QUALITY OF LIFE OF FILIPINO ADULTS WITH CHRONIC KIDNEY DISEASE ON HEMODIALYSIS AND PERITONEAL DIALYSIS IN THE CORDILLERA REGION

BACKGROUND:  

Chronic kidney disease (CKD) is a growing concern in the Philippines, with around 100,000 patients currently requiring dialysis. The World Health Organization (WHO) reports that the number of new CKD cases has been increasing by approximately 15% each year over the past decade. This rise is primarily driven by uncontrolled diabetes and hypertension, both of which are major risk factors for kidney disease that may eventually necessitate dialysis. Dialysis serves as a temporizing measure until a kidney transplant, the gold standard for treatment, can be performed. However, despite the high disease burden, the rate of kidney transplantation in the Philippines remains low. In addition, there is a significant gap in understanding the quality of life (QoL) differences between patients undergoing hemodialysis (HD) and peritoneal dialysis (PD), the two primary treatment modalities for end-stage renal disease (ESRD). While both HD and PD are widely used, existing studies present conflicting and inconclusive results regarding which approach offers a superior QoL. This gap in knowledge is further complicated by a lack of comprehensive research that addresses the psychosocial, emotional, and lifestyle aspects of patients’ well-being.

OBJECTIVE:  

To determine the  Quality of Life (QoL) of  young adult patients with CKD  undergoing HD compared with PD using World Health Organization Quality of Life  (WHO-BREF QoL) questionnaire.

A cross-sectional study was conducted at a tertiary hospital in Baguio City Philippines, involving adult CKD patients undergoing HD and PD. Participants completed the self-administered WHO-BREF QoL questionnaire, which evaluates four domains of QoL: physical health, psychological health, social relationships, and environment. Each item was  rated on a Likert scale, with higher scores indicating better QoL. An independent t-test was used to compare the QoL scores across the two groups, providing insights into potential differences in the impact of HD and PD on patients’ well-being

RESULTS

TABLE 1: CLINICO DEMOGRAPHIC PROFILE OF HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS

            Table 1 shows the Demographic data wherein out of 112 respondents,  a total of 86  adult CKD patients gave their consent, underwent and completed the study.  It shows that majority of the population of patients undergoing hemodialysis and peritoneal dialysis  where under the age group of 45-60 which is the middle aged group which has no statistically significant association between age distribution and dialysis modality (p = 0.244). With regards to sex, a higher proportion of males were in the PD group (57.7%) compared to the HD group (36.7%) however it was not statistically significant at the 0.05 level. Both groups also showed that most of the HD and PD patients where being supported financially as well as socially. When it comes to comorbidities pertaining to physical disability their are more patient observed in the HD group, however the difference between groups was not also statistically significant. Almost all of the patients in both groups are also residing in the Cordillera Administrative Region. In both groups, majority were functionally independent, with the majority in both groups falling under Performance Status 1 (HD: 76.7%, PD: 84.6%). No patients in the PD group had Performance Status levels 0, 3, or 4. Despite these differences, there was no statistically significant association between WHO Performance Status and dialysis type (p = 0.397)

In this study, none of the examined clinicodemographic variables were significantly associated with the type of dialysis treatment received by CKD patients.

TABLE 2:  Comparison of Quality of life scores adults CKD V on HD

Table 2 shows the Comparison of quality of life scores among hemodialysis and peritoneal dialysis patients. It showed that there is no significant difference on the average quality of life scores in terms of physical health, psychological, social, environmental and overall health of the CKD patients undergoing HD and patients undergoing PD. Whereas, there is a significant difference Satisfaction with health, of the CKD patients undergoing HD and PD, with PD having a higher domain scores reflecting better quality of life.

 DISCUSSION

This study compared 86 adult CKD patients undergoing either hemodialysis (HD) or peritoneal dialysis (PD), highlighting differences in clinicodemographic characteristics and their association with dialysis type. The clinicodemographic traits of patients receiving HD and PD did not differ significantly in this study. There was no statistically significant correlation between the type of dialysis modality and factors like age, sex, comorbidity status, WHO performance status, or place of residence. Additionally, both patient groups received steady financial and social support, which might have helped them access treatment options. These imply that, in our context, clinical judgment, resource availability, or patient preference are probably more important factors in determining the choice between hemodialysis and peritoneal dialysis than demographic or baseline clinical characteristics.

Using the WHOQOL-BREF instrument the study also evaluated several aspects of quality of life (QoL), such as physical, psychological, social, environmental, and general well-being, using the WHOQOL-BREF instrument.  According to the results, the average scores for each of these domains did not significantly differ between the HD and PD groups. However, PD patients score higher on health satisfaction, which differ significantly with HD patients (p = 0.001). This is also consistent with earlier research indicating that patients prefer PD in terms of control and general well-being.

Previous studies  also showed mixed findings on QoL comparisons between HD and PD. While several studies (e.g., Joshi et al., Goncalves et al., and Depaynos et al.) support the notion that PD offers better QoL due to its flexibility and fewer restrictions, other research (e.g., Chin et al., Wakeel et al., and Wu et al.) suggests that HD patients may benefit from more structured care and support, resulting in better physical functioning. These contrasting perspectives highlight that QoL is multifactorial and influenced by both treatment-related and personal variables, including mental health, social support, comorbid conditions, and healthcare access.

In conclusion,  this study shows no significant differences between hemodialysis (HD) and peritoneal dialysis (PD) patients in terms of age, sex, comorbidities, performance status, or area of residence. All patients had steady  social and financial support. Quality of life scores were also similar between the two groups in most areas, including physical, psychological, social, environmental, and overall well-being. However, PD patients were significantly more satisfied with their health (p = 0.001). This suggests that while patient background does not seem to influence treatment choice, PD may offer some advantages in how patients feel about their health, highlighting the importance of considering patient experiences when choosing a dialysis method. With previous studies showing mixed findings on the quality of life between HD and PD patients, this study shows that QoL among patients is complex and is influenced by variety of individual and treatment related factors. These results showed that shared decision making and individualized treatment are important in choosing a dialysis modality.