Effect of dialysis modality on frailty phenotype, disability, and health-related quality of life in maintenance dialysis patients

PLoS One. 2017 May 3;12(5):e0176814. doi: 10.1371/journal.pone.0176814. eCollection 2017.

Abstract

Background: Health-related quality of life (HRQoL) surveys are needed to evaluate regional and ethnic specificies. The aim of the present study was to evaluate the differences in HRQoL, frailty, and disability according to dialysis modality in the Korean population.

Patients and methods: We enrolled relatively stable maintenance dialysis patients. A total of 1,616 patients were recruited into our study. The demographic and laboratory data collected at enrollment included age, sex, comorbidities, frailty, disability, and HRQoL scales.

Results: A total of 1,250 and 366 participants underwent hemodialysis (HD) and peritoneal dialysis (PD), respectively. The numbers of participants with pre-frailty and frailty were 578 (46.2%) and 422 (33.8%) in HD patients, and 165 (45.1%) and 137 (37.4%) in PD patients, respectively (P = 0.349). Participants with a disability included 195 (15.6%) HD patients and 109 (29.8%) PD patients (P < 0.001). On multivariate analysis, the mean physical component scale (PCS) and mental component scale (MCS), symptom/problems, and sleep scores were higher in HD patients than in PD patients. Cox regression analyses showed that an increased PCS in both HD and PD patients was positively associated with patient survival and first hospitalization-free survival. An increased MCS in both HD and PD patients was positively associated with first hospitalization-free survival only.

Conclusion: There was no significant difference in frailty between patients treated with the two dialysis modalities; however, disability was more common in PD patients than in HD patients. The MCS and PCS were more favorable in HD patients than in PD patients. Symptom/problems, sleep, quality of social interaction, and social support were more favorable in HD patients than in PD patients; however, patient satisfaction and dialysis staff encouragement were more favorable in PD patients than in HD patients.

MeSH terms

  • Activities of Daily Living
  • Dialysis / adverse effects
  • Dialysis / methods*
  • Dialysis / statistics & numerical data
  • Disabled Persons* / psychology
  • Disabled Persons* / statistics & numerical data
  • Exercise
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Independent Living / statistics & numerical data
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Peritoneal Dialysis / adverse effects
  • Peritoneal Dialysis / statistics & numerical data
  • Proportional Hazards Models
  • Quality of Life* / psychology
  • Renal Dialysis / adverse effects
  • Renal Dialysis / statistics & numerical data
  • Republic of Korea / epidemiology

Grants and funding

This work was supported by the Medical Research Center Program (2015R1A5A2009124) through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.