ABSTRACT
BACKGROUND/AIMS: Studies comparing quality of life (QOL) between peritoneal and hemodialysis patients have yielded inconsistent results. Physical (PCS) and mental component summary (MCS) scales of Short Form 36 (SF-36) health survey are highly validated measures of self-assessed QOL. We sought to evaluate these indices in PD patients: (1) as measures of QOL, (2) predictors of QOL, (3) to study change in QOL over time, and (4) to compare QOL in PD vs. hemodialysis patients. METHODS: SF-36 questionnaires were administered every 3 months to patients over a 2-year period and PCS and MCS were calculated. Mean follow-up was 15.3 +/- 6.6 months for PD and 14.5 +/- 5.7 months for HD. RESULTS: Average PCS in PD (31.8 +/- 7.8) was lower than HD (36.9 +/- 9.8) (p < 0.02), while MCS was similar in the groups (p = NS). The prevalence of depression was 26.1% in PD and 25.4% in HD patients (p = NS). Serum albumin was the only significant predictor of PCS among PD patients and explained much of the decrease in PCS in them. The number of hospitalizations and in-hospital days were significantly lower for PD compared to HD patients (p < 0.05). PCS as well as MCS remained stable in both groups throughout the observation period. CONCLUSION: Self-assessed physical function is diminished, while mental function is similar in PD compared to HD patients. When corrected for serum albumin, this difference is eliminated. Over time, QOL in patients treated with PD remained stable.
Subject(s)
Kidney Failure, Chronic/psychology , Peritoneal Dialysis/psychology , Quality of Life , Self-Assessment , Adult , Aged , Female , Health Status , Health Surveys , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Renal Dialysis/psychology , Time FactorsABSTRACT
BACKGROUND: Physical (PCS) and mental (MCS) component summary scales of the Short Form 36 (SF-36) health survey are validated measures of quality of life (QOL) and functional status. We sought to evaluate the PCS and MCS in haemodialyis patients as compared to the general population and other chronic diseases. METHODS: A cohort of 134 haemodialysis patients (mean age 60.9+/-14.3 years, males 63.4%, Caucasians 66.4%) was followed from January 1996 to December 1998 (mean follow up 14.5+/-5.7 months). SF-36 questionnaires were administered every 3 months and PCS and MCS were calculated. Results were compared to the general population and other chronic diseases. Correlators of PCS and MCS, change in QOL over time, and the correlators of this change were determined. RESULTS: Mean PCS was 36.9+/-8.8 and mean MCS was 47+/-10.7. Compared to the general US population, these represent a decline of 8.7+/-0.8 for PCS (P<0.0001) and 2.7+/-0.8 for MCS (P<0.001). PCS and MCS in end-stage renal disease (ESRD) were lower than in most other chronic diseases studied. Univariate correlators of PCS in haemodialysis patients included age, male sex, haematocrit, serum albumin, and severity of comorbid cardiac and pulmonary illnesses. Multivariate analysis demonstrated independent correlators of PCS to be male sex, serum albumin and severity of comorbid cardiac and pulmonary diseases. Univariate as well as multivariate correlators of MCS included: serum albumin, KT/V(urea), and status living alone. A trend analysis revealed that both PCS and MCS tended to decline in the initial months of dialysis but stabilized over time. Status living alone was a significant predictor of improvement in MCS by univariate as well as multivariate analysis. CONCLUSIONS: Self assessed physical and mental health of haemodialysis patients is markedly diminished compared to the general population and other chronic diseases.
Subject(s)
Health Status , Kidney Failure, Chronic/therapy , Mental Health , Renal Dialysis , Adult , Aged , Aged, 80 and over , Educational Status , Ethnicity , Female , Health Surveys , Humans , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/psychology , Male , Marital Status , Mental Status Schedule , Middle Aged , New York , Racial Groups , Renal Dialysis/psychology , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
1. People can recover fully from even the most severe forms of mental illness. 2. The Empowerment Model of Recovery describes the dynamics of recovery and prevention of mental illness. 3. PACE (personal assistance in community existence) is the application of the recovery principles.
