis in assisted automated peritoneal dialysis patients. An analysis of data from the French Language Peritoneal Dialysis Registry. Nephrology, Dialysis, Transplantation, 22(4), 1218–1223.CrossRefPubMedGoogle Scholar
  50. 50.
    Griva, K., Li, Z. H., Lai, A. Y., Choong, M. C., & Foo, M. W. Y. (2013). Perspectives of patients, families, and health care professionals on decision-making about dialysis modality—The good, the bad, and the misunderstandings! Peritoneal Dialysis International, 33(3), 280–289.PubMedCentralCrossRefPubMedGoogle Scholar
  51. 51.
    Li, P. K.-T., Lui, S. L., Leung, C. B., Yu, A. W.-Y., Lee, E., Just, P. M., et al. (2007). Increased utilization of peritoneal dialysis to cope with mounting demand for renal replacement therapy—Perspectives from Asian countries. Peritoneal Dialysis International, 27(Supplement 2), S59–S61.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • K. Griva
    • 1
    • 2
  • C. S. Goh
    • 1
  • W. C. A. Kang
    • 1
  • Z. L. Yu
    • 1
  • M. C. Chan
    • 3
  • S. Y. Wu
    • 3
  • T. Krishnasamy
    • 3
  • M. Foo
    • 3
  1. 1.Department of PsychologyNational University of SingaporeSingaporeSingapore
  2. 2.Health Services Research GroupCity UniversityLondonUK
  3. 3.Department of Renal MedicineSingapore General HospitalSingaporeSingapore

Personalised recommendations