Multidimensional health-status assessment of chronic hemodialysis patients: the impact on quality of life

Abstract

Aim: This study was designed to define impairment of body functions and structures, limitations in activity, restrictions in participation, and health-related quality of life of chronic hemodialysis (HD) patients, in order to assign proper rehabilitation programs.

Methods: Forty-five patients with end-stage renal disease (ESRD) from the Dialysis Unit of the Trescore Balneario's Hospital were enrolled into the study. Clinical characteristics of the disease and Tinetti's test were used to assess impairment of body structures/functions. Limitations in activities were evaluated by functional independence measure (FIM). Marital status, living environment, employment status and recreational activities were questioned; short form-36 (SF-36) was used to measure health-related quality of life.

Results: Mean age of the patients (27 male, 18 female) was 63.8+/-11 years. ESRD was mainly caused by glomerulonephritis (22%). Tinetti's test showed that 11% of HD patients could not walk without help. On the day of dialysis the total FIM score of HD patients dropped about 40 points. Only 2 patients (4.5%) were able to live alone and 6 patients (13%) have gone for vacation since they started dialysis treatment. Compared to the general population sample (91.99+/-23.41), HD patients (50.08+/-22.56) scored significantly lower total SF-36 scores (P<0.001).

Conclusion: HD patients had to face increased limitations in functional independence on the day of dialysis, as well as highly restricted social participation. Preventive and rehabilitative programs including medical management, nursing care and a range of multidisciplinary services can promote quality of life of patients with ESRD on HD.