Depressive Symptoms, Patient Satisfaction, and Quality of Life Over Time in Automated and Continuous Ambulatory Peritoneal Dialysis Patients: A Prospective Multicenter Propensity-Matched Study

Abstract

Health-related quality of life (HRQOL) is an important clinical outcome for dialysis patients. However, relative superiority in HRQOL between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) are not clearly known. We compared HRQOL over time between APD and CAPD patients and evaluated factors associated with HRQOL.All 260 incident patients initiating APD or CAPD at multiple centers throughout Korea were prospectively enrolled in this study between October 2010 and February 2013. HRQOL, depressive symptoms, and renal treatment satisfaction were assessed 1 and 12 months after the start of dialysis by the Kidney Disease Quality of Life Short Form 36 (KDQOL-36), the Beck Depression Inventory (BDI), and the Renal Treatment Satisfaction Questionnaire (RTSQ), respectively.Of 196 patients who completed all questionnaires and did not change the peritoneal dialysis (PD) modality during the 1-year follow-up period, 160 were matched. APD patients showed better baseline HRQOL than CAPD patients for the symptoms, patient satisfaction, pain, and social function domains. There were no differences in HRQOL between the 2 groups at 12 months, and CAPD patients had significantly greater improvements in symptoms (P = 0.02), the mental composite summary (P = 0.03), and health status domains (P = 0.03) than APD patients. There were similar improvements in depressive symptoms (P = 0.01) and patient satisfaction with treatment (P = 0.01) in CAPD and APD patients. Interestingly, depressive symptoms, not PD modality, was the most influential and consistent factor for HRQOL. Despite the spontaneous improvement of depressive symptoms, considerable PD patients still had depressive symptoms at the 1-year appointment.APD has no advantage over CAPD for HRQOL. Considering the substantial negative effect of depressive symptoms on HRQOL, it is important to evaluate PD patients for depression and to treat those with depression to improve their HRQOL.

FIGURE 1

Mean changes in health-related quality of life scores from 1 to 12 months after starting therapy in propensity score-matched peritoneal dialysis patients. CAPD patients showed significantly greater improvement over time than APD patients in SF-36 scores, especially in MCS (A) and in the domains “symptoms” and “self-assessment regarding health status compared to 1 year ago” (b). APD = automated peritoneal dialysis, BKD = burden of kidney disease, CAPD = continuous ambulatory peritoneal dialysis, CF = cognitive function, DSE = dialysis staff, EF = energy/fatigue, EKD = effects of kidney disease, EW = emotional well-being, GH = general health, HS = health status compared to 1-year ago, KDCS = kidney disease composite summary; encouragement, MCS = mental composite summary, OHR = overall health rate, P = pain, PCS = physical composite summary, PF = physical functioning, PS = patient satisfaction, QSI = quality of social interaction, RE = role-emotional, RP = role-physical, S1 = symptom, S2 = sleep, SF1 = sexual function, SF2 = social function, SF-36 = short form-36, SS = social support, TS = total scores, WS = work status. ^∗P < 0.05 vs APD in the mean change of score.

FIGURE 2

Incidence of depressive symptoms according to severity in propensity score-matched peritoneal dialysis patients. CAPD patients showed a higher incidence of at least a moderate degree of depressive symptoms at 1 month than APD patients but this difference was not observed at 12 months. APD = automated peritoneal dialysis, CAPD = continuous ambulatory peritoneal dialysis. P-value, APD vs CAPD in the incidence of moderate to severe depressive symptoms (BDI scores ≥20).

FIGURE 3

Mean changes in the Beck Depression Inventory (BDI) and Renal Treatment Satisfaction Questionnaire (RTSQ) scores 1 to 12 months after starting therapy in propensity score-matched peritoneal dialysis patients. CAPD patients showed significantly greater decreased BDI scores and greater improvement in patient satisfaction with treatment at 1 year later than APD patients (A). The items which showed significantly greater improvement in CAPD patients compared with APD included satisfaction with freedom afforded by treatment, discomfort or pain involved with treatment, how well treatment fits in with lifestyle, and recommendation this treatment to others (B). APD = automated peritoneal dialysis, CAPD = continuous ambulatory peritoneal dialysis. ^∗P < 0.05 vs APD in the mean change of score.