4.2 Article

Quality of life in advanced renal disease managed either by haemodialysis or conservative care in older patients

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BMJ SUPPORTIVE & PALLIATIVE CARE
卷 13, 期 1, 页码 87-94

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BMJ PUBLISHING GROUP
DOI: 10.1136/bmjspcare-2020-002237

关键词

renal failure; supportive care; clinical decisions; quality of life

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The objective of this study was to report on quality of life and other functional outcomes in patients with advanced chronic kidney disease. The study found that patients receiving hemodialysis had significantly better scores on the Symptoms/Problems List subscale of the KDQoL-36 questionnaire compared to those under conservative management. However, there was no significant difference in the Burden of Kidney Disease subscale scores between the two groups. These findings suggest the use of quality of life assessment tools for clinical prognostication and appropriate management of advanced CKD patients.
ObjectiveConsideration of quality of life (QoL) in people with end-stage renal disease has become an important part of treatment decision-making. The aim of this study was to report on QoL and other functional outcomes in patients with advanced chronic kidney disease (CKD). MethodThis was a cross-sectional study. Two samples of older patients (>60 years old) either conservatively managed (CM) or receiving hospital-based haemodialysis (HD), compared Kidney Disease Quality of Life (KDQoL-36) outcomes. ResultsData from 263 CM patients (CKD 4 n=188, mean age 73.6 years, 48 women; CKD 5 n=75, mean age 74.4 years, 26 women) and 74 patients on HD (mean age 73.8 years, 24 women) were analysed. Significant group differences were identified for two subscales of KDQoL-36. Symptoms/Problems List subscale was significantly better for those receiving HD compared with those CM with CKD 5 (p=<0.001). Symptom/Problem List scores of CM CKD stage 4 patients were not significantly different compared with HD patients but were significantly better than CM CKD stage 5 patients (p<0.001). Burden of Kidney Disease subscale was significantly better for both CKD 4 (p<0.001) and CKD 5 (p<0.001) CM patients when compared with those receiving HD. ConclusionSymptoms of advanced CKD significantly impact QoL for patients CM with CKD stage 5. Conversely, QoL is significantly impacted for those in receipt of HD due to the burden of treatment. These findings provide evidence for the use of QoL tools to help with clinical prognostication in advanced CKD. Using QoL tools will ensure specialist support is available for appropriate management of patients with CKD.

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