Osasuyi Iyasere1, Edwina Brown2, Fabiana Gordon3, Helen Collinson4, Richard Fielding5, Richard Fluck6, Lina Johansson7, Neal Morgan8, John Stoves9, Anand Vardhan10, Graham Woodrow11, Andrew Davenport12. 1. John Walls Renal Unit, Leicester General Hospital, Leicester, UK uyit2001@yahoo.com. 2. Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK. 3. Statistical Advisory Service, School of Public Health, Imperial College, London, UK. 4. Renal department, Hull Royal Infirmary, Hull, UK. 5. Renal Services, Freeman Hospital, Newcastle, UK. 6. Renal Services, Royal Derby Hospital, Derby, UK. 7. Imperial College London, Department of Nutrition and Dietetics, Hammersmith Hospital, London, UK. 8. Renal Unit, Daisy Hill Hospital, Southern Health and Social Care Trust, Northern Ireland, UK. 9. Renal Unit, Bradford St Luke's Hospital, Bradford, UK. 10. Department of Renal Medicine, Manchester Royal Infirmary, Manchester, UK. 11. Renal Unit, St James University Hospital, Leeds, UK. 12. UCL Centre for Nephrology, Royal Free Hospital, London, UK.
Abstract
BACKGROUND: In-center hemodialysis (HD) has been the standard treatment for older dialysis patients, but reports suggest an associated decline in physical and cognitive function. Cross-sectional data suggest that assisted peritoneal dialysis (aPD), an alternative treatment, is associated with quality of life (QoL) outcomes that are comparable to in-center HD. We compared longitudinal changes in QoL between modalities. METHODS: We enrolled 106 aPD patients, matched with 100 HD patients from 20 renal centers in England and Northern Ireland. Patients were assessed quarterly for 2 years using the Hospital Anxiety and Depression Scale (HADS), SF-12 physical and mental scores, symptom score, Illness Intrusiveness Rating Scale (IIRS), Barthel's score, and the Renal Treatment Satisfaction Questionnaire (RTSQ). Mixed model analysis was used to assess the impact of dialysis modality on these outcomes during follow-up. P values were adjusted for multiple significance testing. RESULTS: Multivariate analysis showed no difference in any of the outcome measures between aPD and HD. Longitudinal trends in outcomes were also not significantly different. Higher age at baseline was associated with lower IIRS and RTSQ scores during follow-up. One-hundred and twenty-five (60.6%) patients dropped out of the study: 59 (28.6%) died, 61 (29.6%) withdrew during follow-up, and 5 (2.5%) were transplanted. CONCLUSIONS: Quality of life outcomes in frail older aPD patients were equivalent to those receiving in-center HD. Assisted PD is thus a valid alternative to HD for older people with end-stage kidney disease (ESKD) wishing to dialyze at home.
BACKGROUND: In-center hemodialysis (HD) has been the standard treatment for older dialysis patients, but reports suggest an associated decline in physical and cognitive function. Cross-sectional data suggest that assisted peritoneal dialysis (aPD), an alternative treatment, is associated with quality of life (QoL) outcomes that are comparable to in-center HD. We compared longitudinal changes in QoL between modalities. METHODS: We enrolled 106 aPD patients, matched with 100 HD patients from 20 renal centers in England and Northern Ireland. Patients were assessed quarterly for 2 years using the Hospital Anxiety and Depression Scale (HADS), SF-12 physical and mental scores, symptom score, Illness Intrusiveness Rating Scale (IIRS), Barthel's score, and the Renal Treatment Satisfaction Questionnaire (RTSQ). Mixed model analysis was used to assess the impact of dialysis modality on these outcomes during follow-up. P values were adjusted for multiple significance testing. RESULTS: Multivariate analysis showed no difference in any of the outcome measures between aPD and HD. Longitudinal trends in outcomes were also not significantly different. Higher age at baseline was associated with lower IIRS and RTSQ scores during follow-up. One-hundred and twenty-five (60.6%) patients dropped out of the study: 59 (28.6%) died, 61 (29.6%) withdrew during follow-up, and 5 (2.5%) were transplanted. CONCLUSIONS: Quality of life outcomes in frail older aPD patients were equivalent to those receiving in-center HD. Assisted PD is thus a valid alternative to HD for older people with end-stage kidney disease (ESKD) wishing to dialyze at home.
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