Quality of Life Similar Between Patients With CKD Receiving Hemodialysis, CAPD

There is no difference in quality of life between patients with chronic kidney disease (CKD) undergoing hemodialysis and those having continuous ambulatory peritoneal dialysis (CAPD) in the hospital, according to a new study.

The study, conducted in Indonesia and published in the Journal of Public Health Research, found that 82.4% of hemodialysis patients reported good quality of life, compared with 81.6% of CAPD patients. The results of statistical analysis showed a P value of .515, indicating the difference was not statistically significant.

However, the authors noted, “For patients on CAPD, peritoneal dialysis which is home-based [and] automated could increase the quality of life better than any other forms of dialysis.”

Investigating which therapies provided better quality of life is even more relevant given that CKD is one of several comorbidities linked to COVID-19, the researchers said. The prevalence of CKD was 8.66% in African countries like Senegal and Congo and 9.07% in Malaysia, while in Europe the rate was far higher (18.08%). There are no definitive data on prevalence in Indonesia, but a reported 0.2% of the population had CKD in 2013.

The study consisted of a total of 250 patients, half of whom underwent hemodialysis and half CAPD. Results were provided for 5 components: the ability to move or walk to an acceptable degree, adequate self-care, performance of usual activities, minimal amount of pain or discomfort during treatment, and acceptable levels of anxiety or sadness. The majority of residents were male, aged between 46 and 55 years, educated, and had been on hemodialysis for 3 to 6 years or CAPD for 1 to 3 years, with no comorbidities. Research was conducted from September to November 2019.

The study found the following percentages of patients reporting a good quality of life in each measured component:

• Ability to walk: 71.2% hemodialysis, 68.8% CAPD
• Self-care: 92.8% hemodialysis, 85.6% CAPD
• Usual activities: 71.2% hemodialysis, 68.0% CAPD
• Pain/discomfort: 52.8% hemodialysis, 46.4% CAPD
• Anxiety/sadness: 66.4% hemodialysis, 77.6% CAPD

Notably, however, whereas 52.8% undergoing hemodialysis reported a good quality of life for pain and discomfort, a similar percentage (51.2%) of those receiving CAPD reported a moderate quality of life instead.

The difference, the authors said, is that hemodialysis patients without serious complications feel pain just twice a week during therapy, whereas CAPD patients who frequently perform self-dialysis and fluid changes (4 times a day) at home feel it 4 times a day. They also sometimes report pain during fluid replacement. Furthermore, hemodialysis patients feel minimal pain if they have adequate vascular access.

A small percentage (3.2%) of CAPD patients reported bad quality of life in the self-care category. No hemodialysis patients reported bad quality of life. A larger share of CAPD patients (8%) reported bad quality of life as far as partaking in usual activities, compared with 1.6% of hemodialysis patients.

Statistics showed that the share of CAPD patients with anxiety/sadness was 10 percentage points lower, which could reflect that hemodialysis patients form strong social relationships with fellow patients in the medical setting, so when others in the group experience death or decline, they feel it more acutely.

The authors urged practitioners “to provide information about components of quality of life to patients and families with CKD who undergo hemodialysis and CAPD.”

Reference

Rini IS, Rahmayani T, Sari EK, et al. Differences in the quality of life of chronic kidney disease patients undergoing hemodialysis and continuous ambulatory peritoneal dialysis. J Public Health Res. 2021;10(2). doi:10.4081/jphr.2021.2209