Does ethnicity influence perceived quality of life of patients on dialysis and following renal transplant?

Abstract

Background: Quality of life (QoL) as perceived by patients with end-stage renal disease (ESRD) is an important measure of patient outcome. There is a high incidence of ESRD in the Indo-Asian population in the UK and a lower rate of transplantation compared with white Europeans. The aim of this study was to determine whether perceived quality of life was influenced by treatment modality and ethnicity.

Methods: Sixty Indo-Asians treated with either peritoneal dialysis (n=20), hospital haemodialysis (n=20) or with a renal transplant (n=20) for >3 months were compared with 60 age-matched white Europeans closely matched for gender, diabetes and duration of renal replacement therapy. QoL was measured using the Kidney Disease and Quality of Life questionnaire (KDQOL-SF). The KDQOL-SF measures four QoL dimensions: physical health (PH), mental health (MH), kidney disease-targeted issues (KDI) and patient satisfaction (PS). Adequacy of treatment was measured by biochemistry, 24 h urine collection and dialysis kinetics. The number of comorbid conditions was scored. Social deprivation was calculated from the patient's postal address using Townsend scoring.

Results: QoL was significantly lower in Indo-Asians than white Europeans for PH, MH and KDI. This was not related to treatment adequacy, which was similar in both for each modality. Indo-Asians had a worse index of social deprivation than white Europeans (P=0.008). PH and KDI were related to social deprivation (P=0.007 and P=0.005, respectively). QoL (except PS) was inversely correlated with comorbidity. Dialysis patients had higher comorbidity than transplant patients (P<0.02). Comparing only those dialysis patients considered fit for transplantation (n=51) with transplant patients, comorbidity was similar, but differences in QoL persisted.

Conclusion: This study demonstrates a lower perceived QoL in Asians compared with white Europeans with ESRD. Analysis of QoL indicates that Asian patients in particular perceive kidney disease as a social burden, even if successfully transplanted.