Quality of Life among Patients Undergoing Hemodialysis in Penang, Malaysia.

BACKGROUND: Quality of life is one of the parameters to check the improvement of hemodialysis treatment among hemodialysed patients. Those patients will be dealing with this treatment in long term if this treatment is the only way for them to replace their kidney function and this thing will affect their quality of life.
OBJECTIVE: To evaluate the quality of life patients on hemodialysis using kidney disease quality of life-short term 24 (KDQoL-SF24) Malaysian Version.
MATERIALS AND METHODS: Cohort observational study was conducted in this study. The study included 78 hemodialysed patients in HD center Penang, Malaysia.
RESULTS: There were 9 components which had the lower of the mean and standard deviation (SD) than the standard form; work status (15.01 ± 35.57), cognitive function (75.66 ± 13.75), quality of life social interaction (76.32 ± 16.11), sleep (55.86 ± 15.30), social support (59.61 ± 22.08), patient satisfaction (43.24 ± 15.32), physical functioning (50.06 ± 42.81), general health (29.62 ± 25.56), and role emotional (54.27 ± 49.92). In this HD center, the group of patient's age who had the lower mean ± SD from the KDQoL-SF Manual Standard were the first and the sixth groups of patient's age (≤20 and 61-70).
CONCLUSION: The study conducted in HD center, Penang, Malaysia showed that the scoring of work status, cognitive function, quality of social interaction, sleep, social support, patient satisfaction, physical functioning, general health, and role emotional were low than standard form.

INTRODUCTION

Malaysia is prevalent in end-stage renal disease (ESRD).[1] Hemodialysis is one of the treatments that has been used for ESRD patients,[2] and this treatment will be used permanently to replace kidney function. Many of hemodialysed patients cannot accept their condition while some of them feel frustrated. Hence, quality of life of these patients will be affected by this continuous treatment. To measure quality of life of hemodialysed patients, kidney disease quality of life-short term 24 (KDQoL-SF24) was used among these patients. This questionnaire was available in RAND Website for Malaysia Version.

In the KDQoL-24, there were 24 questions with 4 categories of questions; health (11 questions), kidney disease (3 questions), effects of kidney disease on daily life (8 questions), and satisfaction with care (2 questions). The website also provides the manual scoring as a guidance to determine the value of the quality of life. The mental and physical health dimensions among hemodialysed patients are strongly associated with morbidity and mortality.[345] Nutritional status, HD duration, age, and ethnicity are other factors which are associated with quality of life of hemodialysed patients.[367]

Information about quality of life among hemodialysed patients in Malaysia is limited. A limited number of studies have examined the relationship between sociodemographics with quality of life among hemodialysed patients.[38] Due to of that, the relationship between the socio-demographics and quality of life of hemodialysed patients in HD center Penang, Malaysia is necessary to be conducted.

MATERIALS AND METHODS

Study location

Research was carried out in hemodialysis ward General Hospital Pulau Pinang, Malaysia.

Study participants

The study included diabetic and/hypertensive patients who had undergone hemodialysis. Universal sampling was used to select 78 hemodialysed patients in HD center Penang, Malaysia.

Study design

A cohort prospective study was conducted in this HD center.

Inclusion criteria

All hemodialysis patients who have diabetic and/hypertensive

Patients ≥18 years.

Exclusion criteria

Patients <18 years

Cancer patients

Pregnancy patients

HIV/AIDS patients

Systemic lupus erythema patients.

Ethical clearance

Ethical clearance was sourced by Clinical Research Committee General Hospital Pulau Pinang. The approval letter was given before starting of data collection with the number: (5)KKM/NIHSEC/P16-133.

Data collection and handling

The researcher would define the patients by the list of patients in the ward, and before collecting data from medical record, the researcher would explain about the research (background and the purpose of the research) to the patients. Data collection would be starting after patients signed the informed consent as an agreement of the research. For assessing quality of life among hemodialysed patients in HD center Penang, Malaysia, KDQoL-SF24 Malaysian version was downloaded from RAND website and was used to hemodialysed patients in this HD center without pilot study.

RESULTS

To assess health-related quality of life (HRQOL) hemodialysed patients in both HD centers, KDQoL-SF24 was used. KDQoL-SF24 for Malaysian version can be downloaded in RAND website.

Figure 1 shows the total number of patients who were included in the assessment of HRQOL using KDQoL-24 in HD center in Penang, Malaysia. The total number of patients was 78 patients; 48 patients were males and 30 patients were females.

Figure 1

Kidney disease quality of life assessment among hemodialysed patients during the period of observation based on gender

Figure 2 shows 7 groups of patient’s age (≤20, 21–30, 31–40, 41–50, 51–60, 61–70, and >70) who were included in the assessment of KDQoL-SF24 in this HD center. The highest number of patient was the fifth group; 29 patients.

Figure 2

Kidney disease quality of life assessment among hemodialysed patients during the period of observation based on age

Scoring of kidney disease quality of life-short term 24

Table 1 shows mean and standard deviation (SD) of each component in KDQoL-SF24 questionnaire between the study and the standard form in HD center Penang, Malaysia.

Table 1

Scoring of kidney disease quality of life.short form 24 questionnaire for 78 Malaysian patients

The mean score and SD for overall health rating in this HD center were higher than standard form as shown in Table 1.

Table 2 shows correlation between gender and KDQoL-SF24 scores for each component among hemodialysed patients in Penang, Malaysia.

Table 2

Kidney disease quality of life-short form 24 scores for each component based on gender among hemodialysis patients in HD Centre Penang, Malaysia

There was no significant relationship between each component of KDQOL-SF24 and gender among hemodialysed patients in this HD center as shown in Table 2, but there was significant correlation between gender and question 17 (part of sleep component).

Table 3 shows correlation between age and KDQoL-24 score for each component among hemodialysed patients in Penang, Malaysia.

Table 3

Kidney disease quality of life-short form 24 score for each component based on age among hemodialysed patients in Penang, Malaysia

No significant relationship between age and each of KDQOL-24 component was found in this HD center.

Table 4 shows correlation between race and KDQoL-24 score for each component among hemodialysed patients in a HD center Penang, Malaysia.

Table 4

Kidney disease quality of life-short form 24 scores for each component based on race among hemodialysed patients in a HD Center Penang, Malaysia

There are there races in Malaysia: Malay, Chinese, and Indian. The race in Indonesia is only one; Indonesian. Correlation between race and score of each item on KDQoL-SF24 was conducted only for HD center Penang, Malaysia.

In this HD center, no significant relationship was found between race and each component of KDQoL-SF2 as shown in Table 4, but there was significant correlation between race and question 12c (part of burden of kidney disease component), question 13a (part of quality of social interaction), and question 9 g (part of energy/fatigue component).

Table 5 shows correlation between clinical outcome and overall health rating of KDQoL-SF24 score among hemodialysed patients in Penang, Malaysia.

Table 5

Scoring of overall health rating by kidney disease quality of life-short form 24 tool based on clinical outcome in HD Center Penang, Malaysia

There was no significant relationship found between clinical outcome and overall health rating of KDQoL-SF24 among hemodialysed patients in Penang, Malaysia as shown in Table 5.

Table 6 shows mean and SD of each component in KDQoL-SF24 questionnaire between the study and standard form among hemodialysed patients in Penang, Malaysia based on gender.

Table 6

Scoring overall health rating by kidney disease quality of life-short form 24 tool based on gender

The mean ± SD between male and female in this HD center was more than the manual standard as shown in Table 6. It means the quality of life of those hemodialysed patients based on gender was good.

Table 7 shows mean and SD of each component in KDQoL-SF24 questionnaire between the study and standard form among hemodialysed patients in Penang, Malaysia based on age.

Table 7

Scoring overall health rating by kidney disease quality of life-short form 24 tool based on age

There were 7 groups of patient’s age (≤20, 21–30, 31–40, 41–50, 51–60, 61–70, and >70). In this HD center, the group of patient’s age who had the lower mean ± SD from the KDQoL-SF Manual Standard were the first and the sixth groups of patient’s age (≤20 and 61–70) as shown in Table 7. The lower scores showed that the quality of life of those component among diabetic and/or hypertensive patients who had undergone hemodialysis was not good.

DISCUSSION

In HD center Penang, Malaysia, the mean (SD) of work status, cognitive function, quality of social interaction, sleep, social support, patient satisfaction, physical functioning, general health and role emotional were lower than the KDQoL-SF Manual Standard. It means the quality of life of those hemodialysed patients for those component was not good. In this HD center, overall, hemodialysis gave impact to social activity of those patients although physical functioning and sleep activity were also influenced by hemodialysis treatment. This finding is also similar with M. Nakayama et al.’s study while 22% of 179 patients became unemployed after dialysis inception with a corresponding decrease in average working hours and annual income.[9]

Sleep disorder, role emotional, and physical functioning are the components, which also can determine the quality of life of diabetic and/or hypertensive patients who had undergone hemodialysis. Zyoud et al.’s study revealed significant positive association between HRQOL and male gender among patients on hemodialysis.[10] Another study which was conducted in Malaysia discovered that quality of life of patients on dialysis was positively influenced by gender, body mass index, religion, education, marital status, occupation, income, mode of dialysis, hemoglobin, diabetes mellitus, coronary heart disease, cerebral vascular accident, and leg amputation.[11]

In HD center Penang, Malaysia, race is one of the parts of sociodemography which always be assessed. Overall, race did not influence KDQOL-SF24 components, but there was some significant relationship between race and one question of burden of kidney disease component, one question of social interaction component, and one question of energy/fatigue component in a HD center Penang, Malaysia. The same finding is found in Feroze et al.’s study while they revealed no significant differences between racial and quality of life in the other four health-related quality of life among 223 hemodialysis patients – African Americans.[12] Another study found race as a risk factor in mortality among hemodialysed patients while African patients undergoing dialysis had a lower death rate compared with American patients (232,361 deaths [57.1% mortality] vs. 585,792 deaths [63.5% mortality]).[13]

CONCLUSION

Assessment of KDQoL-SF24 among hemodialysed patients in HD center Penang, Malaysia showed that the scoring of work status, cognitive function, quality of social interaction, sleep, social support, patient satisfaction, physical functioning, general health, and role emotional were low than the standard form. From the overall health rating – KDQoL-SF24, the group of patient’s age who had the lower mean ± SD from the standard form were the first and the sixth groups of patient’s age (≤20 and 61–70).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.