Download - Introduction
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A quality of life of patients with End Stage Renal Disease undergoing Hemodialysis and Peritoneal dialysis in Naresuan University
Hospital and Buddhachinaraj Hospital, Phitsanulok.
Pattarawadee Siriprapanonkul*, Kan Arayakul*, Kinzang Wangchuk*
Suphinda Sirirak, MD**•5th year Medical student, Naresuan university
** Adviser, Nephrologist, Naresuan University Hospital
A quality of life of patients with End Stage Renal Disease undergoing Hemodialysis and Peritoneal dialysis in Naresuan University
Hospital and Buddhachinaraj Hospital, Phitsanulok.
Pattarawadee Siriprapanonkul*, Kan Arayakul*, Kinzang Wangchuk*
Suphinda Sirirak, MD**•5th year Medical student, Naresuan university
** Adviser, Nephrologist, Naresuan University Hospital
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Introduction
The National Health Security Office (2011)
Patients with ESRD: ~ 0.41 million
Rate : 643 per 100,000 population.
Northern Thailand:
Total patient: ~ 86 thousand
734 per 100,000 population.
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Background & rationale
Renal replacement therapy (RRT ) for patients with End stage renal disease(ESRD):
Hemodialysis(HD ) Peritoneal dialysis(PD)
Kidney transplantation(KT )
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Background & rationale
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Research question
1) How does quality of life (QoL) in ESRD patients undergoing RRT with HD differ from PD at Naresuan University hospital & Buddhachinaraj hospital?
2) What factors are correlated with QoL in ESRD patients undergoing RRT?
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Research hypothesis
Patients with ESRD undergoing RRT with PD has
QoL better than patients undergoing HD and
factors that we study is related to the QoL of
ESRD patients.
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Objectives
1) To study & compare the QoL of patients with ESRD undergoing RRT, HD or PD.
2) To study the factors associated with QoL of patients with ESRD.
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Research methodology
1) Research Design2) Patient population3) Data collection4) Questionnaire5) Data analysis
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Research methodology
Research Design• Descriptive, Cross-sectional study
Patient population• Patients with ESRD undergoing HD or
follow-up appointment during 21-25 January 2013.
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Patient population
Inclusion criteriaa. Patients diagnosed as ESRD.b. Can speak & understand Thai.c. Age ≥ 18 yearsd. Undergoing RRT ≥ 6 months.e. Willing to participate.
Exclusion criteriaa) Patients with cognitive impairment, unable to
communicate & hearing disorders.b) undergoing RRT for < 6 months.
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Research methodology
Data collection: Date: 21th - 25th Jan, 2013 Distribution of questionnaire at NU
Hemodialysis unit & Buddhachinaraj hospital
CHOICE health Experience Questionnaire (CHEQ) :Thai version.
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Research methodology
Statistic analysis: STATA version 10.1 percentage, mean & SD, median and IQR,
t-test, Mann-Whitney U test, Logistic Regression
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Results
1.Demographic data2.Social function & Financial3.Illness4.Factors associated with QoL5.Laboratory results related to
QoL
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Research result
Demographic data
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14 15
4
8
0
2
4
6
8
10
12
14
16
Hemodialysis Peritoneal dialysis
Female
Male
SEX
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Age
1
13 14
1
54
3
0
2
4
6
8
10
12
14
Hemodialysis peritoneal dialysis
< 40
40-60
61-80
>80
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Marital status
2
26
13
9
00
5
10
15
20
25
30
Hemodialysis Peritoneal dialysis
Single
Maried
Divorsed
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Education level
2
4
12
2
54
2
0
54
10
0
2
4
6
8
10
12
Hemodialysis Peritoneal dialysis
Illiterate
Primary school
Secondary school
Diploma
Bachelor's Degree
Master's degree or higher
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Results
Social function & Financial
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Occupation
1
8
0
23
2
13
0 0 0 0
23
2
4
1
0
2
4
6
8
10
12
14
Hemodialysis Peritoneal dialysis
Student
Government official
State enterprise employee
Agriculturist
Shop keeper
Employee
No occupations
Others
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Income
9
7
10
34
7
1 1
0
1
23
45
67
89
10
Hemodialysis Peritoneal dialysis
≤ 3,000 Bath
3,001-10000 Bath
10,001-30,000 Bath
> 30,000 Bath
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Scheme of health care
20
0
4 5
0 0 01
0 0
10
0 01
0
24
6
8
1012
14
16
1820
Hemodialysis Peritoneal dialysis
Direct payment
State enterprise payment
Social Security Fund ofEnterprises Universal health coverage
Insurance
Self finance
Others
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Results
Illness
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Duration of renal replacement therapy
3
8
4
12
2
0
2
5
32
0 00
2
4
6
8
10
12
Hemodialysis peritoneal dialysis
< 1 year
>1- 3 years
>3- 5 years
> 5- 10 years
>10-20 years
> 20 years
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Underlying diseases
0
14
23
6
13
13
12
1 1
0
5
10
15
20
25
hemodialysis peritoneal dialysis
None
DM
Hypertension
CVD
Others
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Travelling distance
13
54
32 2
54
10 0
2
0
2
4
6
8
10
12
14
Hemodialysis peritoneal dialysis
≤ 10 km
11-30 km
31-50 km
51-70 km
71-90 km
>90 km
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Cause of ESRD
13
18
12
3
10
4
0
2
4
6
8
10
12
14
16
18
Hemodialysis peritoneal dialysis
DM
Hypertension
Others
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Frequency of HD
1
14 14
0
2
4
6
8
10
12
14
Hemodialysis
Once a week
2 times/wk
3 times/wk
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Infection(PD)
6 6
0
1
2
3
4
5
6
Peritoneal dialysis
Yes
No
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Results
Comparison of Quality of life score
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กราฟแสดงค่�าเฉลี่��ยรวมในS F 36เปร�ยบเที�ยบในผู้��ป�วยP Dแลี่ะHD536.23
500.23
480
490
500
510
520
530
540
PD HD
คะแนนเฉลี่ยรวม
Mean diff. = 35.99 (95% CI-75.06 , 147.05 ,P-value =
0.52)
ค่ะแนนเฉลี่��ยรวม
980.28
1056.08
940
960
980
1000
1020
1040
1060
1080
HD PD
คะแนนเฉลี่ยรวม
Comparison of Quality of life scores between PD and HD
Mean diff. = 75.79(95% CI -75.67 , 227.25 ,P-value =
0.32)
ESRD specific Quality of Life
SF-36 general health Quality of Life
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Physical functionRole physical*
Bodily painMental health*
Role emotionalSocial function
VitalityGeneral health
ESRD specific
58.33
25
71.87
6260.41 68.75
63.33
46.0260.41
56.72
0
64.6560
49.1364.82
57.41
46.33
68.96
0
20
40
60
80
กราฟแสดงค่�าMean เปร�ยบเที�ยบในS F 36 domains ระหว�างผู้��ป�วยP D แลี่ะ HD
HD
PD
Mean(%)
General Health sub-domain analysis between PD and HD
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ESRD specific Quality of Life sub-domain analysis between PD and HD
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Factors associated with the patient’s Quality of life
Results
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SF-36 General Health scores (DM)
mean SF-36 domain score
427.63
569.65
0
100
200
300
400
500
600
เป็�นโรคเบาหวาน ไม�เป็�นโรคเบาหวาน
mean SF-36 domain score
Mean diff. = 142.02 95% CI = 49.72 , 234.32 P-value = 0.002
patients with DM
patients without DM
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SF-36 General Health scores (CVD)
mean SF-36 domain score
346.34
550.63
0
100
200
300
400
500
600
เป็�นโรคห�วใจ ไม�เป็�นโรคห�วใจ
mean SF-36 domain score
Mean diff. = 204.28 95% CI = 94.47 , 314.10 P-value = 0.028
patients with CVD patients without CVD
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ESRD specific Quality of Life scores (CVD)
808.11
1049.58
0
200
400
600
800
1000
1200
CVD
Yes
No
Mean Diff.= 241.47 95% conf. interval)=83.62 , 399.32 P-value= 0.008
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ESRD specific Quality of Life scores(occupation)1085.26
896.68
0
200
400
600
800
1000
1200
Occupation
Yes No
Mean Diff. = 188.58 95% conf. interval=61.86 , 315.31 P-value= 0.007
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Multivariable logistic regression
-----------------------------------------------------------------------------------------------------------Total ESRD scores | Coef. P>|t| [95% CI]----------------------------------------------------------------------------------------------------------- DM - 2532219| . 0724.
-1695074. - 118863 CVD - 2279726| . 0006.
- -38810486784048. . cons | 1097.327 0.000 1006.497-
1188.156-----------------------------------------------------------------------------------------------------------
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Laboratory results related to
Quality of life
Results
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Laboratory results
SF-36 Quality of Life ESRD specific Quality of Life
Odds ratio 95%CI P-value* Odds ratio 95%CI P-value*
Albumin ≤4.1 5.70 1.20-27.12 0.029 0.59 0.13-2.74 0.504
Creatinine ≤ 10.0 2.289 0.50-10.45 0.286 7.8 1.60-38.11 0.011
Na ≤ 41 0.75 0.07-7.61 0.808 0.75 0.07-7.61 0.808
K ≤4.3 1.92 0.42-8.84 0.402 0.37 0.08-1.58 0.179
HCO3 >22 .68 0.14-3.35 0.636 3.68 0.41-33.45 0.247
Chloride ≤98 0.95 0.20-4.54 0.953 0.52 0.12-2.34 0.395
Calcium >9.0 3.13 0.34-28.74 0.313 0.56 0.11-2.83 0.483
Phosphate <4.6 0.27 0.06-1.20 0.086 0.27 0.06-1.20 0.086
Hematocrit >30.0 1.64 0.29-9.26 0.577 0.13 0.03-0.63 0.011
LDL ≤70 0.57 0.06-5.63 0.637 30 2.87-313.46
0.004
KT/V >2.0 0.48 0.11-2.03 0.031 0.27 0.06-1.20 0.086
Relation between Laboratory results and quality of life scores
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Discussion
• No statistical significance in total QoL scores for both groups.
• The patients who undergo PD have total QoL scores more than HD patients in both domains but not statistically different.
Erika Juergensen et.al. Hemodialysis and Peritoneal dialysis: Patients’ Assessment of Their Satisfaction with Therapy and the Impact of the Therapy on Their Lives.
Clinical Journal of the American Society of Nephrology 2006 Nov;1(6):1191-6.
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Discussion
ESRD-specific health domain:• Occupation (P value=0.007).• Mental health in PD patients (P
value=0.03).
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Discussion
• General health domain: Patients with diabetes & cardiovascular disease (P value = 0.002 and 0.028respectively).
• In ESRD-specific domain: patients with CVD (P value= 0.008)
• Similar to Wipada Mahawirotratana1’s study 1 )ว�ภาดา มหาว�โรจน�ร�ตน�.ค่ ณภาพชี�ว%ตของผู้��ป�วยไตวายเร*+อร,งระยะส ดที�ายที��ได�ร,บการร,กษาด�วยว%ธี�การฟอกเลี่*อดแลี่ะการลี่�างชี�องที�องอย�างต�อ
เน*�อง.รายงานการว�จ�ย . รายงายว�ทยาน�พนธ์� สาขาว�ทยาการระบาด บ�ณฑิ�ตว�ทยาลี่�ย มหาว�ทยาลี่�ยมห�ดลี่ , 2541.
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Discussion
• Laboratory results includes: Cr, Hct, LDL) and Kt/V
• The patient who had serum creatinine >10 mmol/l and LDL < 70 mg/dl was better QoL scores significantly.
• But the patient who had Hct level > 30% was worse QoL scores significantly.
• Differs from Kamyar Kalantar-Zadeh1 study
Kamyar Kalantar-Zadeh ,et.al. Association Among SF36 Quality of Life Measures and Nutrition, Hospitalization, and Mortality in Hemodialysis.
Journal of Amarican Sociaty of Nephrology. December 1, 2001vol. 12 no. 12 2797-2806.
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Limitation
• Small Samples size• Short duration for study• There are a lot of confusing
questions
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Suggestion
• In the future, the research should study about risk factors of DM and CVD that affect quality of life.
• The further research should have enough samples and appropriate sampling method.
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Thank you for your
attention
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References1 ) การจั,ดบร%การฟอกเลี่*อดด�วยเค่ร*�องไตเที�ยม (Hemodialysis :HD) ป0 2556. ค)�ม*อบร�หารงบกองท,นหลี่�กป็ระก�นส,ขภาพ
แห�งชาต� 2556. ส*บค.นจาก http://library.nhso.go.th/pages/nhsodoc/e-nhso/PDF_BOOK03.zip2 ) ทว ชาญช�ยร,จ�รา . Continuous care in renal replacement therapy : Hemodialysis. ใน อาย รศาสตร2ที,นย ค่ 2555
= Update in internal medicine 2012 better outcome with the continuity of care (พ�มพ� คร�0งท 1). ภาคว�ชาอาย,รศาสตร� คณะแพทยศาสตร�ศ�ร�ราชพยาบาลี่, 2555: 253.
3) น�ภา อ�ยยสานนท� . การเปร�ยบเที�ยบค่ ณภาพชี�ว%ตของผู้��ป�วยไตวายเร*+อร,งที��ได�ร,บการบ3าบ,ดทีดแทีนไตโดยการฟอกเลี่*อด แลี่ะการลี่�างไตทีางชี�องที�องอย�างถาวร . รายงายการว�จ�ย . สาขาว�ชาว�ทยาการส�งคมแลี่ะการจ�ดการระบบส,ขภาพ บ�ณฑิ�ตว�ทยาลี่�ย มหาว�ทยาลี่�ยศ�ลี่ป็าการ , 2552.
4) ย,วด ธ์ระศ�ลี่ป็2.ค่ ณภาพชี�ว%ตของผู้��ป�วยไตวายเร*+อร,งระยะส ดที�าย (QUALITY OF LIFE IN END- STAGE RENAL DISEASE PATIENTS ). ภาคว�ชาจ�ตเวชศาสตร� คณะแพทยศาสตร� จ,ฬาลี่งกรณ�มหาว�ทยาลี่�ย , 2547.
5) สมชาย เอยมอ�องแลี่ะคณะ . Textbook of nephrology . เท4กซ์� แอนด� เจอร�น�ลี่ พ�ลี่ลี่�เคช�น จ6าก�ด , กร,งเทพฯ; 2554 :1903-1922.6) ส6าน�กงานกลี่างสารสนเทศบร�การส,ขภาพ แลี่ะส6าน�กงานหลี่�กป็ระก�นส,ขภาพแห�งชาต�.จั3านวนแลี่ะอ,ตราของผู้��ป�วยใน (หลี่,กประก,นส ขภาพ ถ�วน
หน�า แลี่ะสว,สด%การร,กษาพยาบาลี่ข�าราชีการแลี่ะค่รอบค่ร,ว ) ต�อประชีากร 100,000 ค่น รวมที กการ ว%น%จัฉ,ยโรค่ จั3าแนกเพศแลี่ะโรค่ / กลี่ �มโรค่ 298 กลี่ �มโรค่ รายภาค่ ตามบ,ญชี�จั3าแนกโรค่ระหว�างประเทีศ ฉบ,บแก�ไข ค่ร,+งที�� 10) พ.ศ.2554.
7) ว�ภาดา มหาว�โรจน�ร�ตน�.ค่ ณภาพชี�ว%ตของผู้��ป�วยไตวายเร*+อร,งระยะส ดที�ายที��ได�ร,บการร,กษาด�วยว%ธี�การฟอกเลี่*อดแลี่ะการลี่�างชี�องที�องอย�างต�อเน*�อง.รายงานการว�จ�ย . สาขาว�ทยาการระบาด บ�ณฑิ�ตว�ทยาลี่�ย มหาว�ทยาลี่�ยมห�ดลี่ , 2541.
8) โศภณ นภาธ์ร . กลี่ไกการเก�ดโรคไตวายเร*0อร�ง . ในเกรยงไกร ต�0งสง�า แลี่ะคณะ, บรรณาธ์�การ . Hemodialysis.กร,งเทพมหานคร : Text and Journal Publication ; 2542. หน.า1-40.
9) Atiporn Ingsathit, Ammarin Thakkinstian,et.al. Prevalence and risk factors of chronic kidney disease in the Thai adult population: Thai SEEK study. Nephrol Dial Transplant (2010) 25: 1567–1575.
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References
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