SP460DIALYSIS ADEQUACY AND QUALITY OF LIFE OF DIABETIC AND NONDIABETIC BANGLADESHI PATIENTS ON MAINTENANCE HAEMODIALYSIS

Abstract

INTRODUCTION AND AIMS: Quality of life (QOL) is one of the chief areas required to be addressed when caring for people with end stage renal disease (ESRD). The continual function of the native kidneys to excrete uraemic toxins are replaced in such patients by few sessions of few hours of rapid and enforced urea clearance in an entire week. This study aimed to explore whether greater number of weekly hemodialysis sessions and higher weekly hemodialysis adequacy do improve patient's QOL and if this is beneficial enough at the extra cost of taking additional dialysis sessions for people in a low income country like Bangladesh. Whether being diabetic influences QOL was also investigated. METHODS: This cross-sectional study recruited 135 adults (60% males) who were on maintenance haemodialysis (MHD) for 3 months or more from dialysis centers of three tertiary care hospitals in Dhaka from January to December, 2013. Patients with advanced malignancy, dementia and psychosis were excluded. Patients were interviewed once by the investigators to fill a validated Bangla version of the kidney disease quality of life short form questionnaire (KDQOL-SF-36 version 1.3) and calculate a score for QOL. Several clinical parameters were recorded for each patient and a few laboratory tests were run (including those necessary to calculate dialysis adequacy). The data was analyzed with SPSS 11.5.0 using Student's t-tests and ANOVA where applicable. Statistical significance was set at p<0.05. RESULTS: Mean age, mean duration of chronic kidney disease (CKD) and MHDwere 50612 years, 4.965.1 years and 12611.8 months respectively. Diabetes was the commonest aetiology of ESRD (60%). Overall QOL score for the study sample was 50617. Only 43 (31.9%) patients received adequate haemodialysis with a mean Kt/V of 1.3 while the rest (with Kt/V<1.2) had achieved an average Kt/V of 0.8 (p<0.001). Number of months since commencement ofMHDand blood hemoglobin, serum total protein, albumin, ferritin as well as transferin saturation were not significantly different for those who received adequate dialysis compared to the rest. No improvement in any of the QOL parameters assessed was found to be present in those with with Kt/V>1.2 (adequate dialysis). However, when a comparison was made between those with 3 dialysis sessions/week (n=63 with meanMHDduration of 24614 months) with patients receiving 2 dialysis sessions/week (n=72 with meanMHDduration of 8.4±11 months), the former group had lower “effect of kidney disease” scores (p=0.021), higher “quality of social interaction” scores (p=0.031) and lower “role emotion” scores (p=0.002). When quality of life parameters were compared between diabetic patients (n=82, mean age 5468 years,MHDduration 18.569.5 months) and non-diabetic subjects (n=53, aged 42613 years,MHDduration of 25616 months), “effects of kidney disease”, “cognitive function” and “quality of social interaction” scales were significantly higher in those having diabetes (with p<0.045, p<0.024 and p<0.022 respectively). CONCLUSIONS: Achieving a hemodialysis adequacy (Kt/V>1.2) was not found to improve QOL scores in the study subjects and therefore bearing the extra cost of an additional dialysis session per week may not be advisable for those not so well off.