SP348AN EVALUATION OF HEALTH-RELATED QUALITY OF LIFE IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS AND AUTOMATED PERITONEAL DIALYSIS MODALITIES

Abstract

Introduction and Aims: Health-related quality of life (HRQOL) is an important predictor of clinical outcomes for ESRD patients and therefore HRQOL has been suggested to be used as a valuable supplement to clinical outcome measures. HRQOL of patients undergoing ESRD treatment is affected by both medical and nonmedical factors. However, there are only few studies on factors influencing HRQOL in peritoneal dialysis (PD) patients and amongst Asian ESRD patients. This study aims to compare and evaluate the health-related quality of life (HRQOL) in Asian end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) in Singapore. Methods: Data used in this study were from two cross-sectional surveys conducted between 2009 and 2013. Participants were recruited from the PD centers of Singapore General Hospital and National University Hospital. The inclusion criteria were ESRD patients who has been on PD for at least 3 months and is at least 21-years-old. In both surveys, participants completed the Kidney Disease Quality of Life (KDQOL) instrument and questions assessing socio-demographic characteristics. Co-morbidities, clinical, and dialysis-related variables (i.e. vintage, dialysis adequacy, dependency status [self-cared/assisted]) were retrieved from medical records. The 36-item KDQOL (KDQOL-36) was used to generate two generic summary scores (physical component summary [PCS], mental component summary [MCS]), three disease-specific scales (Symptoms, Effects, Burden), and two health utility scores (Short Form 6-Dimension [SF-6D] and EuroQol 5-Dimension [EQ-5D]). For all these scales, higher scores indicate better HRQOL. The HRQOL of patients treated with CAPD and APD measured by the above-mentioned scales was compared using separate linear regression models with adjustment of variables collected. The variables were also assessed for their contribution to the HRQOL by the multiple linear regression. Results: Of the 382 PD patients approached, 266 were eligible and agreed to participate: 145 on CAPD (mean age: 60.8 years) and 121 on APD (mean age: 57.4 years). After adjustments, the HRQOL of CAPD and APD patients were similar according to all measures except for KDQOL symptoms (difference: 7.0, p<0.01) and PCS (difference: 2.8, p<0.05), suggesting that APD was associated with milder dialysis-related symptoms and better physical health. Except for the impact of dialysis modality, multiple linear regression analysis also demonstrated the following factors were significantly associated with higher HRQOL scores: young age (<45 years), Chinese ethnicity, high albumin level (≥37g/l), and self-cared dialysis with PCS; high albumin level with MCS. No association with Burden was observed. As for the health utility scores, factors significantly correlated with higher SF-6D included the high albumin level, whereas those of higher EQ-5D included young age, Chinese ethnicity, high albumin, self-cared dialysis. Conclusions: APD patients experience better HRQOL in some domains than CAPD patients in Singapore, although generic utility measures are not sensitive to this treatment advantage. Important clinical and socio-demographics determinants of the HRQOL in PD patients in Singapore as demonstrated in this study can serve to guide selection and management of the local PD patients.