FP715MEASURING WHAT MATTERS IN KIDNEY DISEASE: THE INFLUENCE OF TREATMENT MODALITY ON QUALITY OF LIFE

Abstract

Introduction and Aims: Health-related quality of life (HRQOL) is an important outcome measure in patients needing renal replacement therapy (RRT) as it has been shown to predict mortality. It is also a key factor guiding patient decision making. However, there is surprisingly little robust data available on the QOL of patients on RRT in the UK. In this study, we measured HRQOL in RRT patients, determined the factors associated with it and compared it with normative data from the general population. Methods: This was a cross-sectional survey undertaken as part of the Welsh Renal Network's 2014 audit programme. The KDQOL-SF and SF-36 questionnaires were used to assess QOL in dialysis and transplant patients respectively. SF-36 normative data for the region's general population was available from published literature. Multiple linear regression (MLR) analysis was used to study factors associated with SF-36 composite scores. The response rate was 52%. The total number of patients who responded was 497 [main unit haemodialysis (HD, n=68), satellite HD (n=307), peritoneal dialysis (PD, n=49), home HD (n=19) and transplant (n=54, all patients included were 12-14 months post transplant)]. Results: Physical and mental composite scores (PCS and MCS) were significantly higher amongst transplant patients compared to home therapies and unit HD patients respectively (PCS: 43.5±11.1, 31.6±8.3, 32.4±9.7; p<0.001, MCS: 46.8±10.1, 41.6±12.6, 42.5±11.8; p=0.03). On MLR analysis corrected for age and gender, transplanted state and the number of co-morbidities were both significantly associated with PCS [transplant B= 9.30 (95% CI 6.30-12.30) and co-morbidity B= -2.53 (-3.61 --1.46)] and MCS [B= 5.70 (2.09-9.31) and B= -2.20 (-3.50 --0.90)] respectively. There were no significant differences in KDQOL disease-specific scores between unit HD, home HD and PD. Individual dimension scores of the physical and mental domains of SF-36 in patients <60 years old (top panel) and >60 years old (bottom panel) are shown in the figure. " QOL gap " between dialysis patients and the general population was particularly marked in younger patients. Although younger transplant patients reported lower QOL than their general population peers, older recipients' scores were similar to those of the general population, especially the mental domain scores. Conclusions: Transplant patients reported better QOL as compared to patients on dialysis. The younger dialysis patients in particular report low physical and emotional well being. Unexpectedly, patients on home therapies did not report better QOL than those on unit based dialysis. This study has potentially important implications for future service development (such as the role of psychology/physiotherapy support) and for patient decision making.