Quality of life in end-stage renal disease patients

doi:10.1053/ajkd.2001.26824

American Journal of Kidney Diseases

Volume 38, Issue 3, September 2001, Pages 443-464

https://doi.org/10.1053/ajkd.2001.26824 Get rights and content

Abstract

Health-related quality of life (QOL) refers to the measure of a patient's functioning, well-being, and general health perception in each of three domains: physical, psychological, and social. Along with survival and other types of clinical outcomes, patient QOL is an important indicator of the effectiveness of the medical care they receive. QOL of patients with end-stage renal disease is influenced by the disease itself and by the type of replacement therapy. Numerous studies have identified the effect of such factors as anemia, age, comorbidity, and depression on QOL. Most of these factors appear during the predialysis period, and the adequate management of some of them could influence patient outcomes. Among replacement therapies, transplantation appears to give the best QOL for large groups of patients. No conclusive data exist to prove differences in QOL between hemodialysis patients and peritoneal dialysis patients. In the case of elderly patients or those with a high degree of comorbidity, the best treatment option should be assessed in each individual case, taking all possible factors into account. Finally, it has been proven that physical and mental function are inversely correlated with the risk for hospitalization and mortality. © 2001 by the National Kidney Foundation, Inc.

Section snippets

Measurement of QOL

Translating the various aspects and components of QOL into quantitative values is a complex task. It implies the need to evaluate multiple dimensions, with multi-item assessment of each dimension.¹¹ A consequence of this complexity is that a great number of measurement instruments have been developed in the past few years within a rapidly developing science of health-care evaluation, psychometric and sociometric research. Physicians learn more systematically and objectively through such

QOL in ESRD

As renal insufficiency progresses, patients may experience symptoms that affect their daily lives. In more advanced phases when ESRD has been reached, the impact of the illness on functional state and health-related QOL as perceived by the patient is considerable. Such renal replacement therapies as hemodialysis and peritoneal dialysis only partially correct the symptoms experienced by the patient and provoke additional changes in the patient's lifestyle. These changes then can affect QOL. More

QOL as a factor in predicting morbidity and mortality

Lower levels of social support, decreased behavioral compliance with the dialysis prescription, and increased negative perception of the effects of illness were independently associated with increased mortality in 295 hemodialysis patients (266 black patients).¹²¹ The study by DeOreo¹⁴ of 1,000 dialysis patients measuring QOL using the SF-36 showed that functional status was as important in predicting mortality and hospitalization as Kt/V and PCR. With each five-point increase in physical

Renal transplantation and QOL

There is a broad consensus among health professionals and patients regarding the positive effect of a functioning transplant on QOL.11, 39 Renal transplant patients showed better QOL measured by various instruments than patients treated with different dialysis techniques. In some dimensions of QOL, results obtained in transplant recipients were similar to those obtained in the general population.39, 50, 117, 123 Transplantation is the treatment that most resembles normal renal function and

Conclusion

In evaluating outcomes in patients with ESRD, QOL assessment becomes as important as morbidity and mortality. Although specific tests for dialysis patients have been developed, generic questionnaires may be useful. Different factors have been associated with the health-related QOL perceived by the patient. Some of these are dependent on the patient (age, associated diseases [including diabetes], female sex, depression, nutrition), and others depend on the disease (lower GFR, late nephrology

Acknowledgements

The authors gratefully acknowledge the centers participating in the Spanish Study Group of Quality of Life in Chronic Renal Failure.

References (163)

NG Kutner
Assessing end-stage renal disease patient's functioning and well-being: Measurement approaches and implications for clinical practice
Am J Kidney Dis
(1994)
PL Kimmel
Just whose quality of life is it anyway? Controversies and consistencies in measurements of quality of life
Kidney Int
(2000)
RA Rettig et al.
Assessing health and quality of life outcomes in dialysis: A report on an Institute of Medicine Workshop
Am J Kidney Dis
(1997)
ET Edgell et al.
A review of health-related quality of life measures used in end-stage renal disease
Clin Ther
(1996)
KA Cagney et al.
Formal literature review of quality-of-life instruments used in end-stage renal disease
Am J Kidney Dis
(2000)
PB DeOreo
Hemodialysis patients assessed functional health status predicts continued survival, hospitalization and dialysis-attendance compliance
Am J Kidney Dis
(1997)
G Guyatt et al.
Measuring change over time: Assessing the usefulness of evaluative instruments
J Chronic Dis
(1987)
G Bravo et al.
Estimating the reliability of continuous measures with Cronbach's alpha or the intraclass correlation coefficient: Toward the integration of two traditions
J Clin Epidemiol
(1991)
B Kirshner et al.
A methodologic framework for assessing health indices
J Chronic Dis
(1985)
GH Guyatt et al.
Responsiveness and validity in health status measurements: A clarification
J Clin Epidemiol
(1989)

MR Tuley et al.

Estimating and testing an index of responsiveness and the relationship of the index to power

J Clin Epidemiol

(1991)

MR Avram et al.

Hemodialysis and the elderly patient: Potential advantages as to quality of life, urea generation, serum creatinine, and less interdialytic weight gain

Am J Kidney Dis

(1990)

RA Rettig et al.

Measuring, managing and improving quality in the end-stage renal disease treatment setting

Am J Kidney Dis

(1994)

NG Kutner et al.

Continued survival of older hemodialysis patients: Investigation of psychosocial predictors

Am J Kidney Dis

(1994)

R Jofre et al.

Quality of life for patient groups

Kidney Int

(2000)

JL Welch et al.

Quality of life in black hemodialysis patients

Adv Ren Replace Ther

(1999)

LE Harris et al.

Clinical correlation of functional status in patients with chronic renal insufficiency

Am J Kidney Dis

(1993)

F Valderrábano

Erythropoietin in chronic renal failure

Kidney Int

(1996)

DA Revicki et al.

Health-related quality of life associated with rHu-EPO therapy for predialysis chronic renal disease patients

Am J Kidney Dis

(1995)

MV Rocco et al.

Cross-sectional study of quality of life and symptoms in chronic renal disease patients. The Modification of Diet in Renal Disease Study

Am J Kidney Dis

(1997)

NR Shidler et al.

Quality of life and psychosocial relationships in patients with chronic renal insufficiency

Am J Kidney Dis

(1998)

RG Simmons et al.

Quality-of-life issues for end-stage renal disease patients

Am J Kidney Dis

(1990)

R Jofre et al.

Changes in quality of life after renal transplantation

Am J Kidney Dis

(1998)

JL Holley et al.

An analysis of factors affecting employment of chronic dialysis patients

Am J Kidney Dis

(1994)

D Patrick et al.

Health Status and Health Policy. Quality of Life in Health Care Evaluation and Resource Allocation

MA Testa et al.

Methods for quality of life studies

Annu Rev Public Health

(1994)

TM Gill et al.

A critical appraisal of the quality of quality of life measurements

JAMA

(1994)

G Apolone et al.

Review of the concept of quality of life assessment and discussion of the present trend in clinical research

Nephrol Dial Transplant

(1998)

RD Hays et al.

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

Qual Life Res

(1994)

R Gokal

Quality of life in patients undergoing renal replacement therapy

Kidney Int

(1993)

FM Lord

Applications of Item Response Theory to Practical Testing Problems

(1980)

DH Feeny et al.

Incorporating utility-based quality of life assessment measures in clinical trials: Two examples

Med Care

(1989)

RA Peterson et al.

Depression, perception of illness and mortality in patients with end-stage renal disease

Int J Psychiatry Med

(1991)

PL Kimmel et al.

Survival in hemodialysis patients: The role of depression

J Am Soc Nephrol

(1993)

PL Kimmel et al.

Aspects of quality of life in hemodialysis patients

J Am Soc Nephrol

(1995)

PL Kimmel et al.

Behavioral compliance with dialysis prescription in hemodialysis patients

J Am Soc Nephrol

(1995)

O Ifudu et al.

Predictive value of functional status for mortality in patients on maintenance hemodialysis

Am J Nephrol

(1998)

W McClellan et al.

Functional status and quality of life predictors of early mortality among patients entering treatment for end stage renal disease

J Clin Epidemiol

(1991)

MA Testa et al.

Current concepts: Assessment of quality-of-life outcomes

N Engl J Med

(1996)

IB Wilson et al.

Linking clinical variables with health-related quality of life

JAMA

(1995)

J Tsevat et al.

Using health-related quality of life information: Clinical encounters, clinical trials and health policy

J Gen Intern Med

(1994)

MA Testa et al.

Quality of life and antihypertensive therapy in men. A comparison of captopril and enalapril

N Engl J Med

(1993)

X Badia et al.

Adaptación de una medida de la disfunción relacionada con la enfermedad: la versión española del Sickness Impact Profile

Med Clin (Barc)

(1994)

DN Churchill

Psychosocial adaptation of dialysis patients

GH Guyatt et al.

Measuring health-related quality of life

Ann Intern Med

(1993)

DL Patrick et al.

Generic and disease-specific measures in assessing health status and quality of life

Med Care

(1989)

A Lapaucis et al.

A disease-specific questionnaire for assessing quality of life in patients on hemodialysis

Nephron

(1992)

MA Dew et al.

The advantage of multiple measures of quality of life

Scan J Urol Nephrol

(1990)

G Mingardi

From the development to the clinical application of a questionnaire on the quality of life in dialysis. The experience of the Italian Collaborative DIA-QOL Group

Nephrol Dial Transplant

(1998)

DA Karnofsky et al.

The clinical evaluation of chemotherapeutic agents in cancer

Cited by (402)

The impact of induction therapy in low-immunological risk kidney transplant recipients regardless of HLA matching
2023, Transplant Immunology
Induction agents have proved to reduce the rate of acute rejection (AR) in kidney transplant recipients (KTRs) without improving long-term graft and patient survival (PS).
This study evaluates the utility of induction therapy in low immunological risk KTRs regardless of donor-to-recipient HLA matching.
We retrospectively reviewed the records of 218 patients undergoing kidney transplantation (KT). These patients were divided into two groups according to the usage of induction therapy: 82 did not receive any induction therapy (Group I), and 136 patients received either Anti-IL2 receptor antibodies or anti-thymocyte globulin (Group II). All patients had panel reactive antibody (PRA) < 20% and absence of donor-specific antibodies (DSA). The difference in outcomes were assessed at different intervals following KT.
The rate of bacterial infections at one year (p-value = 0.032) and the frequency of CMV disease (p-value = 0.044) were significantly higher in Group II (with induction therapy). The duration of hospital stay, the rate and severity of acute rejection, the occurrence of delayed graft function, the rate and type of surgical complications at one year, and the graft function and survival at one and three years were similar between the two groups (p-value = NS). In addition, the financial burden is much less in Group I (without induction therapy), reducing the total cost of the transplant procedure.
We conclude that induction therapy in low-immunological risk kidney transplant patients is not a must regardless of donor-to-recipient HLA matching. Therefore, induction therapy did not yield significant health results, but had negative financial consequences.
Factors associated with quality of life and its prediction in renal patients undergoing haemodialysis treatment
2022, Nefrologia
El presente estudio tiene como objetivo analizar los niveles de calidad de vida relacionada con la salud (CVRS) de los pacientes con enfermedad renal crónica avanzada (ERCA) en hemodiálisis y conocer las variables demográficas, médicas y psicológicas que se asocian con la CVRS y contribuyen a predecirla.
Estudio transversal con 302 pacientes con ERCA en tratamiento de hemodiálisis. Se evaluaron las siguientes variables: 1) CVRS (cuestionario Shorter Form Health Survey Questionnaire); 2) Ansiedad y depresión (Escala de ansiedad y depresión de Goldberg); 3) Datos sociodemográficos, y 4) Datos médicos. Se realizaron análisis correlacionales, comparación de medias y análisis de vías con variables latentes (PALV).
El PALV mostró que el 42% de la varianza en la CVRS podría explicarse por las variables evaluadas (χ² / df = 2,10; GFI = 0,938; IFI = 0,920; CFI = 0,918; RMSEA = 0,062; SRMR = 0,056). La depresión fue el predictor más fuerte de la CVRS (-,71; p = 0,002), seguida de la actividad física (-,19; p = 0,044). La edad (-,122; p = 0,034) y la comorbilidad (-,206; p = 0,001) se asociaron débilmente con la CVRS física. La práctica de una actividad física regular está relacionado con la CVRS física (r = 0,21; p = 0,00) y mental (r = 0,12; p = 0,028).
Un alto porcentaje de la varianza en CVRS se explica por los niveles de depresión y actividad física. Las intervenciones para promover la CVRS en pacientes con ERCA deben centrarse en promover la actividad física y cuidar la salud mental del paciente.
The present study aims to analyze the levels of health-related quality of life (HRQL) in patients with end-stage kidney disease (ESKD) in haemodialysis, and to explore what demographic, medical and psychological variables are associated with HRQL and contribute to its prediction.
Cross-sectional study with 302 patients with advanced chronic kidney disease (ACKD) on haemodialysis. They were assessed: (1) HRQoL (Shorter Form Health Survey Questionnaire); (2) Anxiety and depression (Goldberg Anxiety and Depression Scale); (3) Sociodemographic data and (4) Medical data. Correlational analyses, means comparison and path analyses with latent variables (PALV) were conducted.
The PALV showed that 42% of the variance in the HRQL could be explained by the variables evaluated (χ²/df = 2.10; GFI = .938; IFI = .920; CFI = .918; RMSEA = .062; SRMR = .056). Depression was the strongest predictor of HRQL (−.71; p = .002), followed by physical activity (−.19; p = .044). Age (−.122; p = .034) and comorbidity (−.206; p = .001) were weakly associated with physical HRQL. The practice of regular physical activity is related to the physical HRQoL (r = .21; p = .00) and mental (r = .12; p = .028).
A high percentage of the variance in HRQoL is explained by the levels of depression and physical activity. Interventions to promote HRQoL in patients with ESKD should focus in promoting physical activity and taking care of patient's mental health.
Factors associated with quality of life and its prediction in kidney patients on haemodialysis
2022, Nefrologia
The present study aims to analyze the levels of health-related quality of life (HRQoL) in patients with end-stage kidney disease (ESKD) in haemodialysis, and to explore what demographic, medical and psychological variables are associated with HRQL and contribute to its prediction.
Cross-sectional study with 302 patients with ACKD on haemodialysis. They were assessed: (1) HRQoL (Shorter Form Health Survey Questionnaire); (2) Anxiety and depression (Goldberg Anxiety and Depression Scale); (3) Sociodemographic data and (4) Medical data. Correlational analyses, means comparison and a path analyses with latent variables (PALV) were conducted.
The PALV showed that 42% of the variance in the HRQL could be explained by the variables evaluated (χ²/df = 2.10; GFI = .938; IFI = .920; CFI = .918; RMSEA = .062; SRMR = .056). Depression was the strongest predictor of HRQL (−.71; p =.002), followed by physical activity (−.19; p = .044). Age (−.122; p = .034) and comorbidity (−.206; p = .001) were weakly associated with physical HRQL. The practice of regular physical activity is related to the physical HRQoL (r = .21; p = .00) and mental (r = .12; p = .028).
A high percentage of the variance in HRQoL is explained by the levels of depression and physical activity. Interventions to promote HRQoL in patients with ESKD should focus in promoting physical activity and taking care of patient’s mental health.
El presente estudio tiene como objetivo analizar los niveles de calidad de vida relacionada con la salud (CVRS) de los pacientes con enfermedad renal crónica avanzada (ERCA) en hemodiálisis y conocer qué variables demográficas, médicas y psicológicas se asocian con la CVRS y contribuyen a predecirla.
Estudio transversal con 302 pacientes con ERCA en tratamiento de hemodiálisis. Se evaluaron las siguientes variables: 1) CVRS (cuestionario Shorter Form Health Survey Questionnaire); 2) Ansiedad y depresión (Escala de ansiedad y depresión de Goldberg) 3) Datos sociodemográficos y 4) Datos médicos. Se realizaron análisis correlacionales, comparación de medias y análisis de vías con variables latentes (PALV).
El PALV mostró que el 42% de la varianza en la CVRS podría explicarse por las variables evaluadas (χ²/df = 2,10; GFI = ,938; IFI = ,920; CFI = ,918; RMSEA = ,062; SRMR = ,056). La depresión fue el predictor más fuerte de la CVRS (−,71; p = ,002), seguida de la actividad física (−,19; p = ,044). La edad (−,122; p = ,034) y la comorbilidad (−,206; p = ,001) se asociaron débilmente con la CVRS física. La práctica de una actividad física regular está relacionado con la CVRS física (r = ,21; p = ,00) y mental (r = ,12; p = ,028).
Un alto porcentaje de la varianza en CVRS se explica por los niveles de depresión y actividad física. Las intervenciones para promover la CVRS en pacientes con ERCA deben centrarse en promover la actividad física y cuidar la salud mental del paciente.
Fabrication of Ti<inf>3</inf>C<inf>2</inf>T<inf>x</inf>/In<inf>2</inf>O<inf>3</inf> nanocomposites for enhanced ammonia sensing at room temperature
2022, Ceramics International
Ti₃C₂T_x, as a novel two-dimensional material, displays promising prospects in NH₃ detection at room temperature. However, the NH₃ detection limit of pristine Ti₃C₂T_x is still a major research concern. Therefore, it is important to explore new Ti₃C₂T_x-based nanocomposites for better NH₃-sensing performance. In the present experiment, Ti₃C₂T_x/In₂O₃ nanocomposites were successfully synthesized by ultrasonication and characterized by XRD, FESEM, TEM, XPS, and BET. The optimal Ti₃C₂T_x/In₂O₃-based sensor had a high response of 63.8% (30.4 times higher than that of pristine Ti₃C₂T_x) to 30 ppm NH₃ at room temperature. In addition, the optimal Ti₃C₂T_x/In₂O₃-based sensor had stable repeatability, excellent selectivity, and long-term stability, while exhibiting excellent potential for NH₃ detection at room temperature.
Transplantation
2022, Clinical Immunology
Transplantation is a procedure in which cells, tissues, or organs of an individual are replaced by those of another individual or the same person. This procedure has saved the lives of many people since its implementation in medicine. Patients with end-stage organ failure and certain autoimmune diseases or malignancies that would have died otherwise have extended lives, and in some cases, been cured. However, complications such as infection, graft rejection, and graft failure have long existed that affected the lives of the patients following transplantation. Immunosuppressive methods and certain pre-transplant and post-transplant measures have been undertaken and have been successful to improve the quality of life and survival rates of the patients. However, they are still being developed to reach optimal results. The demand for organ transplantation is on the rise, and this leads to extended waiting lists. This issue has affected the criteria for organ transplantation and continues to do so to increase patients’ overall survival rates.
Prostate Cancer, Kidney Transplant Wait Time, and Mortality in Maintenance Dialysis Patients: A Cohort Study Using Linked United States Renal Data System Data
2021, Kidney Medicine
The impact of prostate cancer on mortality in patients with end-stage kidney disease may be different from the general population. Prostate cancer may also delay the kidney transplant but has not been studied in a population-based cohort. We examined how prostate cancer influenced time to kidney transplant and death in a dialysis population.
Retrospective population-based, risk-set propensity score–matched cohort study.
Men, 40-79 years old, who were dialysis-dependent Medicare beneficiaries without prior documented prostate cancer, from the United States Renal Data System.
Incident prostate cancer, identified using International Classification of Disease, Ninth Revision, Clinical Modification system diagnosis code 185.
Time to kidney transplant and death.
Propensity-based risk-set matching to reduce bias between cases and controls. Cox proportional hazards model for time to death, and Fine-Gray competing risk model for time to kidney transplant.
Among a total of 588,478 male dialysis patients who met the eligibility criteria, 18,162 had claims for prostate cancer. After propensity-based risk-set matching, 15,554 pairs of prostate cancer cases and controls were identified. Among the matched pairs, survival rates were 76%, 48%, and 30% at 1, 3, and 5 years in the prostate cancer group, compared with 80%, 51%, and 33% in the control group, with relative mortality of 95%, 94%, and 91% respectively (log-rank test P < 0.001). Prostate cancer was associated with a 22% lower likelihood of kidney transplant (HR: 0.78; 95% CI: 0.72-0.85) and 11% higher likelihood of death (HR: 1.11; 95% CI: 1.08-1.14) compared with controls. Kidney transplant was associated with a 4-fold improvement in overall survival, both in patients with and without prostate cancer (HR: 0.20; 95% CI: 0.18-0.21).
Retrospective registry study.
Prostate cancer is associated with a modest increase in the risk of death and time to transplant in patients with end-stage kidney disease. Kidney transplant is associated with the same degree of survival benefit among those with pretransplant prostate cancer as those without.

View all citing articles on Scopus

^*: Supported in part by grants from Laboratorio Esteve, Barcelona, Spain.

^**: Address reprint requests to Fernando Valderrábano, MD, PhD, Department of Nephrology, Hospital General Universitario, Gregorio Marañón, Dr Esquerdo 46, 28007 Madrid, Spain. E-mail: [email protected]

^*: 0272-6386/01/3803-0001$35.00/0

View full text

In-Depth ReviewQuality of life in end-stage renal disease patients*,**,*

Abstract

Section snippets

Measurement of QOL

QOL in ESRD

QOL as a factor in predicting morbidity and mortality

Renal transplantation and QOL

Conclusion

Acknowledgements

Am J Kidney Dis

Kidney Int

Am J Kidney Dis

Clin Ther

Am J Kidney Dis

Am J Kidney Dis

J Chronic Dis

J Clin Epidemiol

J Chronic Dis

J Clin Epidemiol

J Clin Epidemiol

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Kidney Int

Adv Ren Replace Ther

Am J Kidney Dis

Kidney Int

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Health Status and Health Policy. Quality of Life in Health Care Evaluation and Resource Allocation

Methods for quality of life studies

Annu Rev Public Health

A critical appraisal of the quality of quality of life measurements

JAMA

Review of the concept of quality of life assessment and discussion of the present trend in clinical research

Nephrol Dial Transplant

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

Qual Life Res

Quality of life in patients undergoing renal replacement therapy

Kidney Int

Applications of Item Response Theory to Practical Testing Problems

Incorporating utility-based quality of life assessment measures in clinical trials: Two examples

Med Care

Depression, perception of illness and mortality in patients with end-stage renal disease

Int J Psychiatry Med

Survival in hemodialysis patients: The role of depression

J Am Soc Nephrol

Aspects of quality of life in hemodialysis patients

J Am Soc Nephrol

Behavioral compliance with dialysis prescription in hemodialysis patients

J Am Soc Nephrol

Predictive value of functional status for mortality in patients on maintenance hemodialysis

Am J Nephrol

Functional status and quality of life predictors of early mortality among patients entering treatment for end stage renal disease

J Clin Epidemiol

Current concepts: Assessment of quality-of-life outcomes

N Engl J Med

Linking clinical variables with health-related quality of life

JAMA

Using health-related quality of life information: Clinical encounters, clinical trials and health policy

J Gen Intern Med

Quality of life and antihypertensive therapy in men. A comparison of captopril and enalapril

N Engl J Med

Adaptación de una medida de la disfunción relacionada con la enfermedad: la versión española del Sickness Impact Profile

Med Clin (Barc)

Psychosocial adaptation of dialysis patients

Measuring health-related quality of life

Ann Intern Med

Generic and disease-specific measures in assessing health status and quality of life

Med Care

A disease-specific questionnaire for assessing quality of life in patients on hemodialysis

Nephron

The advantage of multiple measures of quality of life

Scan J Urol Nephrol

From the development to the clinical application of a questionnaire on the quality of life in dialysis. The experience of the Italian Collaborative DIA-QOL Group

Nephrol Dial Transplant

In-Depth Review
Quality of life in end-stage renal disease patients*,**,*