MARKED DISPARITY IN QUALITY OF LIFE: IDENTIFYING MODIFIABLE DETERMINANTS AND THE BURDEN OF DIALYSIS VINTAGE IN AN URBAN SOUTH INDIAN CKD COHORT

The escalating burden of End-Stage Kidney Disease (ESKD) in the Asia-

Pacific region, predominantly driven by a high prevalence of inadequately controlled noncommunicable

diseases, necessitates urgent research into patient-centric outcomes. Health-

Related Quality of Life (HRQoL) is a powerful, prognostic indicator often overlooked in

resource-constrained settings that prioritize survival. Poor HRQoL predicts non-adherence,

increased healthcare utilization, and mortality. This study provides a rigorous, contemporary

assessment of HRQoL among maintenance dialysis patients at a major tertiary center in

Bengaluru, South India, aiming to quantitatively isolate the most significant demographic and

clinical predictors of reduced well-being. The findings are intended to inform cost-effective,

multidisciplinary interventions relevant to the unique challenges of the South Asian

healthcare environment.

This was a six-month (January–June 2024), prospective, cross-sectional study.

We recruited 150 adult ESKD patients (Age >18years) established on either

Hemodialysis (HD) or Peritoneal Dialysis (PD) for at least three months. Exclusion was

limited to patients with acute cognitive compromise. HRQoL was assessed using the

internationally recognized, validated Kidney Disease Quality of Life-Short Form

(KDQOL-SF™), providing generic SF-36 scores (Physical Component Summary [PCS],

Mental Component Summary [MCS]) and 11 kidney-disease-specific scores. Data included

socio-demographics and key clinical variables: dialysis vintage (months), type of dialysis,

primary co-morbidities (Diabetes Mellitus [DM], Cardiovascular Disease [CVD]),

Hemoglobin (Hb), and Serum Albumin. Statistical analysis employed SPSS version 26.

Inferential statistics, including t-tests and multiple linear regression, were utilized to

establish independent predictors of HRQoL domain scores, with significance set at p<0.05.

The cohort (N=150) had a mean age of 52.5 +/-12.8 years, with 65.3%

male and a high median dialysis vintage of 32 months (IQR: 18–60 months). We observed a

marked disparity between physical and mental well-being: the mean PCS score (40.1 +/- 11.5) was profoundly diminished compared to established general population norms, while

the MCS score (51.2 +/- 10.4) was relatively preserved, suggesting significant mental

resilience in the face of physical decline. The most debilitating disease-specific domain

scores were the Symptom/Problem List (45.2 +/- 15.1) and the Burden of Kidney

Disease (49.8 +/- 14.5). Crucially, correlational analysis revealed a strong and statistically

significant negative association between long-term dialysis vintage (>5 years) and PCS

scores (r = -0.38, p<0.001), indicating a progressive erosion of physical function

independent of initial diagnosis. Multiple regression models identified chronic anemia (Hb

<10 g/dL) and co-morbid DM (Type 2) as highly significant independent predictors

of diminished scores across the Physical Functioning and Energy/Fatigue scales (p<0.01

for both).

HRQoL is severely compromised in this South Indian dialysis cohort, with

the primary morbidity concentrated in the physical, functional, and symptom-related

domains. This study provides actionable data for resource allocation, demonstrating that

while mental resilience is high, proactive intervention against long-term physical decay is

essential. The clear negative impact of dialysis vintage, anemia, and diabetes mellitus

necessitates a paradigm shift towards mandatory, structured, multidisciplinary interventions.

We advocate for the routine integration of tailored physical rehabilitation programs and

intensified clinical targets (Hb and glycemic control) alongside dialysis, establishing a cost effective,holistic care model applicable across similar ESKD centers in Asia to enhance both

the duration and quality of life.