Introduction
Materials and methods
Patients and study design
Data collection
Kidney Disease Quality of Life-Short Form
Domains | Meaning | |
---|---|---|
Low | High | |
Symptom/problem list | Extremely bothered by dialysis-related symptoms such as muscle cramps, pruritus, anorexia, and/or access problems | Not at all bothered |
Effect of kidney disease on daily life | Extremely bothered by fluid and dietary restriction, by an inability to travel and dependency on doctors | Not at all bothered |
Burden of kidney disease | Extremely bothered by the time consumed by dialysis, its intrusiveness and degree burden on family | Not at all bothered |
Work status | Unemployed due to health | Employed, health not an issue |
Cognitive function | Affected all of the time by inability to concentrate, confused with poor reaction time | Not at all affected |
Quality of social interaction | Continual irritation and failure to get along with people with virtual isolation | No problem, socially interactive |
Sexual function | Experiencing severe problems with enjoyment and arousal | No problems |
Sleep | Very poor sleep with day time somnolence | No problem with sleep |
Social support | Very dissatisfied | Satisfied with level of social support |
Dialysis staff encouragement | High perceived encouragement and support | Low perceived encouragement and support |
Overall health | Rates health as worst possible | Rates health as best possible |
Patient satisfaction | Very poor | The best |
Data analysis
Results
Patient characteristics
Demographic
| |
Age (years) | 64 ± 14 |
Gender (% male) | 62 |
Caucasian (%) | 86 |
High educational statusa (%) | 24 |
Clinical parameters
| |
Dialysis vintage (years) | 1.9 (1.0–4.2) |
Dialysis frequency (%) | |
2× per week | 6 |
3× per week | 93 |
4× per week | 1 |
Session duration (hours) | 4.0 (3.5–4.0) |
spKt/V urea | 1.4 ± 0.2 |
eGFR (mL/min/1.73 m2)b
| 2.8 (1.2–5.2) |
Vascular access (% fistula) | 84 |
Body mass index (kg/m2), after dialysis | 25 ± 4 |
Systolic blood pressure (mmHg), before dialysis | 142 ± 20 |
Diastolic blood pressure (mmHg), before dialysis | 73 ± 11 |
Current smoker (%) | 21 |
Diabetes mellitus (%) | 20 |
History of cardiovascular disease (%) | 42 |
Hemoglobin (mmol/L) | 7.3 ± 0.8 |
Albumin (g/L) | 36 ± 5 |
Calcium (mmol/L) | 2.3 ± 0.2 |
Phosphate (mmol/L) | 1.6 ± 0.5 |
Dialysis center characteristics
Number of patients treated
| |
Total | 109 (85–155) |
On HD or HDF | 81 (64–125) |
Per dialysis shift | 20 (15–25) |
Per nurse | |
2–2.5 | 5 (21%) |
3–3.5 | 17 (71%) |
4–4.5 | 2 (8%) |
Setting
| |
General hospital | 18 (75%) |
University hospital | 4 (17%) |
Regional satellite unit | 2 (8%) |
Offered dialysis modalities
| |
Peritoneal dialysis | 23 (96%) |
Home dialysis | 14 (58%) |
Nocturnal dialysis | 13 (54%) |
FTE dialysis staff per 100 patients
| |
Nephrologist | 2.6 (2.1–3.2) |
Nurse | 30 (26–34) |
Social worker | 1.6 (1.3–1.8) |
Dietician | 0.9 (0.6–1.2) |
Patient–physician (assistant) contacts per month | |
2× | 3 (13%) |
4× | 18 (75%) |
>4× | 3 (13%) |
Availability of physical exercise during dialysis
| 20 (83%) |
Quality of life differences between dialysis centers
Score | P-value | |||
---|---|---|---|---|
Crude | Adjusted | |||
Case-mix | Case-mix + process variables | |||
Generic domains (SF-36)
| ||||
Physical component summary (PCS) | 40 ± 4 |
0.002
|
0.01
|
0.01
|
Mental component summary (MCS) | 51 ± 3 |
0.01
| 0.20 | 0.27 |
Kidney disease-specific domains
| ||||
Symptom/problem list | 80 ± 4 | 0.06 | 0.68 | 0.94 |
Effects of kidney disease on daily life | 73 ± 5 | 0.35 | 0.59 | 0.48 |
Burden of kidney disease | 47 ± 8 |
0.01
| 0.46 | 0.54 |
Work status | 0 (0–0) | 0.71 | 0.67 | 0.58 |
Cognitive function | 80 ± 6 |
0.01
| 0.11 | 0.19 |
Quality of social interaction | 83 ± 5 |
0.04
|
0.04
|
0.02
|
Sleep | 62 ± 7 |
0.08
| 0.20 | 0.42 |
Social support | 78 ± 7 | 0.44 | 0.33 | 0.18 |
Dialysis staff encouragement | 78 ± 7 |
<0.001
|
0.001
|
0.001
|
Overall health | 60 ± 4 |
0.04
| 0.98 | 0.76 |
Patient satisfaction | 70 ± 5 | 0.99 | 0.99 | 0.99 |
Center characteristics and quality of life
β | 95% CI |
P-value | |
---|---|---|---|
FTE dietician per 100 patients
| |||
Dialysis staff encouragement | 7.1 | 0.8 to 13.5 | 0.03 |
University hospital
| |||
Mental component summary (MCS) | −3.7 | −7.1 to −0.3 | 0.03 |
Effects of kidney disease on daily life | −7.0 | −11.4 to −2.6 | 0.002 |
Burden of kidney disease | −11.5 | −18.9 to −4.1 | 0.004 |
Cognitive function | −8.0 | −13.7 to −2.2 | 0.01 |
Quality of social interaction | −5.7 | −10.6 to −0.8 | 0.02 |
Social support | −8.0 | −14.0 to −2.0 | 0.01 |
Overall health | −5.1 | −9.5 to −0.7 | 0.03 |
Satellite unit
| |||
Physical component summary (PCS) | 8.4 | 2.3 to 14.6 | 0.01 |
Symptom/problem list | 8.9 | 1.9 to 15.8 | 0.01 |
Effects of kidney disease on daily life | 9.3 | 1.0 to 17.7 | 0.03 |
Burden of kidney disease | 15.1 | 1.6 to 28.6 | 0.03 |
Sleep | 11.1 | 1.6 to 20.7 | 0.02 |