EXPLORING QUALITY OF LIFE IN ELDERLY END-STAGE KIDNEY DISEASE PATIENTS: INSIGHTS FROM A CROSS-SECTIONAL STUDY

Introduction:

End-stage kidney disease (ESKD) profoundly impacts the quality of life (QOL) in elderly patients, with factors like age, gender, and socioeconomic status playing a key role. Older patients, those with lower education levels, and limited social support face the greatest challenges. Research shows that home dialysis often leads to better physical health outcomes compared to in-centre hemodialysis. This study delves into these crucial factors, offering fresh insights to enhance the care and QOL of elderly ESKD patients. By uncovering these insights, we aim to drive better care strategies that not only extend life but also enhance the well-being of those living with this relentless disease.

Methods:

We selected elderly ESKD patients aged 55 and above, both with and without dialysis, from Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia and Hospital Sultan Idris Shah, Serdang, Malaysia excluding individuals with significant cognitive impairment or pre-existing psychiatric conditions. We used a translated and validated questionnaire Kidney Quality of Life Instrument (KDQOL-36) for patients while clinical laboratory data were extracted from the hospital electronic system.  Clinical data, along with responses from the KDQOL-36 questionnaire, were analysed using the latest SPSS software.

Results:

We evaluated 100 elderly ESKD patients in three groups: no RRT, haemodialysis (HD), and peritoneal dialysis (PD). The mean ages were 71.21 (No RRT), 68.57 (HD), and 63.9 (PD). 88% of the patients had hypertension, 74% had diabetes, and 29% had ischaemic heart disease. The average RRT duration for HD was 5.69 years, and for PD, it was 2.04 years. Age significantly influenced the choice of dialysis modality, with younger patients more likely to opt for Peritoneal Dialysis (PD) (p = 0.011). Marital status (p=0.017), Malay race (p=0.020), Indian race and burden (p=0.038), and ischaemic heart disease (p=0.015) were associated with mental health. Comorbidities like hypertension and diabetes were prevalent and associated with poorer health outcomes, contributing to lower QOL, though differences in comorbidity rates were not statistically significant. Haemoglobin and urea levels are strongly correlated with Quality of Life (QOL) in elderly ESKD patients, with haemoglobin levels nearly significant among groups (p = 0.055) and urea levels significantly different (p = 0.016). Low haemoglobin levels, indicating anaemia, caused fatigue and poor physical function, lowering QOL. High urea levels, indicating poor renal function and waste accumulation, caused weakness and cognitive problems, worsening these patients' well-being. PD patients had superior quality of life with higher scores in symptoms (82.77), effects (67.33), and burden (50.57).

Conclusions:

We found that younger individuals opting for Peritoneal Dialysis (PD) experienced better Quality of Life (QOL). Key factors influencing QOL included age, comorbidities, and blood parameters such as haemoglobin and urea levels. Effective management of anaemia and kidney function is essential for enhancing QOL in this patient population.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.