Quality of Life and Emotional Distress in Peritoneal Dialysis and Hemodialysis Patients.

Cardiovascular disease-associated morbidity and mortality are reportedly higher in hemodialysis (HD) patients compared with peritoneal dialysis (PD) patients. However, few studies have estimated changes in state of depression and cognitive impairment in patients undergoing HD and PD. The present study evaluated the impact of HD or PD on patients' quality of life (QoL), cognitive impairment, and depression status over 2 years. This 24-month observational, prospective study included 45 HD and 30 PD patients. Patients were assessed before and every 12 months after starting dialysis for 24 months. Measurements included QoL (36-Item Short-Form Health Survey [SF-36]), cognitive impairment (Mini-Mental State Examination [MMSE]), depressive state (Center for Epidemiologic Studies Depression Scale [CES-D]), grip strength, and 24-h urine volume (UV). Physical and social component scores of the SF-36 significantly improved in PD patients at 24 months compared with those observed at baseline (42.8 vs. 39.4; P < 0.05 and 46.4 vs. 37.3; P < 0.05, respectively); however, scores remained unchanged in HD patients. MMSE scores were significantly decreased at 12 and 24 months in HD patients (29.0 vs. 26.0, 25.0; P < 0.05), but remained unchanged in PD patients. Moreover, CES-D scores significantly worsened at 24 months in HD patients (12.8 vs. 16.5), but remained unchanged in PD. Preservation of UV and grip strength was associated with SF-36, CES-D, and MMSE scores. Our findings indicate that PD is associated with higher QoL and recovery from cognitive failure compared with HD.

Hiramatsu T ，Okumura S ，Asano Y ，Mabuchi M ，Iguchi D ，Furuta S ... -  《-》

Clinical outcomes and quality of life in elderly patients on peritoneal dialysis versus hemodialysis.

Harris SA ，Lamping DL ，Brown EA ，Constantinovici N ，North Thames Dialysis Study (NTDS) Group ... -  《PERITONEAL DIALYSIS INTERNATIONAL》

Burden of Kidney Disease, Health-Related Quality of Life, and Employment Among Patients Receiving Peritoneal Dialysis and In-Center Hemodialysis: Findings From the DOPPS Program.

Individuals faced with decisions regarding kidney replacement therapy options need information on how dialysis treatments might affect daily activities and quality of life, and what factors might influence the evolution over time of the impact of dialysis on daily activities and quality of life. Observational cohort study. 7,771 hemodialysis (HD) and peritoneal dialysis (PD) participants from 6 countries participating in the Peritoneal and Dialysis Outcomes and Practice Patterns Studies (PDOPPS/DOPPS). Patient-reported functional status (based on daily living activities), country, demographic and clinical characteristics, and comorbidities. Employment status and patient-reported outcomes (PROs) including Kidney Disease Quality of Life (KDQOL) instrument physical and mental component summary scores (PCS, MCS), kidney disease burden score, and depression symptoms (Center for Epidemiologic Studies Depression Scale [CES-D] score > 10). Linear regression (PCS, MCS, kidney disease burden score), logistic regression (depression symptoms), adjusted for predictors plus 12 additional comorbidities. In both dialysis modalities, patients in Japan had the highest PCS and employment (55% for HD and 68% for PD), whereas those in the United States had the highest MCS score, lowest kidney disease burden, and lowest employment (20% in HD and 42% in PD). After covariate adjustment, the association of age, sex, dialysis vintage, diabetes, and functional status with PROs was similar in both modalities, with women having lower PCS and kidney disease burden scores. Lower functional status (score <11) was strongly associated with lower PCS and MCS scores, a much greater burden of kidney disease, and greater likelihood of depression symptoms (CES-D, >10). The median change in KDQOL-based PROs was negligible over 1 year in participants who completed at least 2 annual questionnaires. Selection bias due to incomplete survey responses. Generalizability was limited to the dialysis populations of the included countries. Variation exists in quality of life, burden of kidney disease, and depression across countries but did not appreciably change over time. Functional status remained one of the strongest predictors of all PROs. Routine assessment of functional status may provide valuable insights for patients and providers in anticipating outcomes and support needs for patients receiving either PD or HD.

Brown EA ，Zhao J ，McCullough K ，Fuller DS ，Figueiredo AE ，Bieber B ，Finkelstein FO ，Shen J ，Kanjanabuch T ，Kawanishi H ，Pisoni RL ，Perl J ，PDOPPS Patient Support Working Group ... -  《-》

Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis.

In-center hemodialysis (HD) is often the default dialysis modality for older patients. Few centers use assisted peritoneal dialysis (PD), which enables treatment at home. This observational study compared quality of life (QoL) and physical function between older patients on assisted PD and HD. Patients on assisted PD who were >60 years old and on dialysis for >3 months were recruited and matched to patients on HD (needing hospital transport) by age, sex, diabetes, dialysis vintage, ethnicity, and index of deprivation. Frailty was assessed using the Clinical Frailty Scale. QoL assessments included Hospital Anxiety and Depression Scale (HADS), Short Form-12, Palliative Outcomes Symptom Scale (renal), Illness Intrusiveness Rating Scale, and Renal Treatment Satisfaction Questionnaire (RTSQ). Physical function was evaluated by Barthel Score and timed up and go test. In total, 251 patients (129 PD and 122 HD) were recruited. In unadjusted analysis, patients on assisted PD had a higher prevalence of possible depression (HADS>8; PD=38.8%; HD=23.8%; P=0.05) and higher HADS depression score (median: PD=6; HD=5; P=0.05) but higher RTSQ scores (median: PD=55; HD=51; P<0.01). In a generalized linear regression model adjusting for age, sex, comorbidity, dialysis vintage, and frailty, assisted PD continued to be associated with higher RTSQ scores (P=0.04) but not with other QoL measures. There are no differences in measures of QoL and physical function between older patients on assisted PD and comparable patients on HD, except for treatment satisfaction, which is higher in patients on PD. Assisted PD should be considered as an alternative to HD for older patients, allowing them to make their preferred choices.

Iyasere OU ，Brown EA ，Johansson L ，Huson L ，Smee J ，Maxwell AP ，Farrington K ，Davenport A ... -  《-》

Comparison of Psychological Distress and Demand Induced by COVID-19 during the Lockdown Period in Patients Undergoing Peritoneal Dialysis and Hemodialysis: A Cross-Section Study in a Tertiary Hospital.

Since the outbreak of COVID-19 in December 2019, it has spread rapidly and widely, bringing great psychological pressure to the public. In order to prevent the epidemic, traffic lockdown was required in many areas of China, which led to inconvenience of treatment for dialysis patients. This study was conducted to explore the psychological distress and the psychological demand induced by CO-VID-19 in the patients undergoing dialysis and compare the difference between hemodialysis (HD) and peritoneal dialysis (PD) patients during the traffic lockdown period. Questionnaires were given to the dialysis patients in the West China Hospital of Sichuan University. The Impact of Event Scale (IES) was used to investigate the patients' trauma-related distress in response to COVID-19. 232 eligible respondents were enrolled in this cross-section study, consisting of 156 PD patients and 76 HD patients. The median IES score for all the enrolled patients was 8.00 (2.00-19.00), which belonged to the subclinical dimension of post-traumatic stress symptoms (PTSS). HD patients had a significant higher IES score than PD patients (11.50 vs. 8.00) (p < 0.05). HD patients already got more psychological support from the medical staff. According to IES scores, 22.4% HD patients and 13.4% PD patients were classified as having moderate or severe PTSS, which need psychological support (p < 0.05). But more patients of both groups considered psychological support was necessary (HD: 50%, PD: 45.5%) (p > 0.05). In the multivariate regression analysis, we found that dialysis vintage, the impact of COVID-19 on the severity of illness and daily life, and confidence in overcoming the disease contributed to IES score (p < 0.05). HD patients had more severe trauma-related stress symptoms than PD patients. When major public healthy events occurred, careful psychological estimate and sufficient psychological support should be provided to the dialysis patients, especially to the HD patients.

Xia X ，Wu X ，Zhou X ，Zang Z ，Pu L ，Li Z ... -  《-》