QUALITY OF LIFE IN MAINTENANCE DIALYSIS PATIENTS: A PROSPECTIVE OBSERVATIONAL STUDY OF IN-HOSPITAL HEMODIALYSIS, HEMODIAFILTRATION AND HOME PERITONEAL DIALYSIS

 

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https://storage.unitedwebnetwork.com/files/1099/2a1a789f5d6527a48c3954f7423f51ec.pdf
QUALITY OF LIFE IN MAINTENANCE DIALYSIS PATIENTS: A PROSPECTIVE OBSERVATIONAL STUDY OF IN-HOSPITAL HEMODIALYSIS, HEMODIAFILTRATION AND HOME PERITONEAL DIALYSIS

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Dinesh
Khullar
Ashok Kumar ashokbaroda04@gmail.com Max Super Speciality Hospital, Saket Nephrology and Renal Transplant Medicine New Delhi Iran -
Dinesh Khullar drdineshkhullar@gmail.com Max Super Speciality Hospital, Saket Nephrology and Renal Transplant Medicine New Delhi India *
Deepak Panigrahi drdeepaklhmc@gmail.com Max Super Speciality Hospital, Saket Nephrology and Renal Transplant Medicine New Delhi India -
Rahul Grover Rahul.grover@maxhealthcare.com Max Super Speciality Hospital, Saket Nephrology and Renal Transplant Medicine New Delhi India -
Kulwant Singh kulmin2k2@gmail.com Max Super Speciality Hospital, Saket Nephrology and Renal Transplant Medicine New Delhi India -
Abhishek . abhishek91086@gmail.com Max Super Speciality Hospital, Saket Nephrology and Renal Transplant Medicine New Delhi India -
Narinder Pal Singh nanusingh58@gmail.com Max Super Speciality Hospital, Saket Nephrology and Renal Transplant Medicine New Delhi India -
Anish Gupta gupta_ani2007@rediffmail.com Max Super Speciality Hospital, Saket Nephrology and Renal Transplant Medicine New Delhi India -
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Individuals with chronic kidney disease (CKD) undergoing maintenance dialysis encounter substantial lifestyle restrictions, emotional strain, and economic challenges that together affect their overall quality of life (QoL). With the expanding use of various dialysis modalities in India, it is increasingly important to evaluate their influence on patient-reported quality-of-life outcomes. Aim of the study was to assess quality of life indices in patients undergoing maintenance dialysis and compare QoL between in-hospital dialysis (hemodialysis/Hemodiafiltration) and home peritoneal dialysis (PD).

The cross-sectional study was conducted over one year in a tertiary care hospital from North India. Adult CKD stage 5D patients on maintenance dialysis for ≥3 months were enrolled after informed consent. Exclusion criteria included neurological deficit, psychiatric illness, substance abuse, and viral seropositivity (HBsAg/HCV/HIV). Demographic, clinical, and biochemical data were recorded. QoL was assessed using the WHOQOL-BREF questionnaire, encompassing four domains—physical, psychological, social, and environmental. Statistical analysis was performed using IBM SPSS v28. Continuous variables were analyzed using t-test or ANOVA; categorical data with Chi-square test. A p-value < 0.05 was considered significant.

A total of 114 dialysis patients (90 in-hospital, 24 PD) were included. Among the in-hospital group, 43 patients received HD and 47 HDF. Mean age was 55.96 ± 14.56 years, 64.9% were male, and mean BMI was 25.66 ± 4.85 kg/m². Most patients (96.5%) had comorbidities—hypertension (91.2%), diabetes (28.9%), and thyroid disorder (14.9%). Mean dialysis vintage was 3.43 ± 3.21 years. Biochemical parameters were comparable between groups except for higher serum creatinine and PTH, and lower calcium and SGOT levels in the in-hospital group.
Overall mean WHOQOL-BREF scores were: physical 54.08 ± 8.70, psychological 56.70 ± 8.49, social 52.30 ± 9.83, and environmental 52.98 ± 8.29; total 54.02 ± 6.24. Compared with PD, in-hospital dialysis patients had significantly lower physical, psychological, and environmental domain scores, but higher social domain scores. Overall QoL did not differ significantly between HD + HDF and PD. QoL showed no association with age, sex, BMI, or major comorbidities, though thyroid disorders and higher phosphorus and TSH levels correlated negatively with QoL. Among in-hospital patients, dialysis frequency had no effect on QoL, but HDF patients had significantly better domain and total scores than HD patients. On comparison across modalities, HD patients demonstrated the lowest QoL in all domains except social, where HDF patients had the highest scores.

Maintenance dialysis significantly impairs patients’ quality of life. Among modalities, home peritoneal dialysis and in-hospital hemodiafiltration were associated with better QoL than conventional hemodialysis. These findings highlight the need to promote patient-centric, home-based dialysis options and optimize comorbidity management to improve overall well-being in Indian dialysis populations. Further studies with larger sample sizes are recommended to explore various dimensions of the problem and interrelationships of different factors affecting quality of life.

Kewords