Introduction:
Patients with end-stage kidney disease (ESKD) are faced with the dilemma of choosing the modality of dialysis. This study aims to compare the quality of life, caregiver burden, and financial costs of maintenance hemodialysis (MHD), as compared to continuous ambulatory peritoneal dialysis (CAPD).
Methods:
This was a single-centre, cross-sectional, observational study done at the Institute of Nephrology, Madras Medical College, in August 2023. Patients undergoing MHD and CAPD with a minimum dialysis vintage of 10 months were included in the study. Patient-perceived quality of life was measured using the European Quality of Life 5 Determinants/Visual analogue scale (EQ5D/VAS), and caregiver burden was assessed using the Caregiver Zarit questionnaire-22. Additionally, information relating to out-of-pocket expenditure, as reported by the patient, was also collected. This excludes the costs of healthcare that are subsidised by the state (ie, monthly expenditure of Rs 4700 for the consumables used for MHD, and Rs. 18900 for CAPD fluid and consumables). Appropriate statistical analyses were performed to make comparisons between patients on MHD and CAPD.
Results:
A total of 161 patients were studied, of whom 70 were on CAPD (43.5%) and 91 were on MHD (56.5%). The median age of patients 46 years (IQR-22 [14-73]) on CAPD and 43 years (IQR-17 [13-75]) on MHD. The median dialysis vintage was 14 months (IQR-6[10-70] in patients on CAPD, and 36 (IQR-54[10-158]) months in patients on MHD. CAPD was initiated as the first mode of renal replacement therapy in 25 (35.7%) patients, remaining were transferred from hemodialysis due to multiple access failure or intolerance to hemodialysis. The baseline characteristics of the cohorts were comparable in terms of age, mean hemoglobin, serum alkaline phosphatase and serum albumin. The proportion of patients with male gender (71.43% MHD VS 57.14% CAPD) and hypertension (87.9% MHD VS 72.8% CAPD) were more in MHD group whereas proportion of patients with coronary artery disease were higher in CAPD (24.2%) compared to MHD group (5.4%). The patient’s spouse was the most common caregiver in both groups (46.5% in CAPD and 50.5% in MHD). With regard to the EQ5D score, more patients in the HD group had worse scores in the domains of anxiety/depression, pain and ease of performing daily activities. The median EQ5D/VAS score was 75 [IQR (70-80)] in patients on CAPD and 70 [IQR (60-75)] in patients on MHD (p<0.001). The median Caregiver Zarit questionnaire score was 30 [IQR (22-34)] and 33 [IQR (22-42)] in CAPD and MHD respectively (p=0.6). The median out-of-pocket expenditure per month was Rs 2000 (1500-2500) and Rs 3600 (2400-4800) in CAPD and MHD groups respectively (p=0.01).
Conclusions:
More patients on hemodialysis had clinically significant levels of anxiety/depression, pain and had more difficulty in performing daily activities. When assessed by the EQ5D/VAS, the quality of life was superior in the CAPD cohort. However, caregiver burden were similar between the MHD and CAPD groups. Out-of-pocket expenditure was significantly higher in patients on MHD compared with CAPD. However this finding is to be interpreted in the context of the governmental subsidies and implementation of the Makkalai Thedi Maruthuvam (MTM) programme [“Medicine at people’s doorstep”] as through which CAPD bags were delivered at the doorsteps for the patients in the state of Tamil Nadu.
Limitations:
The Disability Adjusted Life Years (DALY) of patients and environmental impacts due to carbon footprints are not compared between CAPD and MHD cohorts in this study.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.