RESUMO
Quality of life [QoL] in end-stage renal disease [ESRD] patients is an important outcome for both physicians and patients in selecting dialysis modality. We conducted a comparison between regular maintenance hemodiaylsis and regular peritoneal dialysis patients in two tertiary referral hospitals in King Saud University in Saudi Arabia. We hypothesize that there might be cultural and socioeconomic factors modifying QoL in dialysis patients. Cross-sectional study on hemodialysis and peritoneal dialysis patients. Two hundred dialysis patients participated in the study, one hundred in each group of dialysis modality, from July 2007 to July 2008. We used a cross-sectional design and collected the date using the Kidney Disease Quality of Life [KDQoL SF] questionnaire. Patients in both groups had similar sociodemographic characteristics [age, marital status, and education]. Mean age [SD] in the hemodialysis group was 47.5 [13.8] years and 51.0 [13.5] years in the peritoneal dialysis group. Males represented 53% and 43%, respectively. Mean duration of dialysis was 77.2 [75.5] months in the hemodialysis group and 34.1 [26.9] months in the peritoneal dialysis group. The mean [SD] score was 49.5 [13.7] in the hemodialysis group and 61.3 [12.4] in the peritoneal dialysis group. QoL mean scores were significantly higher among peritoneal dialysis in all domains and in the total QoL, with the exception of the score of physical QoL, which was higher in the hemodialysis patients, compared to peritoneal dialysis patients, although the difference was not statistically significant. Multiple regression analysis indicated that hemodialysis was a negative predictor of QoL score, compared to peritoneal dialysis. Also, age, male gender, and dialysis duration were negative predictors of QoL score. In the unique culture of Saudi Arabia, peritoneal dialysis patients have better QoL, compared to hemodialysis patients, validating the findings of research reports from other countries.
RESUMO
One out of five Saudi diabetics develops end-stage renal disease [ESRD]. Factors associated with progressive loss of renal function have not been extensively studied and reported in our community. We sought to evaluate the pattern and progression in glomerular filtration rate [GFR] and investigate the potential risk factors associated with progression to diabetic nephropathy [DN] among Saudi patients. Hospital-based retrospective analysis of type 2 diabetic patients seen between January 1989 and January 2004 at Security Forces Hospital and King Saud University in Riyadh, Saudi Arabia. DN was defined as persistent proteinuria assessed by urine dipstick [at least twice for at least two consecutive years and/or serum creatinine >130 micromol/L; and/or GFR <60 mL/min/1.73m[2]. Of 1952 files reviewed, 621 [31.8%] met the criteria for DN, and 294 [47%] were males. The mean [SD] age of the patients at baseline was 66.9 [11.4] years, and mean duration of diabetes was 15.4 [7.5] years. GFR deteriorated from a baseline value of 78.3 [30.3] mL/min/1.73m[2] to 45.1 [24.1] mL/min/1.73m[2] at the last visit, with a mean rate of decline in GFR of 3.3 mL/min/year. Progression of nephropathy was observed in 455 [73.3%] patients, with 250 [40.3%] patients doubling their first-hospital-visit serum creatinine level in a mean of 10.0 [6.0] years. At the end of the study, 1 6.5% of the cohort developed ESRD and were dialyzed. GFR >90 mL/min/1.73m[2] at the first hospital visit; duration of diabetes >10 years; persistent proteinuria; systolic blood pressure >130 mm Hg; and presence of retinopathy were significant markers associated with progression of nephropathy. Diabetic nephropathy tends to be progressive among Saudis, with GFR deteriorating at a rate of 3.3 mL/year and with a doubling of serum creatinine level in 40.3% of patients in 9.9 years