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    peter bondad

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    Post  peter bondad on Wed 12 Aug 2009, 11:30 pm




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    GIL LEGARDA - Answer

    Post  gil_legarda on Sat 15 Aug 2009, 1:12 am

    ANSWER: Based on the study below about suicide as an indicator of quality of life for both hemodialysis and peritoneal dialysis patients the study result shows that there is a lower suicide rate among hemodialysis patients than peritoneal dialysis and the possible basis for this are the 4 principles or differences between these therapies.

    TITLE: Suicide As An Indicator Of Quality Of Life: Evidence From Dialysis Patients
    By: Jon M. Ford, David L. Kaserman

    An emperical study conducted by Jon Ford and David Kaserman to identify the significance of suicide rates between patients undergoing hemodialysis and peritoneal dialysis. It was stated in this study that these two therapies exhibit markedly different for patients undergoing the procedure but there are at least four principle differences identified, hemodialysis is performed at the dialysis center, whereas PD is done at home; HD results a washed-out feeling whereas PD does not; HD is administered only thrice per week for about 3 to 5 hours whereas PD must be done every day in much shorter periods and lastly the dietary restrictions associated with HD are considerably more restrictive than those associated with PD. The data collected were undergone to cross-sectional observation obtained from United States Renal Data System or USRDS for standard analysis consisted of 572,162 patients undergone for ESRD program which random variation were more used than time series data or more aggregate data.

    The result of this study shows a probability of a patient which will commit suicide is lowered by the number of years having or undergoing the therapy also it shows that it is lower in males than females, it increases with the patient’s age, also o patients had a rejection on transplanted kidney. As a primary interest of this study the type of treatment modality between hemodialysis and peritoneal dialysis, there is a negative and statistically significant at point zero one level in both estimations. This study shows that the probability that the dialysis patient will commit suicide is significantly lower in the hemodialysis therapy. Conversely, suicide is significantly more likely if the patients utilize peritoneal dialysis.

    The 4 principles differences between both dialysus therapies are the basis for quality of life among HD and PD patients. HD patients have a feeling of washed-out after the therapy while PD patients still feels the same and a possibility of anxiety and depression is still there also PD must be done everyday and no rest day for this kind of therapy but this kind of therapy is cheaper than HD therapy. Even if the HD is more expensive, have a more dietary restrictions and requires more time for therapy still the suicide rate of PD patients is higher because the feeling of cleansed and refreshed again can’t be achieved with PD therapy. The emotions or the feelings of the patient perceiving the quality of life is more determined on what they feel towards the procedure or therapy they are undergoing to.

    Reference: Ford M.J., Kaserman D.L. (2000). Suicide As An Indicator Of Quality Of Life: Evidence From Dialysis Patients. Journal Article Excerpt. Contemporary Economic Policy, Vol. 18, 2000

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    Post  alkhaloidz on Sun 16 Aug 2009, 8:32 pm

    ANSWER: The difference between the quality of life (QoL) of patients undergoing HD and PD, is that HD patients is experiecing much compromised life compare to PD patients. In addition, the over-all mental health of HD patients are also affected by this treatment modality. Also, HD patients who had been on long term treatment, experiences significant QoL changes over time, including deterioration in physical, social and environmental well-being in comparison to the QoL of PD patients. My statements are supported by the study below:

    Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: Investigating differences in early and later years of current treatment

    The study examines differences regarding quality of life (QoL), mental health and illness beliefs between in-centre haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD/PD) patients. Differences are examined between patients who recently commenced treatment compared to patients on long term treatment. 144 End-Stage Renal Disease (ESRD) patients were recruited from three treatment units, of which 135 provided full data on the variables studied. Patients consisted of: a) 77 in-centre haemodialysis (HD) and 58 continuous ambulatory peritoneal dialysis (CAPD/PD) patients, all currently being treated by dialysis for varied length of time. Patients were compared for differences after being grouped into those who recently commenced treatment (< 4 years) and those on long term treatment (> 4 years). Next, cases were selected as to form two equivalent groups of HD and CAPD/PD patients in terms of length of treatment and sociodemographic variables. The groups consisted of: a) 41 in-centre haemodialysis (HD) and b) 48 continuous ambulatory peritoneal dialysis (CAPD/PD) patients, fitting the selection criteria of recent commencement of treatment and similar sociodemographic characteristics. Patient-reported assessments included: WHOQOL-BREF, GHQ-28 and the MHLC, which is a health locus of control inventory.

    Differences in mean scores were mainly observed in the HD patients with > 4 years of treatment, providing lower mean scores in the QoL domains of physical health, social relationships and environment, as well as in overall mental health. Differences in CAPD/PD groups, between those in early and those in later years of treatment, were not found to be large and significant. Concerning the analysis on equivalent groups derived from selection of cases, HD patients indicated significantly lower mean scores in the QoL domain of environment and higher scores in the GHQ-28 subscales of anxiety/insomnia and severe depression, indicating more symptoms in these areas of mental health. With regards to illness beliefs, HD patients who recently commenced treatment provided higher mean scores in the dimension of internal health locus of control, while CAPD/PD patients on long term treatment indicated higher mean scores in the dimension of chance. Regarding differences in health beliefs between equivalent groups of HD and CAPD/PD patients, HD patients focused more on the dimension of internal health locus of control.

    The results provide evidence that patients in HD treatment modality, particularly those with many years of treatment, were experiencing a more compromised QoL in comparison to CAPD/PD patients. Further, patients who had similar length of current treatment in the two treatment modalities, differ only with regards to their environmental well-being. Thus, in relation to differences between patients in early and later years of treatment, it appears that QoL deficits in HD patients become more extended over time, and seem to be more precisely signified by the factors in the environmental QoL domain. It may be argued that HD patients on long term dialysis appear to be more seriously compromised in their quality of life and mental health.

    Reference: Ginieri-Coccossis, M et. al. Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: Investigating differences in early and later years of current treatment. PMC. November 2008

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    by guomanman

    Post  guomanman on Mon 17 Aug 2009, 2:44 pm

    The study demonstrates that peritoneal dialysis patients have better QoL , compared to hemodialysis patients. The factors underlying this difference need to be investigated.

    Quality of life (QoL) in End Stage Renal Disease (ESRD) patients has become an important focus of attention in evaluating and selecting the type of dialysis therapy. Hemodialysis (HD), Peritoneal dialysis (PD) are important renal replacement treatment in ESRD. In the present Study, we compared the two modalities mentioned. METHODS: This cross-sectional study included all hemodialysis and peritoneal dialysis patients who were referred to the haemodialysis centres of King Khalid University Hospital and Security Forces Hospital at Saudi Arabia during the period from January 2007 to January 2008, Data collection was dome using the Kidney Disease Quality of Life short form (KDQoL SF) questionnaire forms covering 6 domains of QoL, namely physical, emotional, social, illness impact, medical and financial satisfaction, and overall general health. Data analysis was done in terms of scores from 0-100 in each domain. Higher scores indicate better quality of life.


    Al wakeel J, Bayoumi M, Al Ghonaim M, Al Harbi A, Al Swaida A, Mashraqy A.
    byron webb romero

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    Post  byron webb romero on Mon 17 Aug 2009, 3:56 pm

    Noshad and colleagues (2009) compared 60 pateints on peritoneal dialysis with 60 matched patuents on hemodialysis in Tarbriz’s Sina Hospital during the period of 2004-2006. Comparison of the technique, patient’s survival and quality of life were compared by means of a health-related quality-of-life questionnaire (GHQ-28). The results showed that there was no significant difference in the mean age and duration of dialysis between patients on peritoneal dialysis and hemodialysis. Survival of diabetic patients was better with hemodialysis than peritoneal dialysis, but in nondiabetic patients, there was no difference in the survival rates between the two groups. Among patients on peritoneal dialysis, diabetics had a 25% higher mortality rate and nondiabetic patients had a 3% higher mortality rate than their corresponding counterparts on hemodialysis. In all four axes of the GHQ-28 questionnaire, that is, psychosocial dysfunction, stress and sleep disorders, social dysfunction, and major depression, peritoneal dialysis patients had lower scores than hemodialysis patients (p-values are <0.001, <0.001, equal to 0.002 and less than 0.001, respectively), which indicates that patients on peritoneal dialysis had a better quality of life compared to those on hemodialysis. In the same study, technique, patients’ survival and their quality of life, were better on patients undergoing peritoneal dialysis than those on hemodialysis. However, survival and mortality of diabetic patients on hemodialysis were better than those on peritoneal dialysis.

    Noshad, H., Sadreddini, S., Nezami, N., Salekzamani, Y., & Ardalan, M..R. (2009). Comparison of outcome and quality of life: haemodialysis versus peritoneal dialysis patients. Singapore Medical Journal 2009; 50 (2): 185-192. Retrieved August 17, 2009, from http://smj.sma.org.sg/5002/5002a11.pdf.

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    Response- Joanalyn S. Balino

    Post  joanalyn_balino on Mon 17 Aug 2009, 4:26 pm


    Answer: It’s really hard to tell whether there is a difference between the quality of life of hemodialysis and peritoneal dialysis clients. There were inconsistent results in different studies (maybe due to different instrument that they use in measuring Quality of life, the ethnicity of the subjects and other factors). But I think both hemodialysis and peritoneal dialysis don’t differ a lot regarding the quality of life (QOL). These 2 treatment modalities affects the different aspects of a person’s life, Both of this dialysis modality have distinct advantages and disadvantages. The study made by Wasserfallen et al. measured Quality of life (QOL) values using the EuroQol-5D(EQ-5D) questionnaire in chronic HD and PD patients and the result is that the Quality of life was diminished in HD and PD patients. Fong, Bargman and Chan (2007) made a cross-sectional comparison of quality of life and illness intrusive in patients who were treated with nocturnal home hemodialysis versus Peritoneal dialysis. There were similar QOL, depressive symptoms, and illness intrusive scores were observed both in NHD and PD patients.The instrument they used to measure health-related QOL is the Kidney Disease quality of Life-Short Form (KDQOL-SF) Version 1.3.

    Changes in Quality of Life during Hemodialysis and
    Peritoneal Dialysis Treatment: Generic and Disease Specific Measures

    This national , prospective, cohort study initiated by Wu, A. et al. provides a comprehensive and detailed description of the quality of life of patients who started hemodialysis (HD) and peritoneal dialysis (PD) and their progress 1 yr later. They examined a comprehensive set of domains of quality of life allowing examination of the impact of dialysis modality on specific aspects of patients’ lives. A total of 1041 ESRD patients (698 HD and 230 PD) who were enrolled between October 1995and June 1998 at 81 outpatient dialysis units in 19 states were included in the study. Inclusion criteria: Hemodialysis or peritoneal dialysis for ESRD; age must be greater than 18 years; Can speak either English or Spanish. Home hemodialysis patients were excluded in the study. These patients Completed the Choice Health experience questionnaire (CHEQ) that included information on generic and dialysis specific ealth related quality of life (HRQOL). CHEQ includes the SF-36 and 14 dialysis-specific domains. The Dialysis-specific domains include: time, freedom, travel, cognitive function, financial concerns, diet restrictions, recreation, work, body image, symptoms, sleep, sexual functioning, dialysis access, and global quality of life. For SF-36: there were physical functioning PF, role limitations as a result of physical problems RP, bodily pain [BP], general health perceptions GH, social functioning SF, role limitations as a result of emotional problems RE, vitality VT, and mental health MH and summary Physical Component (PCS) and Mental Component MCS scores were calculated at baseline and 1 yearr.

    There were no differences between hemodialysis and peritoneal dialysis according to gender or other measures such as baseline residual renal function. Once unadjusted mean dialysis-specific and SF-36 domain scores were compared PD patients had significantly P =0.05 higher scores for SF-36 bodily pain and for the dialysis domains of travel ,diet restrictions, and dialysis access, both at baseline and 1 yr later compared with HD patients . Peritoneal dialysis patients also had significantly higher baseline scores for the SF-36 domains The only domains for which significant differences favored hemodialysis patients were vitality and sexual functioning at 1 yr.The comparisons of crude Quality of Life Domain Scores between HD and PD: HD patients tended to show greater improvement in SF-36 domain scores than did PD patients when unadjusted mean changes in SF-36 domain scores from baseline to 1 yr later were compared.. Hemodialysis patients had significantly greater improvements in physical functioning and GH perceptions than PD patients. There were a mixed Results for dialysis domains , HD patients exhibiting significantly greater improvement in sleep and global quality of life over 1 yr, and PD patients showing greater improvement in the finance domain . The comparison of adjusted Quality-of-Life domain scores between HD and PD: when mean change over 1 year was adjusted for potential confounders there was a similar pattern of results obtained. HD patients showed greater improvement in all SF-36 domains except mental health, although only differences in PF and GH perceptions were statistically significant for generic HRQOL, Regarding with dialysis-specific domains, HD patients had a significantly greater improvement in sleep whereas PD patients had significantly greater improvement in the finance domain after adjustment for confounders.The comparisons of deteriorations and improvements in domains by modality in all patients: in generic domains of HRQOL: considering change in overall domain health status(worsened, no change, improved); defined by changes in domain score; death; kidney transplantation; or changes in extent of comorbidity among all patients the result is: 20 to 31% had a worsening, 42 to 60% had no change, and 19 to 28% had an improvement . In the dialysis-specific domains of HRQOL among all patients, 19 to 30% had a worsening, 50 to 65% had no change, and 16 to 24% had an improvement. There were no statistically significant differences between hemodialysis and peritoneal patients regarding the changes for any of the generic or dialysis-specific domains.

    This national , prospective, cohort study initiated by Wu, A. et al. suggest that there is no simple answer to the question of which dialysis modality can be expected to provide better quality of life but health and general well-being should improve during the first year of dialysis. Based on the results it does not seem that PD produces a better quality of life than HD for patients who initiate renal replacement therapy. Changes in the dialysis-specific aspects of life were more mixed, and there were more differences between the two modalities. There is a distinct advantages and disadvantages to each of the two modalities that should be explored with patients who are choosing between hemodialysis and peritoneal dialysis. This study help us to identify specific aspects of life that were differed by the modality. This information might be useful to individual patients with specific preferences as they attempt to decide between modalities. Nurses should be as explicit as possible in describing specific tradeoffs and attempt to elicit individual preferences for the aspects of quality of life.

    Wu, A et al.(2003). Changes in Quality of Life during Hemodialysis and Peritoneal Dialysis Treatment: Generic and Disease Specific Measures. J Am Soc Nephrol 15: 743–753. Retrieved August 16, 2009 from http://jasn.asnjournals.org/cgi/content/full/15/3/743

    Wasserfallen et al.(2004). Quality of life on chronic dialysis: comparison between haemodialysis and peritoneal dialysis. Nephrol Dial Transplant 19: 1594-1599. Retrieved August 16, 2009 from http://ndt.oxfordjournals.org/cgi/content/full/19/6/1594#SEC1

    Fong,E., Bargman, J., and Chan, C. (2007) Cross-Sectional Comparison of Quality of Life and Illness Intrusiveness in Patients Who Are Treated with Nocturnal Home Hemodialysis versus Peritoneal Dialysis. Clin J Am Soc Nephrol 2: 1195-1200. Retrieved August 16, 2009 from http://cjasn.asnjournals.org/cgi/content/full/2/6/1195#SEC1

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    Reply to the thread

    Post  rodel_perez_rn on Mon 17 Aug 2009, 10:51 pm

    A study conducted by Fassett, et. Al (2009) about the Comparison of Markers of Oxidative Stress, Inflammation and Arterial Stiffness between Incident Hemodialysis and Peritoneal Dialysis Patients can reveal some of the benefits of dialysis wherein a picture of what type of dialysis is best suitable for clients with ESRD.

    An accelerated incidence of atherosclerosis leading to cardiovascular morbidity and mortality is observed among patients undergoing hemodialysis and peritoneal dialysis. Usually, atherosclerosis is linked to an increase in endothelial dysfunction and elevated oxidative stress as well as inflammatory processes in the arteries. Thus this study pertains to determine the effects of hemodialysis and peritoneal dialysis on vascular function, myocardial structure and oxidative stress as well as inflammation among ESRD patients.

    Eighty-five ESRD patients were included in the study and were structurally provided with follow-up for one year. The outcome measures of the client after having series of hemodialysis or peritoneal dialysis will be measured in terms of the arterial stiffness measured by aortic pulse wave velocity, oxidative stress assessed by plasma F2 isoprostanes and inflammation measured by plasma pentraxin-3. Secondary outcomes will include additional measures of oxidative stress and inflammation, changes in vascular function assessed using the brachial artery reactivity technique, carotid artery intimal medial thickness, augmentation index and trans thoracic echocardiography to assess left ventricular geometry, and systolic and diastolic function.

    Results revealed better outcome for clients undergoing hemodialysis. This was proven by using linear modeling to compare baseline continous variables between groups. The outcome measures of each groups was measured by the Mean differences and repeated P-values with a 95% level of confidence.

    Authors and Disclosures
    Robert G. Fassett,1,2,4,5 Ritza Driver,2 Helen Healy,1 Dwarakanathan Ranganathan,1 Sharad Ratanjee,1 Iain K. Robertson,3 Dominic P. Geraghty,3 James E. Sharman 4,5 and Jeff S Coombes 2,4
    1Renal Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, 4029, Australia
    2Renal Research Tasmania, Launceston General Hospital, Launceston, Tasmania, 7250, Australia
    3School of Human Life Sciences, University of Tasmania, Launceston, Tasmania, 7250, Australia
    4School of Human Movement Studies, The University of Queensland, St Lucia, Queensland, 4072, Australia
    5School of Medicine, The University of Queensland, Queensland, 4072, Australia

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    By: Raymond C. Ursal

    Post  monchRN on Tue 18 Aug 2009, 12:33 am


    Peritonial dialysis is for client with acute kidney disease with less complication in morbidity and mortality compare Hemodialysis which is for client with chronic kidney diseases or end stage renal failure (ESRD).

    Treatment Options for End Stage Renal Disease
    Crawford P. et. al.

    The article talks about the different options for end stage renal failure (ESRD): Statistically more than 314,000 are receiving hemodialysis on the other hand 25,000 are receiving peritoneal dialysis, significantly there are about 16.8% of the population has chronic kidney disease (CKD).

    Gordon Murray created a dialyzer in 1946which become the first successful dialysis in North America. Many patient perceptions that their kidneys are going to recover and that dialysis is “only temporary” but in reality health care providers know that their kidney disease is irreversible and that they will need renal replacement therapy for the rest of their life. Some of the contraindications to hemodialysis would be hemodynamic instability, hypotension, unstable cardiac rhythm and patient refusal. In counterpart, peritoneal dialysis is used for client with acute kidney failure typically in the client in the intensive care unit (ICU) which requires the monitoring of client intake and output. Peritonitis is the common complications of client undergoing peritoneal dialysis and has a lower morbidity and mortality compare to hemodialysis.

    Crawford P. et. al.(2008), Treatment Options for End Stage Renal Disease. Retrieved on August 17, 2009, from: http://www.mdconsult.com/das/article/body/147270351-3/jorg=journal&source=MI&sp=20546642&sid=858429917/N/635667/s0272638607016095.pdf?SEQNO=1&issn=0272-6386


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    Response: difference between HD and PD QoL

    Post  VonDeneb_Vitto on Wed 19 Aug 2009, 1:05 am

    Juergensen et. Al. (2006) conducted a study that aimed to examine patient’s satisfaction with hemodialysis and peritoneal dialysis therapies, focusing on the positive and negative impact on patient’s life. Patients rated their overall satisfaction with and the overall impact of their dialysis therapy on their lives, using a 1 to 10 Likert scale. They were also asked to rate the impact of their therapy on 15 domains as being important for patients’ quality of life. PD patients revealed that there was less impact of the dialysis treatment on their lives globally. Both PD and HD Patients were asked to comment freely on the positive and negative effects of the dialysis treatments on their lives. The study suggests that PD patients in general are more satisfied with their overall care and believe that their treatment has less impact on their lives than HD patients.

    Juergensen, E., Wuerth, D., Finkelstein, S., Juergensen, P., Bekui, A., & Finkelstein, F. (2006). Hemodialysis and Peritoneal Dialysis: Patients’ Assessment of Their Satisfaction with Therapy and the Impact of the Therapy on Their Lives. Clinical Journal of the American Society of Nephrology ePress (2006). Retrieved August 18, 2009, from http://cjasn.asnjournals.org/cgi/rapidpdf/CJN.01220406v1.pdf.

    Lucy Yuan

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    Post  Lucy Yuan on Wed 19 Aug 2009, 10:04 pm

    ANSER: health-related quality of life (HRQoL) for dialysis patients may be more related to personal attributes, interactions with multiple diseases, social support and quality of care received.

    TILE:Health-related Quality of Life Taiwanese Dialysis Patients: Effects of Dialysis Modality

    Lih-Wen Maua, Herng-Chia Chiub, Pi-Yu Changc, Su-Chen Hwangd and Shang-Jyh Hwang

    The Kaohsiung Journal of Medical Sciences
    Volume 24, Issue 9, September 2008, Pages 453-460

    Taiwan has the highest incidence and prevalence of end-stage renal disease worldwide. However, not many studies have focused on the influence of dialysis modality on health-related quality of life (HRQoL) for dialysis patients in Taiwan. This study intended to compare the differences in HRQoL between peritoneal dialysis (PD) and hemodialysis (HD) and to evaluate the effects of dialysis modality on patient HRQoL. A cross-sectional survey using the Taiwan-version 36-item short-form health survey questionnaire (SF-36) was completed by 244 dialysis patients (58 PD and 186 HD patients) at two hospital-based dialysis units in southern Taiwan. Patient characteristics, diagnoses and laboratory data were individually extracted from the annual survey and matched with primary HRQoL data. Multiple linear regression analysis was performed to evaluate the effects of dialysis modality on HRQoL. Compared with HD patients, PD patients had higher scores in six of the eight SF-36 subscales, including physical functioning, role limitations due to physical and emotional problems, bodily pain, vitality, and mental health. However, only role limitations due to emotional problems and bodily pain reached significant difference levels (p < 0.05). After controlling for patient characteristics, comorbid conditions and laboratory values, the bodily pain score was 7.88 points higher for PD patients compared with HD patients, while the social functioning score was 9.00 points higher for HD patients compared with PD patients (p < 0.05). The present study provides cross-sectional confirmation for equivalent levels of HRQoL between PD and HD patients except for the subscales of bodily pain and social functioning. In addition to dialysis modality, HRQoL for dialysis patients may be more related to personal attributes, interactions with multiple diseases, social support and quality of care received. When informing patients about modality choices for dialysis, trade-offs should be discussed and individual preferences for specific aspects of HRQoL should be considered.


    Hemo/Peritoneal Dialysis

    Post  *alexus on Thu 20 Aug 2009, 5:12 pm


    The reseach entitled:
    Comparing problems of patients with chronic renal failure undergoing hemodialysis and peritoneal dialysis referring to medical university's hospitals concluded there was no significant difference between the mean scores of depression, social readjustment and marital satisfaction of two groups.


    BACKGROUND: Renal failure affects patients' physical, psychological and social health. Various treatments prolong the life of these patients, but they face many physical, emotional, social and economical difficulties. This study aims to investigate and compare the problems of these patients undergoing hemodialysis (HD) and peritoneal dialysis

    METHODS: This is a descriptive
    comparative study on 72 patients in two groups of hemodialysis (36 patients) and peritoneal dialysis (36 patients) referring to Al-Zahra and Noor hospitals in Isfahan. Data were collected using five questionnaires on sleeping disorders, depression, marital satisfaction, tiredness and readjustment with society. The questionnaires were completed either by the patients themselves or by interview and data were analyzed using
    independent t-test and chi square test.

    RESULTS: Demographic data were the same in both groups and diabetes and blood pressure were the most common causes of kidney failure in both groups. The mean scores of sleeping disorders and tiredness in hemodialysis group was higher than peritoneal dialysis group, but there was no significant difference between the mean scores of depression, social readjustment and marital satisfaction of two groups.

    CONCLUSION: Dialysis is a complicated problematic treatment, causing patients lots of tension and stress. The results of this study showed that hemodialysis and peritoneal dialysis patients have sleep disorders and tiredness, but the severity of tiredness and sleep disorder is higher in hemodialysis patients. Therefore, nurses should pay more attention to these patients and provide them more support and care.


    Maryam Eghbali, Nahid Shahqolian, Fatemeh Nazari,

    Sima Babaee. Comparing problems of patients with chronic renal
    failure undergoing hemodialysis and peritoneal dialysis referring to medical
    university's hospitals.
    Research Article of
    Isfahan University of Medical Sciences, No: 285125



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    Psychosocial issues and quality of life

    Post  YangChunHua on Thu 20 Aug 2009, 11:46 pm

    The aim of the present study was to investigate psychosocial variables related to objective and subjective indicators of quality of life in a single center cohort study of patients undergoing in-center hemodialysis (HD), Continuous Ambulatory Peritoneal Dialysis (CAPD) and renal transplant recipients (RTx). We studied 40 HD patients, 36 CAPD, and 48 RTx patients by a special questionnaire examining demographics, functional status, employment status, and impact of therapy on psychosocial issues such as anxiety and depression. The RTx patients disclosed a better functional and employment status than the CAPD and the HD patients. They were also more compliant and satisfied with their therapy and their relationship with the medical and nursing personnel. The CAPD patients were also more satisfied, more compliant, better motivated, and less anxious and depressed compared with the HD patients who scored low in every aspect studied. Successful renal transplantation is a superior modality of therapy than HD or CAPD regarding psychosocial and quality of life issues. However these results can partially be explained by some selection bias, as RTx patients are usually younger and CAPD patients are selected for this modality after examining functional and social status.
    1. Unruh ML, Weisbord SD, Kimmel PL. Health¬related quality of life in nephrology research and clinical practice. Semin Dial 2005;18:82¬90.
    2. Kaitelidou D, Maniadakis N, Liaropoulos L, et al. Implications of hemodialysis treatment on employment patterns and everyday life of patients. Dial Transplant 2005;34:138-44.
    3. Juergensen E, Wuerth D, Filkenstein SH,et al. Hemodialysis and peritoneal dialyis: Patients assessment of their satisfaction with therapy and the impact of the therapy on their lives. Clin J Am Soc Nephrol 2006;1:1191-6.
    4. Mollaoglu M. Depression and health-related quality of life in hemodialysis patients. Dial Transplant 2004;33:544-9.
    5. Unruh M, Benz R, Green T, et al. Effects of hemodialysis dose and membrane flux on health related quality of life in the HEMO study. Kidney Int 2004;66:355-66.
    6. Paniagua R, Amato D, Vonesh E, et al. Health¬related quality of life predicts outcomes but is not affected by peritoneal clearance. Kidney Int 2005;67:1093-104.
    7. http://www.sjkdt.org/article.asp?issn=1319-2442;year=2009;volume=20;issue=2;spage=212;epage=218;aulast=Panagopoulou



    Post  nancelle on Fri 21 Aug 2009, 12:34 am

    Nancelle Grace G. Dumlao

    Peritoneal Dialysis Thread:


    It is a given fact that both dialysis modalities cost the patients so much – not only in terms of money, but more importantly, the procedures sap them of their energy, time and exhaust their emotion as well as their spirit. In hemodialysys, the patient is expected to travel back and forth to the hospital or clinic 3 to 4 times a day to undergo 3-4 hours of dialysis connected to a machine. Peritoneal dialysis on the other hand, are performed at home by the patient trained to care for himself using manual exchanges of dialysate about 4-5 times a day or by using a machine during the night. The PD patients has more mobility since he visits the hospital only once month. Both require initial operation to create access for the dialysate and exchanges: arteriovenus fistula for HD and putting peritoneal catheter in the peritoneal cavity for PD. Both procedures greatly affect the quality of life of the patients. Thus, it is only just for patients to expect quality of care from these treatments considering the amount of time and resources they spend on them to ensure prolonged and better quality of life.

    Also, considering the growing number of clients afflicted with chronic renal failure, the option to prolong life is limited to renal replacement therapy which includes dialysis (hemodialysis or peritoneal dialysis) and kidney transplant. However, due to the shortage of kidney donors and the ethical controversies surrounding kidney donation and transplantation as well as the high cost involved in the procedure, majority of the ESRD patients are undergoing either hemodialysis or peritoneal dialysis as their only recourse or while awaiting kidney transplant. In the past, there are many studies focusing on the outcomes of treatment which is largely based on the rate of survival, the hospital expenses, the achievement of normal electrolyte and serum values. However, nowadays, more emphasis is being given to the quality of life of these patients. But what does ‘quality of life’ mean? It means patient’s well- being which includes not only the physical but the psychological and social function as well.
    In determining which dialysis modality to utilize, what are some ‘quality of life’ parameters are we to base our assessment on whether hemodialysis (HD) or peritoneal dialysis (PD) is better for a patient?
    In a longitudinal study of 88 peritoneal dialysis patients conducted in 2002 (Bakewell ) on the adequacy of dialysis nutrition, and quality of life it was discovered that the quality of life in a patient undergoing PD deteriorated over time owing to the fact that they feel frustrated in dealing with their disease and the time spent in trying to manage it ---- it interferes with their life. Some male patients wanted more emotional support and some ethnic patients wanted to have more social support. In fact, some say that there is a tendency to focus more on meeting the clinical goals than ensuring their mental health and satisfaction with the therapy.

    In another cohort study (Rubin, et al, 2004) of 656 dialysis patients in 37 dialysis centers in the USA, the authors attempted to evaluate which dialysis modality provides better quality of care to ESRD patients. They wanted to find out what the patient’s views are regarding which modality is better assuming that both treatments will result to equivalent survival benefits and clinical efficacy. In the study, the authors developed a 23-item questionnaire from focus group discussions of patients receiving both HD and PD. It was revealed that the patient’s choice of modality depends on several factors and these are the domains used: “availability of nephrologists, technical quality, interpersonal treatment, information, and coordination; nurse and dialysis staff availability, response to pain, information and social worker availability.”

    The result of the study indicates that PD patients (85%) rate the dialysis care they receive as excellent overall than HD patients (56%). The best rated for both modalities are “caring and concern of nurses,” “caring and concern of dialysis center staff,” “ attention to cleanliness,” “ response to pain,” and “ availability in emergencies.” On the other hand, the 5 worst-rated domains (same for PD and HD) are : low frequency of nephrologist visit to patient, amount of fluid removed from dialysis, accuracy of information given and the amount of information provided to help patient decide which modlity to take.

    The significance of the study is its emphasis on the need to disseminate correct and compete information to patients to help them decide which modality to take. It also revealed that the patients who get more relevant information about the 2 options choose the peritoneal dialysis modality. This may be due to the fact that PD patients has to understand and learn the essentials in managing PD in their own homes (ie., doctors give more information to PD patients).

    PD is a more active form of treatment that is why PD patients choose this therapy because they are those people with a greater sense of control over their lives. This could mean that they have more satisfaction with their lives.

    Bakewell, A.; Higgins, R.; Edmunds, M. Quality of life in peritoneal dialysis patients: Decline over time and association with clinical outcomes. Kidney International (2002) 61, 239–248; doi:10.1046/j.1523-1755.2002.00096.
    Rubin, H. R., Fink, N. E.; Plantinga, L.C.; Sadler, J.H.; Kliger, A.S.; Powe, N.R. Patient Ratings of Dialysis Care With Peritoneal Dialysis vs Hemodialysis. JAMA. 2004; 291:697-703.

    Posts : 12
    Join date : 2009-06-25


    Post  yachen on Fri 21 Aug 2009, 4:29 am


    Objective] To investigate the relationship between quality-of-life and nutritional status in hemodialysis and peritoneal dialysis patients. [Methods] Quality-of-life in 50 hemodialysis patients and 46 peritoneal dialysis patients was measured using short-form-36. Their nutritional status was also measured using subjective global assessment (SGA). [ Results] There were in general no differences in physical functional, body pain, emotional well-being and fatigue between the two dialysis methods except that

    Quality of life (QOL) has recently been explored as one of the main outcomes of renal replacement therapy. In this study, we sought to compare three groups of patients-hemodialysis, peritoneal dialysis, and transplantation-with regard to QOL. METHODS: Seventy-five hemodialysis, 41 peritoneal dialysis and 20 transplant patients were given Patient Information Form, Short Form Health Survey 36, Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS: The QOL scores of the three groups were similar and lower than the normal Turkish population. Depression and anxiety levels had significant and negative effects on QOL of hemodialysis and peritoneal dialysis, but not transplant patients. In a multiple regression analysis, being male, being older than 46 years, living with family, having middle-higher income, having renal disease for a longer time, having a longer period of dialysis treatment, having comorbid illness, having not enough illness knowledge, and having higher levels of depression and of anxiety significantly correlated with a worse quality of life. CONCLUSIONS: The three forms of renal replacement therapy did not differ with regard to QOL. Among the factors that seem to affect QOL, psychological status and treatment/illness knowledge had the most significant correlation. The underlying mechanisms need to be clarified.

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