ASSOCIATION BETWEEN DIALYSIS ADEQUACY AND HEALTH RELATED QUALITY OF LIFE IN MAINTENANCE HEMODIALYSIS IN A TERTIARY CARE CENTER OF NEPAL

Introduction:

Patients with end-stage renal disease (ESRD) have significant impairments in health related quality of life (HRQOL). Assessment of hemodialysis adequacy is one of the key determinants of quality of life (QOL) in patients with ESRD. Failure of adequacy is associated with increased morbidity, mortality, cost and burden on health care system. The effect of dialysis adequacy on health related quality of life have not been well studied in developing countries like Nepal.The aim of this study was to investigate whether dialysis adequacy is associated with HRQOL in maintenance hemodialysis (MHD) patients.

Methods:

A cross-sectional study was conducted in hemodialysis unit of a tertiary care center of Nepal in August to September 2024. All patients aged more than 18 years who had been on maintenance hemodialysis for ESRD for more than 6 months were enrolled in the study after written consent. Baseline information on demographic factors and detailed clinical information was collected. Dialysis adequacy was determined by using single pool kt/V. Aqequate dialysis was considered when kt/V was more than or equal to 1.2. HRQOL was assessed with the validated Nepali translated version of Kidney Disease Quality of Life Short Form-36 (KDQOL-SF-36) version 1.3, which is a disease specific as well as generic measure for the assessment of QOL. QOL were divided into poor, moderate and good on the basis of mean± one standard deviation scores. Frequency and percentage were calculated for descriptive analysis ,Chi-square test was used for inferential analysis and Odd's ratio was used to evaluate strength of association. P value <0.05 was considered statistically significant. 

Results:

A total of 117 patients were included in the study. The mean age of the study population was 44.37±15.39 years and 77 (65.8%) were male.The mean kt/V was 1.31±0.36. Sixty nine (58.97%) patients received adequate dialysis (mean kt/V=1.54±0.26) while the rest did not achieve adequate dialysis (mean kt/V=0.97±0.19).The mean QOL score for physical component summary (PCS), mental component summary (MCS),kidney disease component summary (KDCS) and overall QOL score were 66.92± 22.32, 55.21±18.95, 66.36±12.99 and 61.04±19.84.The prevalence of good QOL among CKD in the domains of the physical component summary (PCS), mental component summary (MCS), kidney disease component summary (KDCS) and overall QOL scores were 19.66, 23.08%, 12.28%, and 23.93%, respectively. Duration of MHD were not significantly different for those adequately dialysed, compared to the rest. Also no improvement in any QOL parameter was found in those with Kt/V>1.2 (adequate HD). In the present population, patients with average kt/V values greater than or equal to 1.2 did not have significantly better HRQOL. Thus, in our cohort, association between dialysis adequacy and HRQOL was not statistically significant.

Conclusions:

In our study population, dialysis adequacy was seen in more than half of patients. However, HRQOL as determined by KDQOL-SF-36 was poor in more than half of the patients. The study concluded that patients on MHD had overall low HRQOL scores in all domains. In our cohort, dialysis adequacy was not significantly associated with HRQOL. Multicentric studies with larger sample size that examine the effect of increasing kt/V on HRQOL are needed to generalize the results 

I have no potential conflict of interest to disclose.

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