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

Abstract

Background: There are few studies assessing the quality of life of patients with chronic and end stage kidney disease in sub-Saharan Africa. We aimed to describe the health-related quality of life (HRQOL) of patients undergoing in-centre maintenance hemodialysis in Rwanda using the KDQOL™-36 and determine sociodemographic and clinical factors associated with their quality of life. Methods: We conducted a multicenter, cross-sectional study between September 2020 and July 2021. Patients over the age of 18 receiving maintenance in-centre hemodialysis for at least three months at the Rwandan tertiary hospitals were administered the KDQOL™-36 questionnaire to assess physical and mental health functioning, the effect, burden and symptoms and problem of kidney disease. Sociodemographic and clinical information was collected for all eligible patients. Using mixed effects linear regression models, we explored factors associated with overall KDQOL and its domains, while accounting for clustering of patients within hemodialysis centres. Results: Eighty-nine eligible patients were included in the study. The majority of participants were younger than 60 years old (69.7%), male (66.3%), had comorbidities (91%), and 71.6% were categorized as level 3 on a 4 tier in-country poverty scale. All participants had health insurance coverage, with 67.4% bearing no out of pocket payments for hemodialysis. The median (IQR) quality of life score was 45.1 (29.4) for overall HRQOL, 35.0 (17.9) for PCS and 41.7 (17.7) for MCS. Symptoms and problem of kidney disease, effect of kidney disease, and burden of kidney disease scored 58.3 (43.8), 56.3 (18.8) and 18.8 (37.5), respectively. A notable difference of KDQOL scores between hemodialysis centres was observed. Overall KDQOL was associated with male sex (adjusted ß coefficient [aß]: 8.5, 95% confidence interval [CI]: 2.8, 14.3); being employed (aß: 8.2, 95% CI: 2.2, 14.3); dialysis vintage of 13–24 months (aß: 10.5, 95% CI: 3.6, 17.6), hemoglobin of 10-11 g/dl (aß: 7.3, 95% CI: 0.7, 13.7) and comorbidities (e.g., ≥ 3 comorbidities vs. none) (aß: -29.8, 95% CI: -41.5, -18.3). Conclusion: Patients on in-centre hemodialysis in Rwanda have reduced KDQOL scores, particularly in the burden of kidney disease and physical composite summary domains. Higher overall KDQOL mean score was associated with male sex, being employed, and dialysis vintage of 13–24 months, hemoglobin of 10-11 g/dl and absence of comorbidities. The majority of patients receiving in-centre hemodialysis have higher socioeconomic status reflecting the social and financial constraints to access and maintain dialysis in resource limited settings.

Quality of life and social reinsertion of patients on maintenance haemodialysis in three regions of Cameroon

“…The principal nding of this study was that approximately three-quarters of the proportion of patients with kidney failure on dialysis had lower QOL. These ndings were consistent with studies in Ethiopia, Kenya, Rwanda, and the US [17][18][19][20]. However, our QOL is lower than that reported by Cohen et al in the US and Shahrin et al in Malaysia, who reported slightly higher QOL [20,21].…”

Health-related quality of life of patients undergoing haemodialysis therapy in Dar es Salaam, Tanzania

“…We found that the physical composite score (PCS) was lower than the mental composite score (MCS), in line with results from other studies [10,14]. This could be related to the high prevalence of comorbidities such as diabetes and hypertension in this group of patients [4].…”

“…Patients on haemodialysis are also at risk of illnesses such as depression, anxiety, and cardiovascular disease, which can negatively affect their HRQOL [10]. Our findings are consistent with studies conducted in similar settings [8][9][10].…”

“…The lower HRQOL scores may be due to a combination of physical, emotional and lifestyle factors associated with kidney failure and haemodialysis [9]. Patients on haemodialysis are also at risk of illnesses such as depression, anxiety, and cardiovascular disease, which can negatively affect their HRQOL [10]. Our findings are consistent with studies conducted in similar settings [8][9][10].…”

“…Most have reported similar findings to those reported globally, with lower HRQOL compared to the general population. However, there is a considerable heterogeneity in the predictors of HRQOL, and the factors that are associated with this measure vary across different populations and settings [8][9][10][11].…”