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Broadening Options for Long-term Dialysis in the Elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients.

Brown EA, Johansson L, Farrington K, Gallagher H, Sensky T, Gordon F, Da Silva-Gane M, Beckett N, Hickson M - Nephrol. Dial. Transplant. (2010)

Bottom Line: Modality was found to be an independent predictor of illness intrusion with greater intrusion felt in those on HD.Overall, in two closely matched demographic groups of older dialysis patients, QOL was similar, if not better, in those on PD.This study strongly supports offering PD to all suitable older people.

View Article: PubMed Central - PubMed

Affiliation: Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, UK. e.a.brown@imperial.ac.uk

ABSTRACT

Background: Health-related quality of life (QOL) is an important outcome for older people who are often on dialysis for life. Little is, however, known about differences in QOL on haemodialysis (HD) and peritoneal dialysis (PD) in older age groups. Randomising patients to either modality to assess outcomes is not feasible.

Methods: In this cross-sectional, multi-centred study we conducted QOL assessments (Short Form-12 Mental and Physical Component Summary scales, Hospital Anxiety and Depression Scale and Illness Intrusiveness Ratings Scale) in 140 people (aged 65 years or older) on PD and HD.

Results: The groups were similar in age, gender, time on dialysis, ethnicity, Index of Deprivation (based on postcode), dialysis adequacy, cognitive function (Mini-Mental State Exam and Trail-Making Test B), nutritional status (Subjective Global Assessment) and social networks. There was a higher comorbidity score in the HD group. Regression analyses were undertaken to ascertain which variables significantly influence each QOL assessment. All were influenced by symptom count highlighting that the patient's perception of their symptoms is a critical determinant of their mental and physical well being. Modality was found to be an independent predictor of illness intrusion with greater intrusion felt in those on HD.

Conclusions: Overall, in two closely matched demographic groups of older dialysis patients, QOL was similar, if not better, in those on PD. This study strongly supports offering PD to all suitable older people.

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Related in: MedlinePlus

Illness Intrusion Ratings Scores (IIRS) for PD and HD adjusted for age, time on dialysis, comorbidity scores, symptom count, social network score, gender, modality, nutritional status and cognitive function. *Significantly less illness intrusion in PD group, P = 0.032.
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fig1: Illness Intrusion Ratings Scores (IIRS) for PD and HD adjusted for age, time on dialysis, comorbidity scores, symptom count, social network score, gender, modality, nutritional status and cognitive function. *Significantly less illness intrusion in PD group, P = 0.032.

Mentions: Table 5 summarises the results from the linear regressions. The SF-12 PCS scale was found to be influenced by symptom count alone, with a decrease of 1.7 points for each additional symptom reported (P < 0.0001). Increasing symptom count was also significantly associated with a decline in SF-12 MCS (three outliers were excluded to achieve model of best fit for SF-12 MCS) scores by 0.9 points per symptom (P = 0.001). The SF-12 MCS score was found to be significantly lower in mild to moderately malnourished females compared to equivalent males (P = 0.006). In those who were malnourished, the SF-12 MCS score declined by 3.1 points for each increase in comorbidity score (P = 0.021). Increasing illness intrusion was associated with a greater symptom count (P < 0.0001) and decreasing age (P = 0.01). The effect of modality is illustrated in Figure 1, as it was found to independently contribute to illness intrusion with poorer scores in those on HD than in PD (P = 0.032).


Broadening Options for Long-term Dialysis in the Elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients.

Brown EA, Johansson L, Farrington K, Gallagher H, Sensky T, Gordon F, Da Silva-Gane M, Beckett N, Hickson M - Nephrol. Dial. Transplant. (2010)

Illness Intrusion Ratings Scores (IIRS) for PD and HD adjusted for age, time on dialysis, comorbidity scores, symptom count, social network score, gender, modality, nutritional status and cognitive function. *Significantly less illness intrusion in PD group, P = 0.032.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2957589&req=5

fig1: Illness Intrusion Ratings Scores (IIRS) for PD and HD adjusted for age, time on dialysis, comorbidity scores, symptom count, social network score, gender, modality, nutritional status and cognitive function. *Significantly less illness intrusion in PD group, P = 0.032.
Mentions: Table 5 summarises the results from the linear regressions. The SF-12 PCS scale was found to be influenced by symptom count alone, with a decrease of 1.7 points for each additional symptom reported (P < 0.0001). Increasing symptom count was also significantly associated with a decline in SF-12 MCS (three outliers were excluded to achieve model of best fit for SF-12 MCS) scores by 0.9 points per symptom (P = 0.001). The SF-12 MCS score was found to be significantly lower in mild to moderately malnourished females compared to equivalent males (P = 0.006). In those who were malnourished, the SF-12 MCS score declined by 3.1 points for each increase in comorbidity score (P = 0.021). Increasing illness intrusion was associated with a greater symptom count (P < 0.0001) and decreasing age (P = 0.01). The effect of modality is illustrated in Figure 1, as it was found to independently contribute to illness intrusion with poorer scores in those on HD than in PD (P = 0.032).

Bottom Line: Modality was found to be an independent predictor of illness intrusion with greater intrusion felt in those on HD.Overall, in two closely matched demographic groups of older dialysis patients, QOL was similar, if not better, in those on PD.This study strongly supports offering PD to all suitable older people.

View Article: PubMed Central - PubMed

Affiliation: Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, UK. e.a.brown@imperial.ac.uk

ABSTRACT

Background: Health-related quality of life (QOL) is an important outcome for older people who are often on dialysis for life. Little is, however, known about differences in QOL on haemodialysis (HD) and peritoneal dialysis (PD) in older age groups. Randomising patients to either modality to assess outcomes is not feasible.

Methods: In this cross-sectional, multi-centred study we conducted QOL assessments (Short Form-12 Mental and Physical Component Summary scales, Hospital Anxiety and Depression Scale and Illness Intrusiveness Ratings Scale) in 140 people (aged 65 years or older) on PD and HD.

Results: The groups were similar in age, gender, time on dialysis, ethnicity, Index of Deprivation (based on postcode), dialysis adequacy, cognitive function (Mini-Mental State Exam and Trail-Making Test B), nutritional status (Subjective Global Assessment) and social networks. There was a higher comorbidity score in the HD group. Regression analyses were undertaken to ascertain which variables significantly influence each QOL assessment. All were influenced by symptom count highlighting that the patient's perception of their symptoms is a critical determinant of their mental and physical well being. Modality was found to be an independent predictor of illness intrusion with greater intrusion felt in those on HD.

Conclusions: Overall, in two closely matched demographic groups of older dialysis patients, QOL was similar, if not better, in those on PD. This study strongly supports offering PD to all suitable older people.

Show MeSH
Related in: MedlinePlus