Assessment of Quality of Life in Dialysis and Non-Dialysis Chronic Kidney Disease Patients

INTRODUCTION: Chronic kidney disease is a general term for heterogeneous disorders affecting the structure and function of the kidney. The variation in disease expression is related partly to cause and pathology, severity, and rate of progression. Since the introduction of the conceptual model, definition, and staging of chronic kidney disease 10 years ago,1-4 guidelines have recommended a shift from kidney disease being recognized as a life threatening disorder affecting few people who need care by nephrologists, to a common disorder of varying severity that not only merits attention by general internists, but also needs a concerted public health approach for prevention, early detection, and management.4-6 Although guidelines had an important effect on clinical practice, research, and public health, they have also generated controversy. DEFINITIONS AND OUTCOMES: The definition of chronic kidney disease is based on the presence of kidney damage (i.e., albuminuria) or decreased kidney function (i.e., glomerular filtration rate [GFR] <60 mL/min per 1·73 m²) for 3 months or more, irrespective of clinical diagnosis.1,8-9 Because of the central role of GFR in the pathophysiology of complications, the disease is classified into five stages on the basis of GFR: more than 90 mL/min per 1·73 m²(stage 1), 60–89 mL/min per 1·73 m² (stage 2), 30–59 mL/min per 1·73 m² (stage 3), 15–29 mL/min per 1·73 m² (stage 4), and less than 15 mL/min per 1·73 m² (stage 5). Findings from experimental and clinical studies have suggested an important role for proteinuria in the pathogenesis of disease progression.10 Epidemiological studies have shown graded relations between increased albuminuria and mortality and kidney outcomes in diverse study populations, in addition to, and independent of, low GFR and risk factors for cardiovascular disease.11-16 Kidney failure is traditionally regarded as the most serious outcome of chronic kidney disease and symptoms are usually caused by complications of reduced kidney function. When symptoms are severe they can be treated only by dialysis and transplantation; kidney failure treated this way is known as end-stage renal disease. Kidney failure is defined as a GFR of less than 15 mL/min per 1·73 m², or the need for treatment with dialysis or transplantation. Other outcomes include complications of reduced GFR, such as increased risk of cardiovascular disease, acute kidney injury, infection, cognitive impairment, and impaired physical function.17-20 Complications can occur at any stage, which often lead to death with no progression to kidney failure, and can arise from adverse effects of interventions to prevent or treat the disease. AIM OF THE STUDY: The aim of the study is to assess quality of life in dialysis and nondialysis chronic kidney disease patients. OBJECTIVES OF THE STUDY: 1. To study the demographic details of patients with Chronic Kidney Disease and Dialysis Patients. 2. To study the Prevalence of symptoms in patients with Chronic Kidney Disease and Dialysis Patients. 3. Determine the quality of life ofpatients with Chronic Kidney Disease and Dialysis Patients by using Kidney Disease Quality of Life Questionnaire–Short Form (KDQOL-SFTM). DISCUSSION: Measuring the impact of CRF treatment on patients’ quality of life is being recognized as an important outcome measure. The main aim along with treatment in patients with chronic medical conditions, such as CRF, in particular, is to reduce disease burden and suffering caused by thedisease. This means to improve the overall wellbeing of the patient and to improve the individual’s quality of life. The Kidney Disease Quality of Life Questionnaire–Short Form (KDQOL-SFTM) has become themost widely used QOL measures for CRF patients. In this study Quality of Life compared using KDQOL-SFTM scores among patients with dialysis and different CKD stages to study the relationship between QOL and the risks of outcomes. A total of 200CRF patients participated in the study which included 74CRF patients on dialysis (CRF-D) and 126CRF patients not on dialysis (CRF-ND). Table no. 1, shows the gender wise distribution of Study population. Overall 59.4% were male patients greater in number than female 40.5% in CRF-D group, whereas CRF-ND comprised of 56.3% male patients and 43.6% of female. Table no. 2, shows theage wise distribution. In this most of the CRF-D patients were in the age group of more than 60 years (44.5%) followed by 51-60 years (25.6%),41-50 years (17.5%) and less than 40 years(12.1%). CRF-ND patients were more in the age group of more than 60 years (37.3%) followed by 51-60 years (24.6%),41-50 years (21.4%)and less than 40 years(16.6%). In both the groups, most of the participants were over 60 years. Table no. 3, shows the co-morbidities of the study population. Hypertension, Ischemic Heart Disease, Diabetes Mellitus, and Anaemia are the co-morbid diseases commonly found with the CKD patients. In this study most of the CRF-D patients have hypertension(93.2%), followed by anaemia (85.1%), Diabetes mellitus (79.7%), Ischemic Heart Disease (63.5%) and other diseases (36.4%). Most of the CRF-ND patients have hypertension(84.9%), followed by anaemia (77.7%), Diabetes Mellitus (73.8%), Ischemic Heart Disease (50.0%) and other diseases (37.3%). CONCLUSION: The proper measures of QOL in patients with renal disease are unknown. Measures include subjective and objective tools, and generic and diseasespecific scales. The past several years have witnessed an explosion in the number of studies and the populations of patients with CKD in which various aspects of HRQOL have been assessed. It is clear that the many QOL measures are intertwined. A challenge remains to make these domains clinically meaningful. Use of KDQOL-SFTM as a QOL assessment tool, may be valuable in the global assistance of these patients and allow timely health care intervention in the course of the disease. Our findings show that some symptom burden was higher in the non-dialysis group, compared to the dialysis group but most of the symptoms are did not reach statistical significance. Similarly, there was no significant change in the KDQOL-SFTM scores among patients with CRF patients on dialysis and CRF patients not on dialysis. Results obtained from the use of KDQOL-SFTM in CRF patients undergoing dialysis and not on dialysis supports the reliability of the instrument in study area population. Hence, KDQOL-SFTM would help physicians in routine monitoring of patient’s perception of their wellbeing as it forms an integral part to impart better patient care. A better understanding of HRQoL and its determinants would help to formulate individualized treatment strategies. There is a compelling need for further research to better define the spectrum of changes in symptom burden and physical performance among patients started on maintenance dialysis. Such research will crucially inform the discussion between clinicians and patients in the shared decision making process around the timing of dialysis initiation.