WHAT IS THE DIFFERENCE BETWEEN THE QUALITY OF LIFE OF HEMO AND PERITONEAL DIALYSIS CLIENTS?
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
ALBERT W. WU, NANCY E. FINK,JANE V.R. MARSH-MANZI,
KLEMENS B. MEYER,FREDERIC O. FINKELSTEIN,
MICHELLE M. CHAPMAN,and NEIL R. POWE
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