A cross-sectional, correlational survey to explore the relationship between Renal Association biochemical and haematological markers and health-related quality of life in patients receiving haemodialysis in the North West of England.

THE UNIVERSITY OF MANCHESTERABSTRACT OF THESIS? A cross-sectional, correlational survey to explore the relationship between Renal Association biochemical and haematological markers and health-related quality of life in patients receiving haemodialysis in the North West of England? Submitted by Jean Winterbottom for the degree of Doctor of Philosophy in July 2015Introduction with Hypothesis/Objective: Management of long-term conditions requires a holistic approach, which places equal emphasis on the biomedical and the psychosocial. In chronic kidney disease (CKD), whilst biochemical and haematological parameters are routinely measured in accordance with UK Renal Association Standards and Guidelines this is not the case for health-related quality of life (HRQoL). There is evidence that achieving Renal Association biochemical/haematological targets improves mortality & morbidity. However, little evidence is available on whether achieving these targets enhances health-related quality of life (HRQoL). This study? s primary aim was, therefore, to determine whether there was any association between the extent to which patients achieved Renal Association biochemical and haematological targets and their HRQoL. A secondary aim was to explore the association between demographic and other treatment-related factors and HRQoL.Methods: A cross-sectional postal survey was conducted, involving 301 adult maintenance haemodialysis patients (age 18 + yrs.) in North-west England. HRQoL data were collected using the KDQoL-SF and patient records were searched for demographic variables and key biochemical/haematological markers derived from the UK Renal Association Standards and Guidelines. Biomarker achievement was categorised as ? low achievers? (patients who reached 0 ? 2 Renal Association targets), ? medium achievers? (3 ? 5 targets) and ? high achievers? (6 ? 8 targets). Data were initially analysed descriptively then using univariate and multivariate (multiple regression) analysis. Results: Participants were older (mean age 63.4 years), mostly male (64.0%) and predominantly white (87.0%); they had been on HD for a mean of 42.0 months (median 28.0). Patients typically had low scores for most aspects of HRQoL. For Renal Association targets, 5.6 % of the sample were ? low achievers? , 57.1% ? medium achievers? and 35.2% ? high achievers? Apart from the KDQoL-SF subscale of symptom/problem list (medium achievers p<0.012, high achievers p<0.009), there was no association between HRQoL and the level of RA biomarkers achieved. Being Asian was negatively associated with several KDQoL-SF subscales. Increased age was positively associated with many subscales, suggesting a better toleration of poor health in older patients. The individual biomarker albumin was negatively associated with a number of the KDQoL subscales. Conclusion: The study? s findings demonstrate little association between achievement of Renal Association biochemical/haematological targets and HRQoL. A more holistic approach is required to address other aspects of physical and psychological health. Guidelines are needed that contain recommendations for routine monitoring of HRQoL scores. There is a need for better recognition of HRQoL as a specific treatment goal.