P1549TREATMENT BURDEN AND ITS IMPACT ON QUALITY OF LIFE AMONG CHRONIC KIDNEY DISEASE PATIENTS WITH DIABETES MELLITUS IN QATAR
Authors: Al-Ali Fadwa , Ibrahim Rania , Mathew Mincy , Kheir Nadir , Awaisu Ahmed , Izham Mohamed , Almansouri Asmaa , Hamad Abdullah 
Published: June 2020

Abstract

Background and Aims
Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) and on of its top comorbidities. Its management places significant burden on patients and results in impairment of their health-related quality of life (HR-QOL). Little is known about diabetes mellitus treatment-related burden in patients with CKD. This study aimed to investigate the impact of diabetes mellitus on treatment-related burden and HR-QOL among CKD patients in Qatar.

Method
This was a mixed-method, sequential explanatory study conducted at Fahad Bin Jassim Kidney Center in Qatar on hemodialysis and pre-dialysis (GFR&lt;20 but not on dialysis yet) patients. Treatment-related burden and HR-QOL were assessed quantitatively using the Treatment Burden Questionnaire (TBQ) and the Kidney Disease Quality of Life (KDQOL™) questionnaire, respectively. To gain a deeper insight, qualitative one-to-one semi-structured interviews were conducted among the CKD patients. Quantitative data were analyzed descriptively and inferentially using SPSS version 24. Thematic content analysis was performed for the qualitative data.

Results
Two hundred-eighty CKD patients (hemodialysis = 223 and pre-dialysis (GFR &lt;20) = 57) were included. 157 has DM and 66 were non-DM (in hemodialysis) while 32 patients had DM vs 25 non-DM (in pre-dialysis). In general, 35% of patients reported moderate to high burden. Hemodialysis patients experienced significantly higher treatment burden compared to pre-dialysis patients with median (IQR) of 45 (36) versus 25 (33), respectively (p&lt;0.001). DM patients expressed significantly higher TBQ score compared to non-DM (47(40) vs. 36(27) p&lt;0.001). Retinopathy was associated with worsened treatment burden (TBQ 46.5(29) vs. 40(38) p=0.019). Medication burden and lifestyle change burden were the highest perceived treatment-related burden, followed by administrative, social, and financial burden. The presence of antidiabetic medications correlated with worse TBQ score (0.207 p&lt;0.001). There was a strong, negative correlation between TBQ score and KDQOL-36™ score [rs (251) = -0.616, p &lt;0.001]. Presence of DM was associated with worse KDQOL (2110(1055) vs. 2685(1170) p&lt;0.001). Thematic content analysis identified religion and faith in God as well as quality of the care provided as factors that reduce perceived treatment burden and improve patients’ HR-QOL. Conversely, medication burden, lifestyle changes, challenges with international travelling, financial burden, and empathy were factors that worsen perceived treatment-related burden and HR-RQOL.

Conclusion
This study suggests that diabetes mellitus and its treatment negatively impacts treatment-related burden and quality of life in CKD patients. This result should be considered in management strategies when designing healthcare interventions directed to CKD patients with diabetes mellitus.