The Health-Related Quality of Life of Chinese Patients on Hemodialysis and Peritoneal Dialysis
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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.
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.
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.
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.
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.
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.
Compliance with Ethical Standards
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.
Research involving human participants and/or animals
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.
Informed consent was obtained from all individual participants included in the study.
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