Analysis Of Quality Of Life And Related Factors In Patients With Maintenance Hemodialysis

Objective:To analysis the quality of life of patients on maintenance hemodialysis(MHD),determine those factors contribute to the quality of life(QOL).Therefore,we can provide the basis for the clinical work.Methods:98 patients on maintenance hemodialysis were recruited in the Second Hospital of Shandong University from August 2009 to December 2009.KDQOL-SFTM1.3 was used to assess the QOL of the patients by interviewing, and record demographic characteristics included:age,height,weight,health insurance,marital status, educational level, employment status, economic level, clinical characteristics included:primary renal disease, blood pressure, duration of dialysis, interdialytic weight gain.Within one week after completing the KDQOL-SFTM1.3 instrument,we detected hemoglobin(Hb), serum albumin (Albumin), prealbumin (PA), serum calcium, serum phosphorus and parathyroid hormone (iPTH), high-sensitive C-reactive protein (hs-CRP),urea clearance index (Kt/V).Then analysis the quality of life of patients on maintenance hemodialysis,determine those factors contribute to the QOL.Results:1.The top three primary disease of MHD patients are Chronic Glomerular Nephritis(CGN)(34.7%),Hyperterisive Nephropathy(HN)(24.5%)and Diabetic Nephropathy(DN) (20.4%)in the 98 cases;In the elder period of 32 cases,the top three primary disease are Diabetic Nephropathy(DN) (31.2%),Hypertensive Nephropathy(HN)(25%)andChronic Glomerular Nephritis(CGN)(18.8%).There is a increasing incidence of the ESRD caused by secondary kidney disease such as HN and DN in the elderly patients on maintenance hemodialysis.2.The SF-36 of patients receiving hemodialysis were 48.21±13.85,and KDTA were 55.01±8.93,the QOL in most areas was similar to the study in Guangzhou,but lower than the similar study in Europe and America.3.The QOL in hemodialysis patients increases with age,especially for the SF-36 and some branch areas:physical functioning, role-physical, social function(P<0.01),and was significantly negative correlations with sleep(P<0.01).Body mass index(BMI)have no significant effect on the QOL of hemodialysis patients.4. QOL of male patient were superior to female patient in some aspects such as:SF-36, physical functioning, bodily pain(P<0.05).5.There was signifcantly positive correlations between educational level and SF-36(P<0.05),in which high school was superior to primary school.But,there was no correlations between educational level and KDTA.6.There was significantly positive correlations between economic level and SF-36(P<0.01),in which 40 thousand yuan group was superior to 20 thousand yuan group,the trend of SF-36 was quite stable after annual income 40 thousand yuan.But,there was no correlations between economic level and KDTA.7.There was no significantly correlations between blood pressure and QOL. 8.There was significantly negative correlation between duration of dialysis and SF-36, physical functioning, bodily pain,KDTA, symptom problem list, effects of kidney disease(P<0.01).9.There was significantly negative correlation between IWG/DW and KDTA, symptom problem list, effects of kidney disease(P<0.05). 10.Nutritional status influence on QOL:①There were significantly positive correlations between hemoglobin and SF-36, physical functioning, general health, emotional well-being, social function, energy/fatigue,KDTA(P<0.01).②There were significantly positive correlations between serum albumin and SF-36, physical functioning, role-physical, general health, energy/fatigue, KDTA, symptom problem list, effects of kidney disease, sleep(P<0.01).③There were significantly positive correlations between prealbumin and SF-36, physical functioning(P<0.01). 11.The effect of calcium and phosphorus metabolism on QOL:①There were significantly positive correlations between calcium and effects of kidney disease(P<0.01).②There were significantly negative correlations between serum phosphorus and KDTA, symptom problem list, effects of kidney disease(P<0.01).③There were significantly negative correlations between calcium-phosphorus product and KDTA, symptom problem list(P<0.05).④There were significantly negative correlations between iPTH and SF-36, general health, emotional well-being, energy/fatigue,KDTA, symptom problem list, effects of kidney disease, quality of social interaction(P<0.01).12.There were significantly negative correlations between hs-CRP and SF-36, physical functioning, bodily pain, social function, KDTA, symptom problem list(P＜0.01).13.There were significantly positive correlations between Kt/v and SF-36,social function,KDTA, burden of kidney disease(P<0.05).14.Analysis of muti factors that impacted on QOL:the factors which affect on QOL were arranged according to their standardized coefficients:①effect on SF-36 was:Hb, age,iPTH, hs-CRP,ALB,duration of dialysis,Kt/V,PA.Especially, Hb, age and iPTH were independence factors.②effect on KDTA was:ALB,IWG/DW, duration of dialysis,iPTH, serum phosphorus,calcium-phosphorus product, hs-CRP, Kt/V, PA, Hb. Especially, ALB,IWG/DW, duration of dialysis and iPTH were independence factors.Conclusions:l.The SF-36 of patients receiving hemodialysis were 48.21±13.85,and KDTA were 55.01±8.93,the QOL in most areas was similar to the study in Guangzhou,but lower than the similar study in Europe and America.2.Serum albumin and hemoglobin were independent protective factors of QOL in hemodialysis patients.We could significantly improve QOL if we improve the nutritional status and correct anemia.3.iPTH was independent risk factors of QOL in hemodialysis patients.4.IWG/DW was independent risk factors of QOL in hemodialysis patients.IWG shoud be controlled to 3% of dry weight, no more than 5%. 5.Age and duration of dialysis were independent risk factors of QOL in hemodialysis patients.