QUALITY OF LIFE IN PATIENTS ON HEMODIALYSIS : PSYCHOSOCIAL AND CLINICAL VARIATES

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QUALITY OF LIFE IN PATIENTS ON HEMODIALYSIS : PSYCHOSOCIAL AND CLINICAL VARIATES

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Co-author 1

Urmila Anandh uanandh@gmail.com Amrita Institute of Medical Sciences and Research Nephrology Faridabad, Delhi NCR India *

Co-author 2

Rakesh Chadda rakesh.kumarchadda@fbd.amrita.edu Amrita Institute of Medical Sciences and Research Psychiatry Faridabad, Delhi NCR India -

Co-author 3

Sonali Aggarwal sonaliaggarwal@fbd.amrita.edu Amrita Instiyute of Medical Sciences and Research Psychiatry Faridabad , Delhi NCR India -

Co-author 4

Nandini Shukla nandini.shukla@fbd.amrita.edu Amrita Institute of Medical Sciences and Research Clinical Psychology Faridabad , Delhi NCR India -

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Introduction

Chronic kidney disease (CKD) is an important contributor to the global burden of disease. In low and middle income countries, the diagnosis of chronic kidney disease is often at an advanced stage. Most of the patients need dialysis, sometimes for an extended period of time as prospects of receiving a kidney is very low. This largely impacts the quality of life of patients in terms of physical as well as mental well being. This study aims to evaluate the quality of life in patients with CKD on dialysis, encompassing their physical and mental well being, and treatment adherence.

Methods

The study was an observational, cross sectional study conducted in the dialysis unit of a tertiary care hospital from 1st July 2024 to 30th June 2025 . Seventy five subjects were interviewed and their socio demographic data and clinical history were recorded. Their biochemical data were also noted .Kidney Disease Quality of Life instrument - 36 (KDQOL-36), End Stage Renal Disease Adherence Questionnaire (ESRD-AQ), and Depression, Anxiety and Stress Scale (DASS-21) were used to assess quality of life, treatment adherence, depression, anxiety and stress among the patients.

Results

Thirty four percent of subjects undergoing dialysis (with CKD) screened positive on DASS-21. Sixteen subjects screened positive for depression [mild (10), moderate (5), severe (1)] with median score of 3 and IQR 0-9. Eight subjects were screened positive for anxiety [mild (3), moderate (4), severe (1)] with median score of 2 and IQR 0.5-4. 2 subjects were screened positive for stress [mild (1), moderate (1)] with median score of 4 and IQR 2-8. The mean scores of KDQOL-36 subscales burden of kidney disease Mean age of the subjects was 54.61 =/- 15.68 years, with male to female ratio of 1.14:1. Median duration of hemodialysis was 11 months [Interquartile range (IQR): 5-24 months]. Most common medical comorbidity was hypertension (47.83%) followed by diabetes mellitus (21.74%), hypothyroidism (11.96%), coronary artery disease (8.7%), cerebrovascular disorder (2.17%), infection (2.17%) and malignancy (1.09%). Thirty four percent of subjects undergoing dialysis (with CKD) screened positive on DASS-21. Sixteen subjects screened positive for depression [mild (10), moderate (5), severe (1)] with median score of 3 and IQR 0-9. Eight subjects were screened positive for anxiety [mild (3), moderate (4), severe (1)] with median score of 2 and IQR 0.5-4. 2 subjects were screened positive for stress [mild (1), moderate (1)] with median score of 4 and IQR 2-8. The mean scores of KDQOL-36 subscales burden of kidney disease (BKD), symptoms/ problems due to kidney disease (SPKD), effects of kidney disease (EKD), physical and mental component summary (PCS, MCS) found to be 32.83 +/- 24.45, 77.94 +/- 17.76, 70.67 +/- 19.54, 35.9 +/- 7.55, 40.7 +/- 10.46 respectively. Sixty nine (92%) subjects had good adherence with mean score of 1111.33 +/- 117.33 SD (IQR: 1100-1200) while the rest had moderate to poor adherence to their dialysis schedule, medications, fluid restrictions, and diet as per ESRD-AQ scale. Mean score obtained on attitude and perception subscale was 10.19 +/- 3.55 SD (IQR: 8-11).

Conclusion

Most of the patients on maintenance dialysis are old and frail with a huge emotional baggage along with myriad medical comorbidities. The study, thus highlighted the common occurrence of depression, anxiety and stress among these patients due to their long and exhausting dialysis schedules, strict adherence to medicines, diet and fluid restrictions and associated symptoms, problems and effects of kidney disease. However, most of the patients had good compliance and adherence to their schedule. But a few found it emotionally and physically challenging to follow. Hence, routine mental screening, counselling, and education may help improve the quality of life of patients on dialysis.

Kewords