Comparison of the health-related quality of life of end stage kidney disease patients on hemodialysis and non-hemodialysis management in Uganda

Abstract

Background Health-related quality of life is recognized as a key outcome in chronic disease management, including kidney disease. With no national healthcare coverage for hemodialysis, Ugandan patients struggle to pay for their care, driving families and communities into poverty. Studies in developed countries show that patients on hemodialysis may prioritize quality of life over survival time, but there is a dearth of information on this in developing countries. We therefore measured the quality of life (QOL) and associated factors in end stage renal disease (ESRD) patients in a major tertiary care hospital in Uganda. Methods Baseline QOL measurement in a longitudinal cohort study was undertaken using the Kidney Disease Quality of Life Short Form Ver 1.3. Patients were recruited from the adult nephrology unit if aged > 18 years with an estimated glomerular filtration rate ≤ 15mls/min/1,73m2. Clinical, demographic and micro-financial information was collected to determine factors associated with QOL scores. Results Three hundred sixty-four patients (364) were recruited, of whom 124 were on hemodialysis (HD) and 240 on non-hemodialysis (non-HD) management. Overall, 94.3% of participants scored less than 50 (maximum 100). Mean QOL scores were low across all three principal domains: physical health (HD: 33.14, non-HD: 34.23), mental health (HD: 38.01, non-HD: 38.02), and kidney disease (HD: 35.16, non-HD: 34.00). No statistically significant difference was found between the overall quality of life scores of the two management groups. Breadwinner status (p < 0.001), source of income (p0.026) and hemodialysis management type (p0.032) were the only factors significantly associated with QOL scores, and this was observed in the physical health and kidney disease principal domains only. No factors were significantly associated with scores for the mental health principal domain and/or overall QOL score. Conclusion The quality of life of Ugandan patients with ESRD has been found to be lower across all three domains of the Kidney Disease Quality of Life Short Form than reported anywhere in the world, with no difference observed between the non-HD and HD management groups. Interventions targeting all domains of QOL are needed among patients with ESRD in Uganda and, potentially, in other resource limited settings.

Health related quality of life of patients undergoing in-centre hemodialysis in Rwanda: a cross sectional study

“…Similar scores in the physical and mental component summary were seen in comparison to studies conducted in other LMIC, however, the symptom and problem of kidney disease scores in Rwanda were much lower than those seen Kenya and Saudia Arabia (Table 4) [28,[30][31][32]. While our findings Similar findings of low scores in the burden of kidney disease sub-scale and relatively higher score in the symptoms and problem of kidney disease sub-scale have been noted in studies conducted in sub-Saharan Africa [27][28][29]. This suggests that the KDQOL-36 scoring system, which is freely available and shorter to administer than the KDQOL-SF, may be reasonably employed in settings with already constrained human and economic resources to assess an outcome that is important to patients undergoing hemodialysis.…”

“…Patients and their family are required to travel long distances or relocate near dialysis centers to undergo dialysis and this in turn affects their daily activities and relationships with others, which likely contributed to reduced burden of kidney disease domain scores. Many patients had obtained a relatively higher level of education and were from a relatively higher socioeconomic status in ubudehe category 3, echoing other African studies that have highlighted that the majority of patients on hemodialysis are largely from a higher socioeconomic status [10,28,29,[35][36][37]. Interestingly, there were no patients in the highest ubudehe category on in-centre hemodialysis in Rwanda.…”

“…Similar to studies of hemodialysis patients conducted in LMICs, 69.7% of participants were younger than 60 years of age reflecting the epidemiology of kidney disease observed in LMICs, the lack of strategies for prevention and management of communicable and non-communicable diseases, poor socioeconomic status and the limited access to dialysis and transplantation [10,20,[27][28][29][33][34][35]. There was a positive association between dialysis vintage and higher QoL scores, which may reflect survivorship bias and adaptation of patients dialyzed for a longer period but prior to developing complications of longer term dialysis.…”

“…The higher score, the better the quality of life. [24] The overall KDQOL score was obtained from a programed KDQOL-36 ™ scoring tool [29]. All demographic and clinical information were collected on paper, entered into excel with independent double entry by two study investigators to minimize data entry errors.…”

Health Related Quality of Life of Patients Undergoing In-Centre Hemodialysis in Rwanda: a Cross Sectional Study

“…Similar ndings of low scores in the burden of kidney disease sub-scale and relatively higher score in the symptoms and problem of kidney disease sub-scale have been noted in studies conducted Africa. (32)(33)(35) Similar to other studies from LMICs, 69.7% of participants were young than 60 re ecting the pattern of causes and risk factors of kidney disease in LMICs, the lack of strategies of prevention and management of communicable and non-communicable diseases and the poor socioeconomic status and the low access to transplantation. (36)(16)(33)(35)(32)(37)(38)…”