Intensive Hemodialysis and Health-Related Quality of Life

Abstract

Diminished health-related quality of life (HRQoL) is common in dialysis patients and associated with increased risks for morbidity and mortality. Patients may present limitations in both physical and mental HRQoL. Poor physical HRQoL may be defined by limited physical function, role limitations due to physical health, dissatisfaction with physical ability, and impaired mobility. Sleep disorders such as obstructive sleep apnea, restless legs, and fatigue are typical manifestations of poor physical HRQoL in dialysis patients. Poor mental HRQoL may be defined by depressive thinking, lack of positive affect, anxiety, and feelings of social isolation. The prevalence of depression is high in dialysis patients. Intensive hemodialysis (HD) can positively address HRQoL. In 3 randomized clinical trials, relative to conventional HD, intensive HD increased physical and mental component summary scores from the 36-Item Short-Form Health Survey (SF-36), although individual treatment effects of daily nocturnal HD were not statistically significant. In another large prospective study, initiation of short daily HD therapy was followed after 12 months by improvements in all SF-36 domains, sleep quality, and restless legs symptoms. In a small study of nocturnal HD, apnea and hypopnea episodes per hour decreased by almost 70% after conversion from conventional HD. Intensive HD is also associated with a large reduction in postdialysis recovery time. In contrast, 2 randomized clinical trials failed to demonstrate statistically significant effects of intensive HD on the Beck Depression Inventory score despite a significant decrease in Beck Depression Inventory score in the prospective study of short daily HD. Furthermore, intensive HD may not improve objective physical performance and can increase burden on caregivers in the home setting. In conclusion, intensive HD potentially can address both physical and mental aspects of poor HRQoL relative to conventional HD. However, more studies are needed to understand the effects of intensive HD, including specific schedules, on HRQoL.

Nocturnal home hemodialysis with low‐flow dialysate: Retrospective analysis of the first European patients

“…In all cases, patients were trained first to use the HD device for short frequent sessions. Training time to independence at home took a mean of 9.6 (range [8][9][10][11][12][13][14][15][16][17][18][19] sessions. After home training competencies were gained, 12 patients immediately completed 2 additional training sessions to begin nocturnal therapy.…”

“…In addition to the survival benefit, longer hours on dialysis can improve dialysis-related symptoms like fatigue, depression, and sleep apnea, resulting in improvement of quality of life. 15,16 Nocturnal dialysis is not a new concept; the first nocturnal home hemodialysis (HHD), in fact, took place in London in 1964. 17 Throughout the early years of dialysis, nocturnal therapy was the mainstay of treatment for chronic renal failure patients.…”

Complicações Em Pacientes Renais Crônicos Submetidos À Hemodiálise

“…As complicações relacionadas à DRET e ao tratamento hemodialítico configuram-se como importantes fatores a serem observados e prevenidos, pois, dependendo de sua intensidade, podem culminar em consequências graves e menor qualidade de vida do paciente com DRET (8) .…”

The home hemodialysis patient experience: A qualitative assessment of modality use and discontinuation

“…To increase utilization of HHD in the United States, it is necessary to prioritize not only facilitating HHD initiation, but also reducing the high discontinuation rate which has been reported to be 18% to 25% within 1‐year . Although a number of factors have been associated with higher likelihood of HHD discontinuation, including demographic and patient characteristics and comorbidity burden, many practitioners of HHD believe psychosocial issues and burden of therapy are prominent drivers of HHD discontinuation . Thus, qualitative evaluation is an important component of understanding the perspectives of patients about facilitators and barriers for HHD.…”

“…7,[29][30][31][32] Although a number of factors have been associated with higher likelihood of HHD discontinuation, including demographic and patient characteristics and comorbidity burden, 27,29,[33][34][35][36][37] many practitioners of HHD believe psychosocial issues and burden of therapy are prominent drivers of HHD discontinuation. 21,38 Thus, qualitative evaluation is an important component of understanding the perspectives of patients about facilitators and barriers for HHD.…”