Introduction :
• Chronic kidney disease (CKD) is a worldwide public health problem. • Patients with end-stage renal disease (ESRD) have significant impairment in health related to the illness impact. • The assessment of HRQoL helps in evaluating the quality of care and efficacy of medical intervention, improving clinical decisionmaking, and estimating health care needs of the community.
• Hemodialysis patients undergo frequent and long visits to the clinic to receive adequate dialysis treatment, medical guidance, nursing intervention, and support. This may affect quality of life (QOL). Although QOL is a very important management aspect in hemodialysis patients.
• In Saudi Arabia, there is a rising incidence and prevalence of kidney failure. The prevalence of ESRD has doubled in the past 10 years and is expected to continue to rise steadily in the future. • At the present rate it is expected that the number will exceed 15,000 patients by the end of year 2015. and patients are being treated with either hemodialysis or peritoneal Dialysis.
• The dialysis statistics prepared by the Saudi Center for Organ Transplantation (SCOT). At the end of year 2011 showed a total of 13.356 dialysis patients, 12.116 of them are treated by hemodialysis and remaining 1.240 by peritonial dialysis.
Quality of life (QOL) has become an important aspect in assessing the burden of chronic disease. • Moreover improving, maintaining patient satisfaction and quality of life have become important treatment goals in ESRD. • Thus QoL is an important indicator of health and well-being, it determines the effectiveness of treatment, decide the priority for resources distribution, and help in policy developments. •
• Health related quality of life is a multidimensional concept that includes physical functioning, social, role functioning, mental health, and general health perceptions. And measures the individual's subjective perception of his functioning and well-being in his/her day-to-day living.
• WHO has defined "QOL" as "individual’s perceptions of their position in life in the context of the culture and value systems where they live and in relation to their goals, expectations, standards and concerns”.
• QoL impaired over time, with the perception of the quality of physical health deteriorating more than mental health, however many patients continue to feel hopeless, anxious, and worry about finances, loss of sexual function, family burden, and loss of independence.
• Decreased HRQoL among patients on chronic HD is associated with increased mortality and complications. Moreover, a number of factors such as age, anemia, and comorbidity had been implicated in decreased QOL. • In general, patients on dialysis have a reduced QoL compared with transplant patients who have QoL similar to that of the general population
•Assessment of quality of life is still a developing area of clinical research, with researchers continuing to refine the concept . •Recent research suggests that patients’ perceptions may be more important than clinical objective is increasingly well recognized as an important measure of treatment outcome.
• The haemodialysis (HD) is not a cure for CKD but helps to prolong and improve patients’ QOL. • Recently, assessing the quality of life in patients with ESRD treated with hemodialysis (HD) has been considered an important aspect of therapy. • Populations facing chronic illness have been reported to have poorer QoL and mental health including higher levels of depression.
• Not surprisingly, most studies in adult patients on dialysis showed an impaired quality of life on items that reflect both physical and mental health. • As a result of ESRD, the QoL of hemodialysis patients is lower than in patients with congestive heart failure, chronic lung disease, or cancer.
• Regarding relevant researches, findings are mixed with some studies showing that HD patients report better physical well-being, sleep and sexual relationships. However, adverse symptoms such as nocturnal distress and inability to sleep during the nights leading up to dialysis have also been reported by HD patients.
• The long period of treatment, with the absence of any prospect of resolving the clinical situation, has a negative effect on the QoL of uremic patients. • Although much research has been carried out on the QoL of dialysis patients, there is a paucity of such studies in Saudi Arabia.
Aim of the study
To assess the quality of life using kidney disease quality of life short form (KDQOL TM) of patient on HD.
Subjects & Methods
Research Design A cross-sectional descriptive design.
Setting Security Forces Hospital in dialysis unit.
Participants All
patients
on
hemodialysis
aforementioned setting.
in
the
TOOLS 1. Structured interview questionnaire form: Used to collect; patients background data about age, sex, level of education, duration of dialysis.
2- KDQOL-Short Form 1.3 TM: Which included ESRD-Targeted area focus on particular health related to concerns of individuals with kidney disease on dialysis as the following: • • • • • • • • • • •
Burden of kidney disease Cognitive function Dialysis staff encouragement Effects of kidney disease Sleep Quality of social interaction Symptoms/problems list Social support Sexual function Work status Patient satisfaction
And also consists second part as a health survey as a generic eight multi items as: • Energy/fatigue • Emotional wellbeing • General health • Physical functioning • Pain • Role-emotional • Role-physical • Social function
The scoring of the tool responses was done according to the guidelines of the KDQOL-SFTM . The scoring direction was done so that higher scores indicate better QoL.
Patients' personal characteristics
:ESRD-Targeted area
Age
Duration
Education#
Burden of kidney disease
0.006
-.324*
0.019
Cognitive function
.365**
0.105
-.321*
Dialysis staff encouragement
-.281*
-.309*
.318*
Effects of kidney disease
-0.031
-0.084
0.058
Sleep
-.425**
-0.117
.358*
Quality of social interaction
.350*
0.266
-.362**
Symptoms/problems list
-.310*
-0.222
.368**
Social support
.307*
-0.022
-0.195
Sexual function
-0.049
-.414**
-0.165
Work status
-0.145
0.196
.436**
Energy/fatigue
-.660**
-0.163
.457**
Emotional wellbeing
-0.263
-0.241
0.065
General health
-.416**
-0.068
.381**
Physical functioning
-.539**
-0.151
.508**
Pain
-.456**
-0.096
.421**
Role-emotional
-.510**
0.07
.428**
Role-physical
-.425**
0.113
.418**
Correlations between patients' QoL scores and ESRD-Targeted area:
36-item health survey:
Unstandardized Coefficients
Constant
Beta
Std. Error
81.211
7.2
95% Confidence Standardized
p-value
Coefficients
(t-test)
<0.001
Interval for B
Lower
Upper
66.927
95.49 5
Group
12.846
2.937
0.378
<0.001
7.018
3
(reference: hemodialysis) Patient gender
18.67
-6.403
2.808
-0.187
0.025
-11.975
-0.831
-0.425
0.112
-0.366
<0.001
-0.648
-0.203
(reference: male)
Patient age
Best fitting multiple linear regression of overall QoL score
A negative predictors effect of QoL score are patientsâ&#x20AC;&#x2122; age and male sex. More than half of patients had acceptable QOL score. Patients' QoL scores and their age, duration of illness, and level of education were considering as a very important variables that affect on the QoL score . Between all KDQOL-SF items the most highest values among
hemodialysis
patients
as
dialysis
staff
encouragement, sleep, social support and sexual function.
Patient QoL should be the main objective for doctors and nurses during care of dialysis patients. Develop Educational program for dialysis patient to improve all aspects of quality of life.
A family member or significant other should attend the educational program sessions to help dialysis patients to cope. A simple manual of guidelines of care for patients
undergoing
hemodialysis
and
peritoneal dialysis should be made available in all units and provided to newly admitted patients.
Design exercise program for both hemodialyis and peritoneal therapy to improve physical QoL. Further research is suggested to assess the effect on the QoL of children and adolescents.
Reference s
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