Impact of sleep and dialysis mode on quality of life in a Mexican population

Abstract

Background: Health-related quality of life (HR-QOL) is reduced with end-stage renal disease (ESRD) but little is known about the impact of sleep disorders, dialysis modality and demographic factors on HR-QOL of Mexican patients with ESRD. Methods: 121 adults with ESRD were enrolled from 4 dialysis units in the state of Guanajuato, Mexico, stratified by unit and dialysis modality (hemodialysis [HD], continuous ambulatory peritoneal dialysis [CAPD] and automated peritoneal dialysis [APD]). Analysis included clinical information and data from the Sleep Heart Health Study Sleep Habits Questionnaire, the Medical Outcomes Study (MOS) short form (SF-36) HR-QOL measure and Epworth Sleepiness Scale. Results: Overall, sleep symptoms and disorders were common (e.g., 37.2% insomnia). SF-36 scores were worse versus US and Mexican norms. HD patients reported better, while CAPD patients poorer HR-QOL for Vitality. With multivariate modelling dialysis modality, sleep disorders as a group and lower income were significantly associated with poorer overall SF-36 and mental health HR-QOL. Overall and Mental Composite Summary models showed HR-QOL was significantly better for both APD and HD with small to moderate effect sizes. Cost-effectiveness analysis demonstrated an advantage for APD. Conclusions: Mexican ESRD patients have reduced HR-QOL, and sleep disorders may be an important driver of this finding. APD should be the preferred mode of dialysis in Mexico.

Health-related quality of life in a PD-First programme in South Africa

“…Although not examined in this study, when haemoglobin levels were previously examined between our HD and PD cohorts no significant differences were seen [15]. In our study, HD patients scored better in the domain of "energy/fatigue", they specifically reported feeling less worn-out and tired; this is similar to studies performed in Mexico, SA and Turkey [22][23][24]. It has been reported that patients with higher energy/fatigue scores also show better pain scores [17], which might explain the greater degree of pain experienced in our PD patients.…”

Factors Associated With Insomnia in Patients Undergoing Hemodialysis

“…The present study found that patients over 60 years old had statistically significantly higher levels of insomnia than younger patients. Similarly, in a previous study, it was found that a frequent complaint among elderly patients on hemodialysis was the early awakening in the morning [13]. It can be assumed that sleep problems in elderly people on hemodialysis are mostly caused by depressive disorders, cardiovascular problems, systemic inflammation, and comorbid diseases [14] leading to physical, cognitive, and emotional deterioration [15].…”

APD or CAPD: one glove does not fit all

“…It is worth mentioning that in a very recent study on APD patients the severity of obstructive sleep apnea was correlated with decreased RRF and not with dialysis-related indices [89]. In the aforementioned recent Mexican study, unrefreshing sleep, a symptom of insomnia, was more common in CAPD, while snoring and witnessed apneas were more frequent in APD patients [82].…”

“…Similarly, a non-statistically significant trend was shown in a recent Mexican study comparing 39 CAPD, 42 APD and 40 hemodialysis (HD) patients. APD compared to CAPD patients scored non-significantly higher in scales such as Quality of Life, Social Functioning and Physical Functioning [ 82 ]. In the same path, a study by Diaz-Buxo et al .…”