Better Quality of Life of Peritoneal Dialysis compared to Hemodialysis over a Two-year Period after Dialysis Initiation

Abstract

This study aimed to compare health-related quality of life (HRQOL) over time in patients initiating hemodialysis (HD) or peritoneal dialysis (PD). A total of 989 incident patients starting HD or PD were included from a prospective nationwide cohort study. HRQOL was assessed 3, 12, and 24 months after the start of dialysis. The scores of questionnaires were adjusted for clinical and socioeconomic parameters. The adjusted three months scores of patients on PD showed better HRQOL in eight end-stage renal disease (ESRD), three physical component summary and one mental component summary domains compared with patients on HD. Both patients on HD and PD experienced significant decreases in different HRQOL domains over two years and the degree of changes in HRQOL over time was not different between dialysis modality. However, the scores of three (effects of kidney disease, burden of kidney disease, and dialysis staff encouragement, all P < 0.05) and two (sexual function and dialysis staff encouragement, all P < 0.05) ESRD domains were still higher in patients on PD compared with patients on HD at one and two years after initiation of dialysis, respectively. PD shows better HRQOL during the initial period after dialysis even after adjusting for clinical and socioeconomic characteristics, and the effect lasts up to two years. It was similar in terms of changes in HRQOL over time between HD and PD.

Figure 1

Patient flow. Among the 2,160 survivors (1,546 on HD and 614 on PD) at 3 months after dialysis initiation, 989 patients (45.8%, 652 (42.2%) on HD and 337 (54.9%) on PD) completed the questionnaire. At 12 months, among the 2,065 survivors (1,463 on HD and 602 on PD), 492 patients (23.8%, 301 (20.6%) on HD and 191 31.7%) on PD) completed the questionnaire. At 24 months, among the 1,971 survivors (1,388 on HD and 583 on PD), 262 patients (13.3%, 150 (10.8%) on HD and 112 (19.2%) on PD) completed the questionnaire. Abbreviations: HD, hemodialysis; PD, peritoneal dialysis

Figure 2

Mean changes in health-related quality of life scores from 3 to 24 months after starting therapy according to dialysis modality. Patients undergoing HD showed significantly worsened HRQOL, shown in mean changes in score, in three ESRD domains, namely, sexual function (−9.6, P = 0.005), sleep (−2.7, P = 0.04), and patient satisfaction (−3.5, P = 0.04), but improved HRQOL in one PCS domain, namely, role-physical (10.4, P = 0.002). Patients receiving PD experienced significantly worsened HRQOL, shown in mean changes in score, in two ESRD domains, namely, burden of kidney disease (−5.3, P = 0.009) and work status (−6.8, P = 0.03), in one PCS domain, namely, general health (−3.8, P = 0.02), and two MCS domains, namely, emotional wellbeing (−3.4, P = 0.02) and energy/fatigue (−3.1, P = 0.04). Abbreviations: BKD, burden of kidney disease; CF, cognitive function; DSE, dialysis staff encouragement; EF, energy/fatigue; EKD, effects of kidney disease; EW, emotional wellbeing; GH, general health; HD, hemodialysis; KDCS, kidney disease composite summary; MCS, mental composite summary; P, pain; PCS, physical composite summary; PD, peritoneal dialysis; 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; SS, social support; WS, work status. ^* Indicates P < 0.05 in mean changes in health-related quality of life scores from 3 to 24 months.