Comparison of Quality of Life in patients with advanced chronic kidney disease undergoing haemodialysis, peritoneal dialysis and conservative management in Johannesburg, South Africa: a cross-sectional, descriptive study

Abstract

Introduction: Mental health and quality of life are under-appreciated clinical targets which affect patient and modality survival. Lack of dialysis slot availability in the resource-constrained public health sector in South Africa, results in assignment to treatment modalities without regard to effects on these parameters. We assessed the effect of dialysis modality, demographic and laboratory parameters on mental health and quality of life measurements.Methods: Size-matched voluntary cohorts were recruited from patients on haemodialysis (HD), peritoneal dialysis (PD), and patients on conservative management (with an estimated glomerular filtration rate below 20mL/min/1.73m2), between September 2020 and March 2021. Responses to the Hospital Anxiety and Depression Scale (HADS) and Kidney Disease Quality of Life Short Form 36 (KDQOL-SF36) questionnaires and demographic and baseline laboratory parameters were compared between treatment modalities using the Student t-test and Pearson Chi-square test. Linear regression was used to test for independent effect where significant difference was observed.Results: HADS anxiety score was highest (p < 0.001) and KDQOL-SF36 emotional wellbeing was poorer in HD (p < 0.001). Social functioning (p = 0.011) and physical limitation due to pain (p = 0.030) were poorer in PD. Unemployment (p = 0.044) was more frequent in HD; fewer PD patients required a social support grant (p = 0.008). Significant independent effect was found for age (p = 0.009), employment (p = 0.007), and haemoglobin (Hb) (p = 0.025) on anxiety; HD worsened (p = 0.037) and PD improved (p = 0.007) anxiety. Unemployment (p < 0.001) and low Hb (p = 0.018) worsened depression. PD improved (p= 0.002) and HD worsened (p < 0.001) emotional well-being. PD worsened social functioning (p = 0.002). PD (p = 0.007) and higher phosphate (p = 0.022) worsened and HD (p = 0.01) and higher Hb (p = 0.02) improved physical discomfort / pain.Conclusion: Advanced chronic kidney disease increases anxiety and depression and limits quality of life. Peritoneal dialysis improves mental health and emotional wellbeing and preserves the ability to undertake economic activity but limits social functioning and causes greater physical discomfort. Targeting haemoglobin and phosphate may ameliorate modality effects on mental health and quality of life.