Quality of Life and Physical Function in Older Patients on Dialysis

Abstract

Background and objectives In-center hemodialysis (HD) is often the default dialysis modality for older patients. Few centers use assisted peritoneal dialysis (PD), which enables treatment at home. This observational study compared quality of life (QoL) and physical function between older patients on assisted PD and HD.Design, setting, participants, & measurements Patients on assisted PD who were .60 years old and on dialysis for .3 months were recruited and matched to patients on HD (needing hospital transport) by age, sex, diabetes, dialysis vintage, ethnicity, and index of deprivation. Frailty was assessed using the Clinical Frailty Scale. QoL assessments included Hospital Anxiety and Depression Scale (HADS), Short Form-12, Palliative Outcomes Symptom Scale (renal), Illness Intrusiveness Rating Scale, and Renal Treatment Satisfaction Questionnaire (RTSQ). Physical function was evaluated by Barthel Score and timed up and go test. ResultsIn total, 251 patients (129 PD and 122 HD) were recruited. In unadjusted analysis, patients on assisted PD had a higher prevalence of possible depression (HADS.8; PD=38.8%; HD=23.8%; P=0.05) and higher HADS depression score (median: PD=6; HD=5; P=0.05) but higher RTSQ scores (median: PD=55; HD=51; P,0.01). In a generalized linear regression model adjusting for age, sex, comorbidity, dialysis vintage, and frailty, assisted PD continued to be associated with higher RTSQ scores (P=0.04) but not with other QoL measures.Conclusions There are no differences in measures of QoL and physical function between older patients on assisted PD and comparable patients on HD, except for treatment satisfaction, which is higher in patients on PD. Assisted PD should be considered as an alternative to HD for older patients, allowing them to make their preferred choices.

Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis

“…This study showed that the frailty score was associated with lower physical function and higher illness intrusiveness and symptom scores; the only difference between the two dialysis modalities was a higher treatment satisfaction score on aPD [12]. Given these findings, we hypothesized that outcomes of QoL and physical function would be similar between older patients on dialysis and suitably matched patients receiving conservative care for ESKD.…”

“…The FEPOD cohort, which has been previously described [12], consists of older patients on HD and aPD (n ¼ 251). They had been recruited from the same renal centres, between June 2011 and December 2013.…”

Dialysis in the Elderly and Impact of Institutionalization in the United States Renal Data System

“…The morbidity risk is also considerable, with a high prevalence of falls and hospitalization. These issues should be discussed with older patients with advanced kidney disease and their families to allow them choose the most appropriate therapy [28]. Recent reports suggest peritoneal dialysis to be a beneficial treatment strategy for fluid status control in patients with refractory congestive heart failure in terms of hospitalization rates and duration [29,30].…”

Implementing Assisted Peritoneal Dialysis in Renal Care: a Chinese-German Perspective

“…But, cost-effectiveness of assPD compared to in-center (hemo-) dialysis is finally undefined and biased by different mode of calculations and costs included [review by 27]. Nevertheless, in the lack of economical implications level of treatment satisfaction may favour patients´ preferences in assPD modality choice [39].…”

“…Quality of life and physical function in older patients on assPD are equal compared to similar hemodialysis patients, but treatment satisfaction in assPD is higher [39]. This is supported by quality of life assessment in older patients where PD patients experienced less illness and treatment intrusion compared to those on hemodialysis [41].…”