Abstract
Background and Aims
Quality of life (QoL) influences the morbidity and mortality in End-Stage Kidney Disease (ESKD) patients on dialysis and is increasingly well recognized as an important measure of treatment outcome. Identification of the factors that influence QoL in patients receiving peritoneal dialysis (PD) can help improving their management. This study was carried out to determine the clinical, biochemical and psychological predictors for QoL scores among ESKD patients on automated (APD) and continuous (CAPD) ambulatory peritoneal dialysis.
Methods
This was a cross-sectional study which included stable patients from two Peritoneal Dialysis Units. We excluded patients who weren’t able to understand the questionnaires, the language and the ones who had hospitalar admissions in the previous 3 months. Quality of life parameters were assessed by self-administered EuroQol questionnaire (EQ-5D-5L) - higher scores indicate better QoL; Pittsburg Sleep Quality Index (PSQI) was used for assessing sleep quality and evaluation of each patient’s depressive symptoms was made with Patient Health Questionnaire (PHQ-9). In all patients, demographic variables, Charlson Comorbidity Index (CCI), clinical and laboratory parameters were recorded and analyzed. Descriptive statistics was performed. Groups were compared using independent t-test for comparison of continuous variables and Chi square test for categorical variables. In order to evaluate relationship between QoL and the other variables multivariate logistic regression and Pearson bivariate analysis were used.
Results
The study included 70 patients (male/female 44/26; mean age 55.3±14.6 years; APD/CAPD 25/45; PD duration 28±24.2months). Mean CCI was 4.59±1.86; 31.4% of the patients were diabetic, 12.9% presented cardiac insufficiency and 20% had cardiovascular disease. We found that EuroQoL score was significantly associated with Pittsburg Sleep Quality Index (p=0.001), depression score (PHQ-9) (p<0.001), nPCR (p=0.006), duration of PD (p=0.017) and patients’ perception of their own well-being (P=0.002). Comparing EuroQol Score between genders, males had a significant lower score (p=0.011). We found no association with N-terminal pro-brain natriuretic peptide (NTproBNP), overhydration, residual renal function, weekly KT/V and hospital admissions. There were no significant differences regarding EuroQol score between the two modalities of peritoneal dialysis (APD and CAPD patients) or in patients who were PD first.
We also found that the patients with lower EuroQol Score were significantly more depressed (p<0.001) and had poorer sleep quality (p<0.001). Sleep quality wasn’t associated with hypertension or cardiovascular disease. There was no significant difference concerning to age and CCI between the group of patients with worst QoL (EuroQol<0.212) and better QoL (EuroQol Score>0.961).
Plus, there were no significant differences in the EuroQol score in patients with cardiovascular disease.
In a multivariate analysis (linear regression) there was a significant association between EuroQol and depression (B=-0.346; IC 95% -0.022 to -0.004; p=0.004), nPCR (B=-0.417; IC 95% -0.254 to -0.072; p=0.001) and duration of PD (B=-0.351; IC 95% -0.004 to-0.001; p=0,004).
Conclusion
Poor sleep quality, presence of depression and lower nPCR are associated with poorer quality of life. In order to improve life quality in PD patients, quality of sleep, depression and nutritional status should be serially evaluated and given appropriate treatment when required.
EFFECTIVENESS OF AURICULOACUPUNCTURE ON THE SLEEP QUALITY OF WORKING NURSING PROFESSIONALS DURING THE COVID-19 PANDEMIC
