Comparison of quality of life in patients with advanced chronic kidney disease undergoing haemodialysis, peritoneal dialysis and conservative management

Abstract

Introduction: Quality of life is an under-appreciated clinical target which affects patient and modality survival. Lack of dialysis slots in the state sector result in assignment to treatment modalities without regard to effects on these parameters. We assessed the effect of dialysis modality, demographic, and laboratory parameters on mental health and quality of life measurements. Methods: Size-matched voluntary cohorts were recruited from patients on haemodialysis (HD), peritoneal dialysis (PD), and patients on conservative management (CM). Responses to self-administered Hospital Anxiety and Depression Scale (HADS) and Kidney Disease Quality of Life Short Form 36 (KDQOL-SF36) questionnaires and demographic and baseline laboratory parameters were compared between treatment modalities using the Student t-test and Pearson Chi-square test. Linear regression was used to test for independent effect where significant difference was observed. Results: HADS anxiety score was highest (p <0.001) and KDQOL-SF36 emotional wellbeing was poorer in HD (p <0.001) Social functioning (p = 0.011) and physical limitation due to pain (p = 0.03) were poorer in PD. Unemployment (p = 0.044) was more frequent in HD; fewer PD patients required social support grants (p = 0.008). Significant independent effect was found for age (p = 0.009), employment (p = 0.007), and Haemoglobin (Hb) (p = 0.025) on anxiety; HD worsened (p = 0.037) and PD improved (p = 0.007) anxiety. Unemployment (p <0.001) and low Hb (p = 0.018) worsened depression. PD improved (p = 0.002) and HD worsened (p <0.001) emotional well-being. PD worsened social functioning (p = 0.0018). PD (p = 0.007) and higher phosphate (p = 0.022) worsened and HD (p = 0.01) and higher Hb (p = 0.02) improved physical discomfort / pain. Conclusion: Advanced CKD increases anxiety and depression and limits quality of life. PD improves mental health and emotional wellbeing and preserves ability to undertake economic activity but limits social functioning and causes greater physical discomfort. Targeting Hb and phosphate may ameliorate modality effects on mental health and quality of life.