A quality of life of patients with End Stage Renal Disease undergoing Hemodialysis and Peritoneal dialysis in Naresuan University Hospital and Buddhachinaraj.

งานนำเสนอเรื่อง: "A quality of life of patients with End Stage Renal Disease undergoing Hemodialysis and Peritoneal dialysis in Naresuan University Hospital and Buddhachinaraj."— ใบสำเนางานนำเสนอ:

1 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

2 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.

3 Background & rationale
Renal replacement therapy (RRT) for patients with End stage renal disease(ESRD): Hemodialysis(HD) Peritoneal dialysis(PD) Kidney transplantation(KT)

4 Background & rationale
Standard care for ESRD pts. Reduce mortality & increase life expectancy study quality of life of patients At present, the standard care for ESRD can reduce mortality and improve life expectancy but it effect the quality of life of patients significantly. This led to need for study of quality of life of patients with ESRD.

5 Research question How does quality of life (QoL) in ESRD patients undergoing RRT with HD differ from PD at Naresuan University hospital & Buddhachinaraj hospital? What factors are correlated with QoL in ESRD patients undergoing RRT?

6 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.

7 Objectives To study & compare the QoL of patients with ESRD undergoing RRT, HD or PD. To study the factors associated with QoL of patients with ESRD.

8 Research methodology Research Design Patient population Data collection Questionnaire Data analysis

9 Research methodology Research Design Patient population
Descriptive, Cross-sectional study Patient population Patients with ESRD undergoing HD or follow-up appointment during January 2013.

10 Patient population Inclusion criteria Exclusion criteria
Patients diagnosed as ESRD. Can speak & understand Thai. Age ≥ 18 years Undergoing RRT ≥ 6 months. Willing to participate. Exclusion criteria Patients with cognitive impairment, unable to communicate & hearing disorders. undergoing RRT for < 6 months.

11 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.

12 Research methodology Statistic analysis: STATA version 10.1
percentage, mean & SD, median and IQR, t-test, Mann-Whitney U test, Logistic Regression

13 Social function & Financial Illness Factors associated with QoL
Results Demographic data Social function & Financial Illness Factors associated with QoL Laboratory results related to QoL การศึกษาครั้งนี้เป็นการศึกษาเปรียบเทียบคุณภาพชีวิตของผู้ป่วยไตวายเรื้อรังที่ได้รับการบำบัดทดแทนไตด้วยการฟอกเลือดหรือการล้างไตทางช่องท้องถาวรที่มารับการรักษาหรือมาติดตามอาการตามนัดที่หอผู้ป่วยโรคไตของโรงพยาบาลมหาวิทยาลัยนเรศวร และ โรงพยาบาลพุทธชินราชในช่วงวันที่ 21มกราคม ถึง 25มกราคม ปี2556 ข้อมูลที่ได้จะนำมาวิเคราะห์และเสนอผลการวิเคราะห์เป็น 5 ตอนดังนี้

14 Research result Demographic data

15 SEX This study has 41 participants, 29 are patients undergoing hemodialysis and rest are peritoneal dialysis. there were 18 females and 23 males.

16 Age Hemodialysis patient are mostly with age range between 61 to 80 years. At the same time Pd patient mostly belongs to age range less than 40. The mean age of HD patients was years, while PD patients was years old. The oldest patient was 92 years old and the youngest was 25 years old.

17 Marital status Most of the participants were married amounting to percent in HD patient and 75 percent in PD patient.

18 Education level Most of the participants are educated upto secondary school level with 41.67% and 41.38% in HD and PD patient, respectively.

19 Social function & Financial
Results Social function & Financial อ่านตาม slide เลยจ้าๆๆๆ

20 Occupation In this study, maximum of participants do not have occupation for both the groups. One interesting finding is that all the patients with govt service undergo hemodialysis.

21 Income Regarding income of the participants, it was found that patient undergoing Hemodialysis have more income than patients undergoing peritoneal dialysis.

22 Scheme of health care When exploring the scheme of health care, most of the Hemodialysis patient make direct payment for the treatment. On the other hand, Peritoneal dialysis patients mostly belongs to universal health coverage of Thailand.

23 Results Illness

24 Duration of renal replacement therapy
The duration of RRT of the 2 groups showed that patients with HD are mostly …more than 5 years to 10 years, while PD patients mostly belongs to range of 1 year to 3 years . The average duration Of HD patients was 24.5 years, the longest period was 13 years and the shortest was 6 months. The average duration Of PD patients was 2.87 years, the longest period was 6 years and the shortest was 6 months.

25 Underlying diseases For the both groups, the most common underlying diseases were Hypertension followed by Diabetes. Other disease here includes SLE, gout, DLP, Dyspepsia, pulmonary edema, Osteoarthritis and Diabetic retinopathy

26 Travelling distance This graph shows the travelling distance of the patient to the hospital. This indicates that most of the patient live nearby hospital i.e less than 10 km

27 Cause of ESRD The most common cause of ESRD indicated by our study showed that it is Hypertension followed by diabetes. other diseases here includes SLE, kidney stone, DLP, glomerulonephritis, renal cyst, kidney transplant failure, anti-hypertensive drug

28 Frequency of HD This diagram shows that., Almost all the Hemodialysis patients under go HD atleast twice a week.

29 Infection(PD) In PD patients, We also studied the history of infection at abdomen. We Found out that there are equal number of people who have history of infection and who didn’t have.

30 Comparison of Quality of life score
Results Comparison of Quality of life score Now we will be comparing QoL scores between HD and PD pt.

31 Comparison of Quality of life scores between PD and HD
SF-36 general health Quality of Life ESRD specific Quality of Life When we compared the Qol scores for both general and ESRD specific domain, it showed that there was no statistically sig Mean diff. = 35.99 (95% CI , ,P-value = 0.52) Mean diff. = 75.79 (95% CI , ,P-value = 0.32) 31

32 General Health sub-domain analysis
between PD and HD Mean(%) When we explored sub-domain of general health, we found that there were not statistically different

33 ESRD specific Quality of Life sub-domain analysis between PD and HD
However when exploring sub-domains of ESRD specific Quality of Life, QoL scores for mental health was better in PD patients significantly(P value=0.03).

34 Factors associated with the patient’s Quality of life
Results Factors associated with the patient’s Quality of life Now

35 SF-36 General Health scores (DM)
comparison between the patients with DM and without DM, the result showed that In general health domain, both groups of patients with diabetes have lesser QoL scores significantly with P-value = 0.002 Mean diff. = % CI = , P-value = 0.002 patients with DM patients without DM

36 SF-36 General Health scores (CVD)
comparison between the patients with CVD and without CVD, the result showed that In general health domain, both groups of patients with CVD have lesser QoL scores significantly with P-value = 0.028 Mean diff. = % CI = , P-value = 0.028 patients with CVD patients without CVD

37 ESRD specific Quality of Life scores (CVD)
In ESRD specific Quality of Life, comparison between the patients with CVD and without CVD, we found that the patients with CVD also have lesser QoL scores significantly in both groups (P value= 0.008). Mean Diff.= % conf. interval)=83.62 , P-value= 0.008

38 ESRD specific Quality of Life scores (occupation)
When exploring patient’s occupation, it was found that the patient with occupation have QoL scores more than those patient without occupation significantly with P value 0.007 Mean Diff. = % conf. interval=61.86 , P-value= 0.007

39 Multivariable logistic regression
Total ESRD scores | Coef. P>|t| [95% CI] DM | CVD | cons | However after excluding influential factors by Multivariable logistic regression , it revealed that only patients with CVD have lessor QoL scores with a statistical significance (P-value = 0.006).

40 Laboratory results related to Quality of life

41 Relation between Laboratory results and quality of life scores
SF-36 Quality of Life ESRD specific Quality of Life Odds ratio 95%CI P-value* Albumin ≤4.1 5.70 0.029 0.59 0.504 Creatinine ≤ 10.0 2.289 0.286 7.8 0.011 Na ≤ 41 0.75 0.808 K ≤4.3 1.92 0.402 0.37 0.179 HCO >22 .68 0.636 3.68 0.247 Chloride ≤98 0.95 0.953 0.52 0.395 Calcium >9.0 3.13 0.313 0.56 0.483 Phosphate <4.6 0.27 0.086 Hematocrit >30.0 1.64 0.577 0.13 LDL ≤70 0.57 0.637 30 0.004 KT/V >2.0 0.48 0.031 The laboratory result that effects the QoL scores includes Se Cr, Hct, LDL and Kt/v. It indicated that the patient with lesser level of serum creatinin and LDL have more QoL scores significantly ( p=0.01 and respectively) At the same time, the patient with higher hematocrit level i.e > 30 have worse quality of life compared to those with HCT <30 (p=0.04) Regarding Kt/V, pts with Ktv <2 have higher QoL scores than those with more than 2 with statistical significance(p=0.03)

42 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. The findings of this study revealed that the total QoL scores in general health domain and ESRD-specific health domain between these two groups were not statistically different. The patients who undergo PD have total QoL scores more than HD patient. This result was similar to findings of Erika’s study. It showed that the patients undergoing PD have total QoL scores 1.5 times more than HD patient 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):

43 Discussion ESRD-specific health domain: Occupation (P value=0.007).
Mental health in PD patients (P value=0.03). Our study showed that QoL scores for patient with occupation for both groups have higher QoL scores significantly (P value=0.007). The reason behind could be the patient who could earn have better a living standard. QoL scores for mental health was better in PD patients significantly (P value=0.03) This may be due to patient’s ability to get adjusted with their treatment according to the routine of daily life.

44 Discussion General health domain: Patients with diabetes & cardiovascular disease (P value = and 0.028respectively). In ESRD-specific domain: patients with CVD (P value= 0.008) Similar to Wipada Mahawirotratana1’s study In general health domain, both groups of patients with diabetes and cardiovascular disease (CVD) showed lesser QoL scores significantly (P value = 0.002and respectively). In ESRD-specific domain: patients with CVD and without occupation also have lesser QoL scores significantly in both groups (P value= 0.008, respectively). According to Wipada Mahawirotratana1’s study showed that patients with diabetes and cardiovascular disease (CVD) had lesser QoL scores significantly (P value = 0.001, and respectively). วิภาดา มหาวิโรจน์รัตน์.คุณภาพชีวิตของผู้ป่วยไตวายเรื้อรังระยะสุดท้ายที่ได้รับการรักษาด้วยวิธีการฟอกเลือดและการล้างช่องท้องอย่างต่อเนื่อง.รายงานการวิจัย. รายงายวิทยานิพนธ์ สาขาวิทยาการระบาด บัณฑิตวิทยาลัย มหาวิทยาลัยมหิดล, 2541.

45 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 The Laboratory results indicated that patient’s serum Creatinine (Cr),Hematocrit (Hct), Lactate dehydrogenase (LDL)and Clearance, time and volume (Kt/V) level also have effect on QoL scores significantly. Differs to Kamyar Kalantar-Zadeh1 study showed malnutrition and anemia have effect on lower QoL scores. These conditions could be increased complication of treatment and admission rate. 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 

46 Short duration for study There are a lot of confusing questions
Limitation Small Samples size Short duration for study There are a lot of confusing questions Small Samples size Short duration for study. There are a lot of confusing questions

47 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. 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

48 Thank you for your attention

49 References การจัดบริการฟอกเลือดด้วยเครื่องไตเทียม (Hemodialysis :HD) ปี คู่มือบริหารงบกองทุนหลักประกันสุขภาพ แห่งชาติ สืบค้นจาก ทวี ชาญชัยรุจิรา. Continuous care in renal replacement therapy : Hemodialysis. ใน อายุรศาสตร์ทันยุค = Update in internal medicine 2012 better outcome with the continuity of care (พิมพ์ ครั้งที่ 1). ภาควิชาอายุรศาสตร์ คณะแพทยศาสตร์ศิริราชพยาบาล, 2555: 253. นิภา อัยยสานนท์. การเปรียบเทียบคุณภาพชีวิตของผู้ป่วยไตวายเรื้อรังที่ได้รับการบำบัดทดแทนไตโดยการฟอกเลือด และการล้างไตทางช่องท้องอย่างถาวร. รายงายการวิจัย. สาขาวิชาวิทยาการสังคมและการจัดการระบบ สุขภาพ บัณฑิตวิทยาลัย มหาวิทยาลัยศิลปาการ, 2552. ยุวดี ธีระศิลป์.คุณภาพชีวิตของผู้ป่วยไตวายเรื้อรังระยะสุดท้าย (QUALITY OF LIFE IN END- STAGE RENAL DISEASE PATIENTS ). ภาควิชาจิตเวชศาสตร์ คณะแพทยศาสตร์ จุฬาลงกรณ์มหาวิทยาลัย, 2547. สมชาย เอี่ยมอ่องและคณะ. Textbook of nephrology. เท็กซ์ แอนด์ เจอร์นัล พัลลิเคชั่น จำกัด, กรุงเทพฯ; 2554 : สำนักงานกลางสารสนเทศบริการสุขภาพ และสำนักงานหลักประกันสุขภาพแห่งชาติ.จำนวนและอัตราของผู้ป่วยใน (หลักประกันสุขภาพ ถ้วนหน้า และสวัสดิการรักษาพยาบาลข้าราชการและครอบครัว ) ต่อประชากร 100,000 คน รวมทุกการ วินิจฉัยโรค จำแนกเพศและโรค / กลุ่มโรค 298 กลุ่มโรค รายภาค ตามบัญชีจำแนกโรคระหว่างประเทศ ฉบับแก้ไข ครั้งที่ 10) พ.ศ.2554. วิภาดา มหาวิโรจน์รัตน์.คุณภาพชีวิตของผู้ป่วยไตวายเรื้อรังระยะสุดท้ายที่ได้รับการรักษาด้วยวิธีการฟอกเลือดและการล้างช่อง ท้องอย่างต่อเนื่อง.รายงานการวิจัย. สาขาวิทยาการระบาด บัณฑิตวิทยาลัย มหาวิทยาลัยมหิดล, 2541. โศภณ นภาธร. กลไกการเกิดโรคไตวายเรื้อรัง. ในเกรียงไกร ตั้งสง่า และคณะ, บรรณาธิการ. Hemodialysis.กรุงเทพมหานคร : Text and Journal Publication ; หน้า1-40. 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.

50 References Ebony Boulware, Bernard G. Jaar,  Michelle E. Tarver-Carr, Frederick L. Brancati, Neil R. Powe, Screening for proteinuria in US adults: A cost-effectiveness analysis. JAMA 2003. 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): M Ginieri-Coccossis et.al. Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: Investigating differences in early and later years of current treatment. BMC Nephrology, 2008, 9:14 doi:10. From: Nipa Aiyasanon, NalineePremasathian, Akarin Nimmannit, Pantip Jetanavanich Suchai Sritippayawan. Validity and Reliability of CHOICE Health ExperienceQuestionnaire:Thai Version. J Med Assoc Thai 2009; 92 (9): Theofilou Paraskevi .Quality of life in patients undergoing hemodialysis or peritoneal dialysis treatment. Journal of Clinical Medicine Research May 19;3(3):132-8. Wu AW, Fink NE, Cagney KA, Bass EB, Rubin HR, Meyer KB, Sadler JH, PoweNR.Developing a health- related quality-of-life measure for end-stage renal disease: The CHOICE Health Experience Questionnaire. Am J Kidney Dis Jan;37(1):11-2.