Racial differences in health-related quality of life among hemodialysis patients

BACKGROUND; Despite technical progress in therapy, hemodialysis patients continue to report health-related quality of life (HRQOL) substantially lower than that of the general population. While African Americans with end-stage renal disease (ESRD) survive longer than members of other races, few studies have compared the HRQOL of African Americans with that of non-African Americans. METHODS: We examined differences in sociodemographic, clinical, and HRQOL variables by race. A multiple regression model assessed the extent to which race was associated with differences in HRQOL scores after adjustment for sociodemographic and clinical variables. Racial differences in the relationship between comorbid disease severity and HRQOL were explored. RESULTS; In adjusted models, African Americans had higher scores in the Index of Well-Being and burden of kidney disease, but lower scores in cognitive function (all P < 0.05). For scales reflecting symptoms and effects of kidney disease, sleep quality, and the Physical Component Summary, the fall in HRQOL with increasing comorbidity was significantly greater in non-African Americans (all P < 0.05). After adjustment, there were no racial differences in scores on the Mental Component Summary, social support, dialysis staff encouragement, or patient satisfaction. CONCLUSION: To our knowledge, ESRD is the only chronic illness for which African Americans report significantly better psychologic well being and a lower burden of disease than non-African Americans. Further research is needed to understand whether these experiences affect health care utilization, medical decision making, and patient survival. Clarification of the reasons for race differences may suggest measures to improve HRQOL for all patients with ESRD.     

Effects of low dialysate calcium concentration on health-related quality of life in hemodialysis patients

Background A dialysate calcium concentration of 2.5 meq/l (1.25 mmol/l) is currently recommended, but there are not enough studies to examine the effects of this calcium concentration on clinical outcomes. We explored the effects of this calcium concentration on health-related quality of life (HRQOL) in hemodialysis patients.Methods The dialysate calcium concentration was lowered from 3.0 meq/l to 2.5 meq/l in 78 hemodialysis patients. The Medical Outcomes Study (MOS) Short Form 36 (SF-36) norm-based scores, the doses of recombinant human erythropoietin (rHuEpo), and the serum levels of corrected calcium, phosphorus, intact parathyroid hormone (i-PTH), and hemoglobin were compared at baseline and 8 months after the change of dialysate calcium concentration.Results Seventy-three patients completed the study. Mean changes in SF-36 scores were: physical functioning, −2.4; role physical, −3.9; bodily pain, −3.4; general health perception, −1.5; vitality, −2.2; social functioning, −1.9; role emotional, −2.0; mental health, −2.0. The declines of scores for role physical and bodily pain were significant. Serum i-PTH levels increased significantly, from 212 pg/ml to 278 pg/ml, while the doses of rHuEpo and serum levels of corrected calcium, phosphorus, and hemoglobin did not change significantly.Conclusions A dialysate calcium concentration of 2.5 meq/l was not shown to have positive effects on HRQOL.     

Differences of prognosis in hemodialysis patients with different quality of life

Objective To compare the one-year survival rates of maintenance hemodialysis (HD) patients with different quality of life, and analyze related factors affecting the prognosis of patients. Methods Patients on hemodialysis for at least 3 months were enrolled. A short form 36 health survey questionnaire (SF-36) and Pittsburgh sleep quality index (PSQI) were used to evaluate the quality of life and quality of sleep. To observe one-year all-cause mortality and Cox regression model was used to analyze the factors associated with survival outcomes. Results A total of 159 patients undergoing hemodialysis were included, in which 136 patients completed the follow-up after one - year observation. The one - year survival rate in patients with both high physical component summary (PCS) and mental component summary (MCS) scores was significantly better than the patients with low PCS and MCS scores (P ﹤ 0.05). PCS, hemoglobin and serum albumin were the protection factors for HD patients. Conclusions Quality of life is strongly associated with prognosis in HD patients. Enhancing quality of life is of clinical significance in the improvement of HD patients' survival rate.     

Effects of home hemodialysis on health-related quality of life measures

In recent years, there has been an increased interest in performing hemodialysis (HD) more frequently than thrice weekly, particularly in the home setting. This interest has been stimulated by some studies that have indicated significant benefits to performing more frequent HD on various medical and quality of life outcome measures. However, only a few studies using varying quality of life instruments have critically examined the impact of frequent HD on the quality of life of patients. Although not consistent across studies, results suggest a positive impact of more frequent HD on patients' quality of life. It is hoped that the results of two landmark studies, now in progress (the Frequent Hemodialysis Network trial and the FREEDOM study), will provide more insight into the impact of more frequent HD on quality of life.     

Restless legs syndrome in hemodialysis patients: health-related quality of life and laboratory data analysis

AIMS: To compare clinical data, sleep quality and health-related quality of life (HRQOL) with and without RLS in HD patients. MATERIALS AND METHODS: The international RLS study group diagnosis questionnaire was completed by 228 HD patients. The Pittsburg Sleep Quality Index (PSQI) for the evaluation of sleep quality and the Kidney Disease Quality of Life (KDQOL-SF) for the analysis of HRQOL were also used. RESULTS: 53 (23%) patients were diagnosed as RLS. Age and age at the initiation of HD were significantly younger in the RLS group. Serum calcium concentration (Ca) was significantly higher in the RLS group. Sleep quality evaluated by PSQI was significantly lower in the RLS group. In SF-36 domains of KDQOL-SF, bodily pain, general health perceptions, vitality, role functioning emotional, mental health and mental component score were significantly lower in the RLS group. In kidney targeted scales of KDQOL-SF, symptoms/problems, burden of kidney disease, cognitive function, quality of social interaction, sleep and patient satisfaction were significantly lower in the RLS group. CONCLUSION: High Ca was possibly connected to the pathophysiology of RLS which impaired sleep quality as well as HRQOL including mental health and many kidney disease related scales.     

Correlation between quality of life and mineral metabolism in maintenance hemodialysis patients

Objective With multi-center investigation, to assess the life quality of patients with maintained hemodialysis (MHD) in Liaoning Province and to explore the relationship among the mineral metabolism, the life quality of the patients with MHD, and the repeated hospitalization within the latest three years. Methods 1192 patients with hemodialysis (at least 3 months) from January to March in 2015 at ten blood purification centers in Liaoning Province were selected for the cross - sectional survey. The Kidney Health-related Quality of Life (HRQOL) version 1.3 was used to evaluate the MHD patients' life quality. The total length of hospitalization was divided into four groups: 0 days, 3 to 15 days, 16 to 30 days and above 30 days. Results When serum calcium value ranged from 2.1 to 2.5 mmol/L, kidney - disease component summary (KDCS), mental component summary (MCS), physical component summary (PCS) and SF-36+KDCS corresponded to a higher value (P＜0.05). When serum phosphorus value ranged from 1.13 to 1.78 mmol/L, KDCS and SF-36+KDCS corresponded to a higher value (P＜0.05). When the calcium phosphorus product value ranged from 40.68 to 49.94, MCS corresponded to a higher value (P＜0.05). KDCS showed a linear correlation with age (P＜0.001), dialysis age, serum calcium (less than or equal to 2.5 mmol/L) (P＜0.05); PCS showed a linear correlation with age (P＜0.001) and dialysis age (P＜0.05); SF-36+KDCS showed a linear correlation with age (P＜0.001), and serum calcium (less than or equal to 2.5 mmol/L) (P＜0.05), while age and dialysis age were negatively correlated. The hospitalization days showed a linear correlation with age, dialysis age (P＜0.001) and serum phosphorus, calcium phosphorus product value (P＜0.05), while dialysis age and calcium phosphorus product value were negatively correlated. Among different groups of total hospitalization days in three years, age, hemodialysis age, serum calcium, serum phosphorus, calcium-phosphorus product value and quality of life values were all statistically significant (P＜0.05). Conclusions The life quality of patients with MHD were correlated with serum calcium, phosphorus, calcium and phosphorus product value, iPTH, dialysis age and age, while age and dialysis age were of negative correlation. The total number of hospitalization days in 3 years was closely linearly correlated with age and dialysis age, significantly correlated with serum phosphorus, calcium and phosphorus product value, while dialysis age, calcium and phosphorus product value were in a negative correlation. The total number of hospitalization in 3 years was correlated with the patients' age, dialysis age, serum calcium, serum phosphorus, calcium and phosphorus product value and quality of life.     

At-home short daily hemodialysis improves the long-term health-related quality of life

Patients with chronic kidney disease treated by in-center conventional hemodialysis (3 times per week) have significant impairments in health-related quality of life measures, which have been associated with increased morbidity and mortality. FREEDOM is an ongoing prospective cohort study measuring the potential benefits of at-home short daily (6 times per week) hemodialysis. In this interim report we examine the long-term effect of short daily hemodialysis on health-related quality of life, as measured by the SF-36 health survey. This was administered at baseline, 4 and 12 months after initiation of short daily hemodialysis to 291 participants (total cohort), of which 154 completed the 12-month follow-up (as-treated cohort). At the time of analysis, the mean age was 53 years, 66% were men, 58% had an AV fistula, 90% transitioned from in-center hemodialysis, and 45% had diabetes mellitus. In the total cohort analysis, both the physical- and mental-component summary scores improved over the 12-month period, as did all 8 individual domains of the SF-36. The as-treated cohort analysis showed similar improvements with the exception of the role-emotional domain. Significantly, in the as-treated cohort, the percentage of patients achieving a physical-component summary score at least equivalent to the general population more than doubled. Hence, at-home short daily hemodialysis is associated with long-term improvements in various physical and mental health-related quality of life measures.     

A study of the association of higher parathormone levels with health-related quality of life in hemodialysis patients

Secondary hyperparathyroidism (SHPT) is associated with poor outcome including mortality, hospitalization, as well as greater healthcare resource utilization and costs in chronic kidney disease (CKD). We hypothesized that SHPT is also associated with poor self reported health-related quality of life (HRQOL) in prevalent hemodialysis (HD) patients. We conducted a case-control study in patients with CKD receiving longterm HD treatment, in six dialysis clinics in Greece. HRQOL was estimated with the KDQOL-SFTM questionnaire, version 1.3, which includes 43 kidney disease targeted items, and 36 items that provide a generic core and an overall health rating item, with a higher score reflecting a more favorable health state. A total of 156 completed the questionnaire, 50 with high parathormone levels (i.e., PTH > 300 pg/ml and or under vitamin D receptor activators, mean: 329 ± 160.9 pg/ml) and 106 with low parathormone levels (PTH < 300 pg/ml, mean: 132.4 ± 69.0 pg/ml) in a 2 : 1 randomization assignment. Patients with high and with low PTH were 62.1 ± 14.9 and 65.9 ± 14.2 y old and the median dialysis vintage time was 31 and 37 months, respectively. There were no significant differences regarding the presence of comorbidities between groups. Patients with high PTH, compared to patients with low PTH, had lower pain component summary (57.6 ± 33.5 vs. 69.2 ± 28.9; p = 0.041) and physical component summary (41.0 ± 23.8 vs. 50.0 ± 20.8; p = 0.031). Both pain component summary and physical component summary differences remained significant after adjustment for age, gender and vintage (p = 0.036 and p = 0.029, respectively). Low PTH patients scored better in 18 out of 23 subscales. In HD patients, SHPT appears to be associated with worse pain component summary score (p = 0.036) and physical component summary score (p = 0.029). Additional studies are needed to verify these associations and to examine whether correction of SHPT can improve HRQOL.     

Analysis of the influencing factors on the quality of life of the elderly hemodialysis patients

International Urology and Nephrology - The present study aims to identify factors affecting quality of life in elderly patients undergoing maintenance hemodialysis (MHD). A total of 656 patients...     

Effects of hemodialysis dose and membrane flux on health-related quality of life in the HEMO Study

BACKGROUND: It has been widely supposed that high dose and high flux hemodialysis would affect the quality as well as the length of life of patients treated by maintenance hemodialysis. The HEMO Study examined changes in health-related quality of life as a secondary study outcome. Specific hypotheses were that study interventions would affect physical functioning, vitality, Short Form-36 Health Survey (SF-36) physical and mental component summary scores, symptoms and problems associated with kidney disease, and sleep quality. METHODS: At baseline and annually, subjects responded to both the Index of Well-Being and the Kidney Disease Quality of Life-Long Form questionnaires. The interventions were assessed on the basis of their average effects over 3 years. RESULTS: At baseline, the SF-36 physical component summary score was lower than in healthy populations, but the mental component score was nearly normal. Over 3-year follow-up, physical health continued to decline; mental health and kidney disease-targeted scores remained relatively stable. The high dose hemodialysis intervention was associated with significantly less pain (4.49 points, P < 0.001) and higher physical component scores (1.23 points P= 0.007), but these effects were small compared to the natural variability in scores. High flux membranes were not associated with statistically significant differences in health-related quality of life. CONCLUSION: The HEMO Study results demonstrate the marked burden of chronic kidney failure and hemodialysis treatment on daily life. In this trial among patients undergoing maintenance three times a week hemodialysis, the SF-36 physical component summary score and pain scale showed significant but very small clinical effects favoring the higher dialysis dose. No clinically meaningful benefits or either the dose or flux interventions were observed for other indices of health-related quality of life.     

The health-related quality of life and cost implications of falls in elderly women

Summary  Fractures and falls are serious cause of morbidity and cost to society. Our results suggest that the main burden to morbidity, measured as impact on health-related quality of life, is due to fear of falling rather than falls or their sequelae, such as fractures. Introduction  Fractures and falls are serious cause of morbidity and cost to society. We investigated the impact on health-related quality of life (HRQoL) associated with falls, fractures and fear of falling and falls and fractures cost. Methods  Three datasets providing longitudinal data on fear of falling, HRQoL and a common set of baseline risk factors for fracture (smoking status, weight and age) were analysed. Multilevel random effects models were used to estimate the long-term impact on HRQoL associated with falls, fractures and fear of falling. Healthcare resource use primary data were collected to estimate falls and fractures cost. Results  Older, low weight and smoking women reported lower HRQoL. The impact on HRQoL of a fracture was at least twice as large as that associated with falls. The largest negative effect on HRQoL was associated with self-reported fear of falling. The cost of falls was ￡1088. Similarly, the cost of falls leading to a fracture was ￡15,133, ￡2,753, ￡1,863, ￡1,331 and ￡3,498 for hip, wrist, arm, vertebral and other fractures, respectively. Discussion  The main burden to morbidity is due to fear of falling. Interventions aimed at reducing fear of falling may produce larger gains in HRQoL.     

The associations of hemodialysis access type and access satisfaction with health-related quality of life

Objective

In addition to age and comorbidities, health-related quality of life (HRQOL) is known to predict mortality in hemodialysis (HD) patients. Understanding the association of vascular access type with HRQOL can help surgeons to provide patient-centered dialysis access recommendations. We sought to understand the impact of HD access type on HRQOL.

健康教育对长期血液透析患者生活质量的影响

目的:探讨长期血液透析患者生活质量的提高.方法:对2008年1月-2009年6月进行血液透析的65例患者进行健康教育.结果:本组65例患者均由住院转为门诊透析,回家后除生活自理外,还能做力所能及的工作.结论:健康教育使长期血液透析患者的生活质量提高,增强战胜疾病的信心,延长其生命,同时密切了护患关系.     

电子健康素养与社会支持在老年慢性病患者抑郁和生活质量间的中介作用

目的 探讨电子健康素养与社会支持在老年慢性病患者抑郁和健康相关生活质量间的链式中介作用,为制定针对性干预措施提升患者的健康相关生活质量做参考。方法 多阶段分层整群抽取1 545例老年慢性病患者为研究对象,采用一般资料调查表、电子健康素养量表、医院焦虑抑郁量表、社会支持评定量表和欧洲五维健康量表进行调查。结果 老年慢性病患者抑郁评分为9(8,11)分,健康相关生活质量为0.784(0.533,0.897)分。老年慢性病患者抑郁与电子健康素养、社会支持和健康相关生活质量呈负相关（均P<0.05）。经中介效应检验,电子健康素养与社会支持在抑郁与健康相关生活质量中起链式中介作用,中介效应占总效应的15.6%。结论 抑郁不仅直接影响老年慢性病患者的健康相关生活质量,还可通过电子健康素养和社会支持的中介作用间接预测健康相关生活质量。     

长程血液透析对维持性血液透析患者生活质量的影响

目的 研究长程血液透析(LSHD)对维持性血液透析(MHD)患者生活质量的影响.方法 选取首都医科大学附属北京友谊医院血液净化中心40例MHD患者,通过问卷调查和收集临床资料相结合的方法,进行前瞻性配对临床研究.根据临床资料、检验指标、睡眠质量将患者配对分组为普通透析(HD)组和LSHD组,各20例,进行6个月的临床试验,观察两组患者临床表现、生化指标及生活质量的情况.结果 LSHD组的Kt/V(1.73±0.36比1.41±0.23,P＜0.05)、血红蛋白[(124.67±9.08)比(110.55±9.01) g/L,P＜0.01]、血清白蛋白[(45.01±2.66)比(39.28±2.63) g/L,P＜0.01]显著高于HD组 ;血压控制比例(14/20比5/20,P=0.010)和睡眠质量(16/20比5/20,P=0.001)显著优于HD组 ;生活质量SF-36评分显著高于HD组(P＜0.05),差异均有统计学意义.结论 长程透析可以改善MHD患者睡眠质量、营养状况,从而改善生活质量.