Geriatric Nephrology and Urology

, Volume 8, Issue 2, pp 85–94 | Cite as

Health-Related Quality of Life (HRQOL) in End Stage Renal Disease (ESRD) patients over 65 years

  • Pablo Rebollo
  • Francisco Ortega
  • Jose M. Baltar
  • Carmen Díaz-Corte
  • Rafael A Navascués
  • Manuel Naves
  • Ana Ureña
  • Xavier Badía
  • Fernando Alvarez-Ude
  • Jaime Alvarez-Grande
Article

Abstract

Objectives: The aim of the study was to assess Health Related Quality of Life (HRQOL) of elderly patients on renal replacement therapy (RRT) of our region, and to identify socio-demographic and clinical variables which influence it. We also attempted to compare HRQOL of transplant patients, with that of chronic hemodialysis patients. Design: Cross-sectional study. Setting: Institutional Hospital Nephrology Unit Patients: All patients from 9 of the 10 hemodialysis centres in our region, aged 65 years or more, who had been on RRT (chronic hemodialysis and kidney transplantation) for at least three months, showing no cognitive problems, were included. The sample included 124 patients. Interventions: These patients participated in a structured interview using two generic HRQOL questionnaires: Sickness Impact Profile and SF-36 Health Survey. Karnofsky Scale, Comorbidity Index, socio-demographic and clinical data, were also collected. Results: The median age was 71 years (range 65–75); 55.6% of the patients were male; 19.8% of the sample were transplant patients and 80.2%, hemodialysis patients (only 2% on renal transplant waiting list); 69.2% had a low-intermediate socio-economic level, 52.9% had elementary studies, and 10.6% lived alone. Transplant patients had higher HRQOL than hemodialysis patients. Women had lower HRQOL than men. A higher economic level, higher educational level, higher Karnofsky Performance Scale, and lower Comorbidity Index score, were associated with higher HRQOL. Conclusions: The good HRQOL of elderly transplant patients, in comparison with hemodialysis patients, is an important reason for advising kidney transplants in elderly patients. Economic and educational levels, functional status and comorbidity are variables wich influence the HRQOL of these patients.

elderly End Stage Renal Disease Health-Related Quality of Life 

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References

  1. 1.
    Comité de Registro de la Sociedad Española de Nefrología. Registro Nacional de diálisis y trasplante de la Sociedad Española de Nefrología. Informe 1994. Nefrología 1997; 17(5): 365-374.Google Scholar
  2. 2.
    Valderrábano F, Berthoux FC, Jones EHP, Mehls O. EDTAERA Registry Report XXV, 1994. End-stage renal disease and dialysis report. Nephrol Dial Transplant 1996; 11(suppl 1): 2-21.PubMedGoogle Scholar
  3. 3.
    United States Renal Data System (USRDS). The USRDS 1997 Annual Data Report: II. Incidence and prevalence of ESRD. Am J Kidney Dis 1997; 30(2)(suppl 1): 40-53.Google Scholar
  4. 4.
    Oreopoulos DG. Dialyzing the elderly: benefit or burden? Nefrología 1997; XVII(suppl 3): 2-8.Google Scholar
  5. 5.
    Folstein MF, Folstein SE, McHugh PR. Mini Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res 1975; 12(3): 189-198.CrossRefGoogle Scholar
  6. 6.
    Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item Selection. Medical Care 1992; 30(6): 473-483.PubMedGoogle Scholar
  7. 7.
    McHorney CA, Ware JE, Lu JFR, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care 1994; 32(1): 40-66.Google Scholar
  8. 8.
    Alonso J, Prieto L, Antó JM. La versión española del SF-36 Health Survey (cuestionario de salud SF-36): un instrumento para la medida de los resultados clínicos. Medicina Clínica 1995; 104: 771-776.PubMedGoogle Scholar
  9. 9.
    Bergner M, Bobbit RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of health status Measure. Medical Care 1981; 19: 787-805.PubMedGoogle Scholar
  10. 10.
    Badia X. Adaptación transcultural y validación española de una medida de la disfunción relacionada con la enfermedad: el Perfil de las Consecuencias de la Enfermedad (la versión española del Sickness Impact Profile). Tesis Doctoral Universidad Autónoma de Barcelona, 1994.Google Scholar
  11. 11.
    Badia X, Alonso J. Adaptación de una medida de la disfunción relacionada con la enfermedad: la versión española del Sickness Impact Profile. Medicina Clínica 1994; 102: 90-95.PubMedGoogle Scholar
  12. 12.
    Badía X, Alonso J: Reliability of the spanish version of the Sickness Impact Profile. Quality of Life Research 1994; 3: 65-68.CrossRefGoogle Scholar
  13. 13.
    Badía X, Alonso J. Re-scaling the Spanish version of the Sickness Impact Profile: an opportunity for the assessment of cross-cultural equivalence. J Clin Epid 1995; 48(7): 949-959.CrossRefGoogle Scholar
  14. 14.
    Badía X, Alonso J. Validity and reproductibility of the Spanish version of the SIP. J Clin Epidemiol 1996; 49: 359-365.PubMedCrossRefGoogle Scholar
  15. 15.
    Karnofsky DA, Burchenal JHK. The clinical evaluation of chemotherapeutic agents in cancer. In: McLeod CM, editor. Evaluation of chemotherapeutics agents. New York: Columbia University Press, 1949: 191-205.Google Scholar
  16. 16.
    Ortega F. Esperanza y calidad de vida en pacientes de edad avanzada en terapia sustitutiva de la insuficiencia renal. Tesis Doctoral Universidad de Oviedo, 1997.Google Scholar
  17. 17.
    Evans RW, Manninen DL, Garrison LP, Hart LG, Blagg CR, Gutman RA et al. The quality of life of patients with end-stage renal disease. New Engl J Med 1985; 312: 553-559.PubMedCrossRefGoogle Scholar
  18. 18.
    Charlson ME, Pompei P, Ales KL, MacKenzie R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987; 40: 373-383.PubMedCrossRefGoogle Scholar
  19. 19.
    Moreno F, López JM, Sanz-Guajardo D, Jofre R, Valderrábano F. Quality of life in dialysis patients. Spanish National Study on quality of life in dialysis, and factors related to the quality of life of patients with ESRD on dialysis. Proceedings of XXXIInd Congress of EDTA-ENA; 1995 June; Atenas.Google Scholar
  20. 20.
    Moreno F, Aracil F, Pérez R, Valderrábano F. Controlled study on the improvement of Quality of Life in hemodialysis patients after correcting end-stage-renal disease-related anemia with erythropoietin. Am J Kidney Dis 1996; 27: 548-556.PubMedGoogle Scholar
  21. 21.
    Alvarez-Ude F, Vicente E, Badia X. La medida de la calidad de vida relacionada con la salud en los pacientes en programa de hemodiálisis y diálisis peritoneal continua ambulatoria de Segovia. Nefrología 1995; 15: 572-580.Google Scholar
  22. 22.
    Björvell H, Hylander B. Functional status and personality in patients on chronic dialysis. J of Int Med 1989; 226: 319-324.Google Scholar
  23. 23.
    McClellan WM, Anson C, Birkeli K, Tuttle E. Functional status and quality of life: predictors of early mortality among patients entering treatment for end stage renal disease. J Clin Epidem 1991; 44(1): 83-89.CrossRefGoogle Scholar
  24. 24.
    Badia X, Alonso J, Brosa M, Lock P. Reliability of the Spanish version of the Nottingham health profile in patients with stable end-stage renal disease. Soc Sci Med 1994; 38: 153-158.PubMedCrossRefGoogle Scholar
  25. 25.
    Gorlen T, Ekeberg O, Abdelnoor M, Enger E, Aarseth HP. Quality of life after kidney transplantation. A 10-22 years follow-up. Scand J Urol Nephrol 1993; 27: 89-92.PubMedCrossRefGoogle Scholar
  26. 26.
    Merkus MP, Jager KJ, Dekker FW, Boeschoten EW, Stevens P, Krediet RT, and the Necosad Study Group. Quality of Life in patients on chronic dialysis: self-assessment 3 months after the start of treatment. Am J Kidney Dis 1997; 29(4): 584-592.Google Scholar
  27. 27.
    Harris LE, Luft FC, Rudy DW, Tierney WM. Clinical correlates of functional status in patients with chronic renal insuffi-ciency. Am J Kidney Dis 1993; 21: 161-166.PubMedGoogle Scholar
  28. 28.
    Henrich WL. Dialysis considerations in the elderly patient. Am J Kidney Dis. 1990; 16: 339-341.PubMedGoogle Scholar
  29. 29.
    Naves Díaz ML, Díaz López JB, Rodríguez Rebollar A, Gómez Alonso C, Cannata Andía JB. Quality of life in a population older than 54 years. Medicina Clínica, 1997. In press.Google Scholar
  30. 30.
    Maiorca R. Special considerations in dialyzing the elderly patient. Nephrol Dial Transplant 1994; (9 suppl): 157-166.Google Scholar
  31. 31.
    Becker BN, Ismail N, T-Becker Y, MacDonnell RC, Helderman JH. Renal Transplantation in the older end stage renal disease patient. Seminars in Nephrology 1996; 16(4): 353-362.PubMedGoogle Scholar
  32. 32.
    Neves PL. Chronic haemodialysis in elderly patients. Nephrol Dial Transplant 1995; 6(10 suppl): 69-71Google Scholar
  33. 33.
    Kutner NG, Brogan DJ. Assisted survival, aging, and rehabilitation needs: comparison of older dialysis patients and agematched peers. Arch Phys Med Rehabili 1992; 73: 309-315.CrossRefGoogle Scholar
  34. 34.
    Kjellstrand C, Koppy K, Umen A. Hemodialysis of the elderly. In: Oreopoulos DG, editor. Geriatric Nephrology. Boston: Martinus, Nijhoff, 1986: 135-145.Google Scholar
  35. 35.
    Horine JH, Holzer H, Reisinger EC, Krejs GJ, Neugebauer JS. Elderly patients and chronic haemodialysis. Lancet 1992; 339: 183.CrossRefGoogle Scholar
  36. 36.
    Stout JP, Gokal R, Hillier VF. Quality of life of high-risk and elderly dialysis patients in the UK. Dial Transplant 1987; 16: 674-677.Google Scholar
  37. 37.
    Moody H, Moody C, Szabo E. Are older dialysis patients happy and can they fend for themselves or not? XIIth Int. Congr. Nephrol. 1993; 518 (abstr).Google Scholar
  38. 38.
    Wolcott DL, Nissenson AR, Lansverk J. Quality of life in chronic dialysis patients: factors unrelated to dialysis modality. Gen Hosp Psychiatry 1988; 10: 167-177.CrossRefGoogle Scholar
  39. 39.
    Muthny FA, Koch U. Quality of life of patients with endstage renal failure: a comparison of hemodialysis, CAPD and transplantation. Contrib Nephrol 1991; 89: 265-273.PubMedGoogle Scholar
  40. 40.
    Deniston OL, Carpentier-Alting P, Kneisley J. Assessment of quality of life in end-stage renal disease. Hlth Serv Res 1989; 24: 555-578.Google Scholar
  41. 41.
    Seedat YK, Machintosh CG, Subban JV. Quality of life for patients in an end-stage renal disease programme. S Afr Med J 1987; 71: 500-504.PubMedGoogle Scholar
  42. 42.
    Morgan BW. The relationship between chronological age and perceived quality of life of hemodialysis patients. Am Nephrol Nurs Assoc J 1990; 17: 63-66.Google Scholar
  43. 43.
    Rovira J. Aproximación a un análisis coste-utilidad de la terapeútica transfusión/eritropoyetina en los pacientes afectos de anemia nefrológica en hemodiálisis: resultados del estudio en curso. SEDYT 1989; 11: 15-20.Google Scholar
  44. 44.
    Ventura S. Repercusión de la eritropoyetina sobre la calidad de vida. BISEDEN 1991. Monográfico 25-30.Google Scholar
  45. 45.
    Muirhead N, Cattran DC, Zaltman J. Safety and efficacy of recombinant human erythropoietin in correcting the anemia of patients with chronic renal allograft dysfunction. J Am Soc Nephrol 1994; 5: 1216-1222.PubMedGoogle Scholar
  46. 46.
    Evans RW, Rader B, Manninen DL. and the Cooperative Multicenter EPO Clinical Trial Group. The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. JAMA 1990; 263: 825-830.PubMedCrossRefGoogle Scholar
  47. 47.
    Barany P, Petterson E, Konarski-Svensson JK. Long-term effects on quality of life in haemodialysis patients of correction of anaemia with erythropoietin. Nephrol Dial Transplant 1993; 8: 426-432.PubMedGoogle Scholar
  48. 48.
    Muirhead N, Churchill DN, Goldstein M. Comparison of subcutaneous and intravenous recombinant human erythropoietin for anemia in hemodialysis patients with significant comorbid disease. Am J Nephrol 1992; 12: 303-310.PubMedCrossRefGoogle Scholar
  49. 49.
    Laupacis A, Wong C, Churchill D. The use of generic and specific quality-of-life measures in hemodialysis patients treated with erythropoietin. The Canadian Erythopoietin Study Group. Control Clin Trials 1991; 12(suppl 4): 168-179.Google Scholar
  50. 50.
    Macías-Núñez JF, Cameron JS. Conclusions on transplantation in the elderly. In Cameron JS, editor. Treatment of end-stage renal disease in the elderly. Oxford: The Oxford Textbook of Clinical Nephrology 1992; 3: 1631.Google Scholar
  51. 51.
    Fehrman I. Kidney transplantation in patients between 65 and 75 years of age. Transplant Proc 1989; 21: 2018-2019.PubMedGoogle Scholar
  52. 52.
    Grupo de Estudio de la Sociedad Española de Nefrología. Variaciones de la incidencia de las distintas formas de glomerulonefritis primarias en España. Un estudio de 8545 biopsias renales. Nefrología 1988; 8: 105-113.Google Scholar
  53. 53.
    Ifudu O, Paul H, Mayers J, Cohen LS, Brezsnyak WF, Herman AI, et al. Pervasive failed rehabilitation in center-based maintenance hemodialysis patients. Am J Kidney Dis 1994; 23: 394-400.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Pablo Rebollo
    • 1
    • 2
  • Francisco Ortega
    • 1
    • 2
  • Jose M. Baltar
    • 1
    • 2
  • Carmen Díaz-Corte
    • 1
    • 2
  • Rafael A Navascués
    • 1
    • 2
  • Manuel Naves
    • 1
    • 2
  • Ana Ureña
    • 1
    • 2
  • Xavier Badía
    • 3
  • Fernando Alvarez-Ude
    • 4
  • Jaime Alvarez-Grande
    • 1
    • 2
  1. 1.Servicio de Nefrología-I del Hospital Central de AsturiasSpain
  2. 2.Instituto “Reina Sofía” de Investigación NefrológicaSpain
  3. 3.Instituto de Salud Pública de CatalunyaSpain
  4. 4.Hospital General de SegoviaSpain

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