KDQOL Survey Scores in Dialysis Patients Decrease Following the First Year of the COVID-19 Pandemic With Concurrent Changes in Patient Adherence

ABSTRACT

The Kidney Disease Quality of Life (KDQOL) survey is a review of patients’ quality of life (QOL) on hemodialysis. Lower survey scores in depression, burden of disease, and treatment satisfaction are associated with worse compliance to treatment and poorer outcomes. KDQOL surveys were extracted from and stratified by year, with duplicate entries removed. Annual mean scores for each component of the survey were calculated for each clinic. The KDQOL data represents the mean scores for 2017-2019 compared to the first three quarters of 2021. 2020 was excluded due to sampling challenges and high patient turnover creating potentially inaccurate data. Mean scores were compared by Student’s t-test with Bonferroni adjustment for multiplicity. Phosphorus and PTH levels were used as a surrogate for treatment compliance. Patients reported lower QOL scores during the COVID-19 pandemic compared to pre-pandemic (baseline). All KDQOL metrics were significantly lower in 2021 compared to the mean of three years prior to the pandemic. A two sample Student’s T test was used to determine the change in mean score for each category Physical Component Score (t(2)= 14.5, p=0.009), Mental Component Score (t(2)= 36.7, p=0.0004), Burden of Kidney Disease (t(2)= 6.1, p=0.01), Symptoms of Kidney Disease (t(2)= 22.8, p=0.0009), Effects of Kidney Disease (t(2)= 8.8, p=0.006). Phosphorus was significantly higher in 2021 compared to the mean of 2018 and 2019 when calculated via t-test (t(31)= -2.72, p=0.01). Parathyroid Hormone quarterly data was evaluated via t-test for 2018 to 2020 vs. the first three quarters of 2021 (t(12)= -7.15, p=0.01) Using the KDQOL survey to measure patients’ QOL, we found that all measures were significantly lower in 2021 following the pandemic. Using markers of bone metabolism as measures of treatment compliance, phosphorus and PTH levels were also significantly higher in 2021. In ESRD patients who survived the trauma of the pandemic, QOL is perceived to be worse and is likely affecting compliance. Social workers and staff need to be aware of these trends to provide the appropriate counselling and resources to meet the needs of these patients.