ESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity

doi:10.1016/S0272-6386(03)00907-7

American Journal of Kidney Diseases

Volume 42, Issue 4, October 2003, Pages 713-721

https://doi.org/10.1016/S0272-6386(03)00907-7 Get rights and content

Abstract

Background:

Recent research suggests that patients’ perceptions may be more important than objective clinical assessments in determining quality of life (QOL) for patients with end-stage renal disease (ESRD).

Methods:

We interviewed 165 hemodialysis patients from 3 sites using a QOL questionnaire that included the Satisfaction With Life Scale (SWLS) and the McGill QOL (MQOL) scale, which includes a single-item global measure of QOL (Single-Item QOL Scale [SIS]). The MQOL scale asks patients to report their most troublesome symptoms. We also initiated the use of a Support Network Scale and a Spiritual Beliefs Scale.

Results:

Mean patient age was 60.9 years, 52% were men, 63% were white, and 33% were African American. Patients had a mean treatment time for ESRD of 44 months, mean hemoglobin level of 11.8 g/dL (118 g/L), mean albumin level of 3.7 g/dL (37 g/L), and mean Kt/V of 1.6. Forty-five percent of patients reported symptoms. Pain was the most common symptom (21% of patients). There was an inverse relationship between reported number of symptoms and SWLS (P < 0.01), MQOL scale score (P < 0.001), and SIS (P < 0.001). The Spiritual Beliefs Scale correlated with the MQOL scale score, SWLS (both P < 0.01), and SIS (P < 0.05). The Support Network Scale score correlated with the MQOL Existential (P = 0.01) and MQOL Support (P < 0.01) subscales. No clinical parameter correlated with any measure of QOL, spiritual beliefs, or social support.

Conclusion:

Symptoms, especially pain, along with psychosocial and spiritual factors, are important determinants of QOL of patients with ESRD. Additional studies, particularly a longitudinal trial, are needed to determine the reproducibility and utility of these QOL measures in assessing patient long-term outcome and their association with other QOL indices in larger and more diverse patient populations.

Section snippets

Patient population and demographics of the study hemodialysis units

Sites for data collection were BMA-Westover, Morgantown, West Virginia (WV); the Gambro-George Washington University Medical Center (GWUMC) N Street Dialysis Unit, Washington DC; and the Dialysis Center, Winthrop University Hospital, Mineola, NY (WUH). Patient populations at WV and WUH were composed primarily of white patients, and at GWUMC, of African-American patients. Planned recruitment was a minimum of 50 patients from each site.

Recruitment techniques

All patients enrolled in long-term ESRD hemodialysis programs

Demographic and clinical results

One hundred sixty-five of 190 consecutive patients were interviewed, yielding a response rate of 86.8%. Nineteen patients refused, and 6 patients were too sick to participate. Approximately one third of patients were recruited from each study site. The demographics of the study sample are listed in Table 1. The distribution of sex and ethnicity in the study population is similar to that of the US hemodialysis population. Interviews took a mean of 17.6 minutes (range, 5 to 60 minutes).

There

Discussion

More than a quarter of patients surveyed rated their QOL below the scale midpoint on the SIS. We know of few studies that used a similar assessment in patients with ESRD. Steele et al18 used a 1-sentence scale (scored from 1 to 10) in patients treated with peritoneal dialysis and showed correlations with other QOL measures, as we did in the present study. Preliminary studies from the same group, using their 1-sentence scale, yielded a mean score of 6.4 in 12 hemodialysis patients, similar to

Acknowledgements

The authors thank John E. Leggat, Jr, MD, Susan Pfettscher, DNSc, RN, and Melanie Merriman, PhD, for their help in research design and Ahsan Qureshi, MD, Viral Shah, MD, and Theresa Danko for their assistance in data collection.

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: Supported in part by the Promoting Excellence in End-of-Life Care program from the Robert Wood Johnson Foundation.

View full text

Original investigation: dialysis therapyESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity

Abstract

Background:

Methods:

Results:

Conclusion:

Section snippets

Patient population and demographics of the study hemodialysis units

Recruitment techniques

Demographic and clinical results

Discussion

Acknowledgements

Kidney Int Suppl

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Kidney Int

Am J Kidney Dis

Kidney Int

Am J Kidney Dis

Kidney Int

The MOS 36-Item Short-Form Health Survey (SF-36)

Med Care

Development of the Kidney Disease Quality of Life (KDQOL) instrument

Qual Life Res

Aspects quality of life in hemodialysis patients

J Am Soc Nephrol

Factors considered important at the end of life by patients, family, physicians, and other care providers

JAMA

A critical appraisal of quality of life measurements

JAMA

How should quality of life be measured?

J Invest Med

The Satisfaction With Life Scale

J Pers Assess

Original investigation: dialysis therapy
ESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity