Dialysis modality and health-related quality of life of persons with end stage renal disease

Health-related quality of life (HR-QOL) is a significant treatment outcome for persons with end-stage renal disease (ESRD); however, little is known about the HR-QOL of Mexican patients with ESRD. This pilot study describes relationships between demographics, sleep disorders, spirituality, mood, folk practices and dialysis modality on the HR-QOL of patients with ESRD residing in Guanajuato, Mexico. Mexican patients receiving continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and hemodialysis (HD) provided information on demographics, clinical health data including body mass index (BMI), and folk health practices. Measures included the Short Form (SF)-36 HR-QOL survey, Sleep Habits Questionnaire, Latin Spirituality Perspective Scale and Hospital Anxiety and Depression Scale. Data were analyzed using SAS software (V9.1). Signifi¬cance level for this pilot study was set at p<0.10. The Quality-Adjusted Life Year method was utilized to examine cost effectiveness for each dialysis modality. Demographics and clinical data showed participants (N=121) to be 59 (SD=13) years, predominantly men (55.4%), married (66.9%), Catholic (92.6%), and not currently working (78.3%). The majority were diabetic (72%) and slightly overweight (BMI M=26.1; SD=5.1). The CAPD group (n=39) demonstrated significantly lower HR-QOL scores compared to the APD (n=42) and HD (n=40) groups. Patients on HD reported higher rates and greater numbers of sleep disorders, including insomnia symptoms, non-restorative and insufficient sleep, and daytime somnolence compared to patients on CAPD and APD. Patients on CAPD reported more anxiety and depression compared to patients on HD and APD. Overall linear regression for HR-QOL found dialysis type, sleep disorders and income to be significant predictors and the model accounted for 31% of the variance. Cost analysis indicated APD as the preferred treatment because it is less costly and results in the best HR-QOL compared to the other treatment modalities. Findings provide the first SF-36 norms for Mexicans with ESRD. Sleep disorders and dialysis type greatly impinge on the HR-QOL of these patients, particularly their mental health. APD was identified as the preferred treatment based on low cost and improved HR-QOL. Results can inform clinical care and health policy for Mexican patients with ESRD.