Impact of dialysis modality conversion on the health-related quality of life of peritoneal dialysis patients: a retrospective cohort study in China

Abstract

Background: To analyze the health-related quality of life associated with the conversion of dialysis modality among end-stage renal disease patients in China.

Methods: Patients were recruited from hospitals and a dialysis center in Kunshan, China. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis were recruited as the observation group (n = 64), and patients continuing with continuous ambulatory peritoneal dialysis treatment were included in the control group (n = 64) after matching in this retrospective cohort study. Their health-related quality of life was measured using the kidney disease quality of life instrument in 2019 and 2020, respectively. Baseline socio-demographic characteristics and clinical data were collected in 2019. The before-and-after cross-group comparisons of subscale scores of two groups were conducted using a Student's t-test. Multiple linear regression models were fitted to identify the factors associated with the change of each scale.

Results: The health-related quality of life scores of the two groups was comparable in baseline, while the observation group had higher scores in Physical Component Summary (51.92 ± 7.50), Kidney Disease Component Summary (81.21 ± 8.41), Symptoms (90.76 ± 6.30), Effects (82.86 ± 11.42), and Burden (69.04 ± 15.69) subscales after one year. In multivariate regression analysis, the change of Physical Component Summary was significantly associated with conversion to APD (β = 11.54, 95% CI [7.26-15.82]); the change of Mental Component Summary with higher education (β = - 5.96, 95% CI [-10.18--1.74]) and CCI (>2) (β = 5.39, 95% CI [1.05-9.73]); the change of Kidney Disease Component Summary with conversion to APD (β = 15.95, 95% CI [10.19-21.7]) and age (>60 years) (β = - 7.36, 95% CI [-14.11--0.61]); the change of Symptoms with CCI (>2) (β = 7.96, 95% CI [1.49-14.44]); the change of Effects with conversion to APD (β = 19.23, 95% CI [11.57-26.88]); and the change of Burden with conversion to APD (β = 22.40, 95% CI [13.46-31.34]), age (>60 years) (β = - 12.12, 95% CI [-22.59--1.65]), and higher education (β = - 10.38, 95% CI [-19.79--0.98]).

Conclusions: The conversion of dialysis modality had a significant impact on the scores of most subscales. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis generally had improved health-related quality of life scores.

Keywords: Automated peritoneal dialysis; Continuous ambulatory peritoneal dialysis; Dialysis modality conversion; End-stage renal disease; Health-related quality of life.