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Patients with end-stage renal disease (ESRD) undergoing long-term hemodialysis often experience a significant burden of incapacitating symptoms. While there is clear evidence of the relationship between dialysis adequacy measured by Kt/V and important clinical outcomes such as morbidity and mortality, its connection with the quality of life of these patients has not been fully explored. This study aimed to assess differences in the quality of life of patients undergoing hemodialysis, taking into account clinical and laboratory variables, including the Kt/V index.
A descriptive observational single-center study was conducted in April 2023, including adult patients undergoing hemodialysis for more than three months. Participants were administered the KDQOL-36 questionnaire to assess quality of life, and data on clinical history, socio-demographic variables, laboratory results, and hemodialysis sessions were collected. Statistical analysis was performed using the Chi-square test.
A total of 87 patients (72% male), with an average age of 67 years, participated in the study. The majority underwent online hemodiafiltration (74%), and the arteriovenous fistula was the main vascular access (90%). The most common comorbidity was arterial hypertension. It was observed that 64% of patients achieved a Kt/V index greater than 1.4.
Of the surveyed patients, 10% (n=9) reported excellent quality of life (score ≥ p90). In this group, 77% were women, and the mean Kt/V was 1.82, both parameters showing significant differences compared to the non-excellent quality of life group (p=0.005 and p=0.001, respectively). ( Table 1)
Table 1
Excellent Quality of Life (n= 9)
Non-Excellent Quality of Life (n=78)
p
KTV
1.82 (1.78-2.2)
1.43 (1.3-1.68)
0.0018
KTV OCM
1.90 (1.80-2.10)
1.40 (1.30 - 1.6)
0.0005
WEEKLY KTV >1.4
9 (100%)
47 (60%)
0.023
KTV OCM >1.4
9 (100 %)
50 (64%)
0.05
KTV >1.7
7 (78%)
16 (20%)
0.001
KTV OCM >1.7
7 (78%(
12 (16%)
p <0.001
Age
77 (67-80)
67 (53 - 79)
0.21
Effective Dialysis Time
250 (240-250)
0.94
Substitution Volume
23 (22-26)
22 (3-24)
0.18
Ultrafiltration Mean
2000 (1500-2500)
2000 (1500-2875)
0.71
Charlson Score
6 (5-7)
6 (4-7)
0.29
Frailty Score
5 (5-6)
4 (3-6)
0.24
Hemoglobin > 10
6 (67%)
69 (89%)
0.1
PTHi
209 (86 - 249)
335 (206-536)
0.095
Phosphorus
4.00 (3.4-4.4)
4.5 (3.9-5.56)
0.086
Albúmina
3.71 (0.41)
4.03 (0.33)
0.04
Albúmina >3.5
7 (77%)
75 (92%)
0.08
Women
18 (23%)
0.0019
Waiting List
1 (11%)
25 (32%)
0.26
Hemodiafiltration
8 (88%)
57 (73%)
0.43
Diabetes Type 2
3 (33%)
11 (14%)
0.15
Cardiovascular Event
37 (47%)
0.49
Arteriovenous Fistula
8 (89%)
70 (89%)
1
Time On Dialysis
838 (323-1803)
1028 (585-2389)
0.35
Weekly Erythropoietin Dose
8000 (4000-8000)
8000 (2500-12000)
0.62
Hospitalization <1 Year
15 (19%)
0.38
In this patient group, a significant association was observed between excellent quality of life and a higher average Kt/V index. This finding emphasizes the importance of considering dialysis adequacy, measured by Kt/V, as a key factor in the quality of life of patients undergoing long-term hemodialysis. These results underscore the need to investigate and optimize Kt/V levels as an essential part of clinical management, with the aim of improving the experience and well-being of patients with end-stage renal disease undergoing hemodialysis