Quality of Life in Patients with Chronic Renal Failure: Differences between the Early and Later Years of Current Treatment

Background: Renal disease is a chronic disease that can have serious effects on the quality of life (QoL) of patients and particularly on their social, economic and psychological well-being. Consequently, increased interest is observed in QoL issues in the context of the treatment of patients with renal disease. Aim: The study aimed to explore differences regarding QoL, mental health and illness beliefs between patients undergoing in-centre haemodialysis (HD) and patients undergoing continuous ambulatory peritoneal dialysis (CAPD/PD). Differences were also examined between patients who had recently commenced treatment and those on long term treatment. Method: Patients with end-stage renal disease (ESRD) were recruited from three treatment units, 144 in total, of whom 135 provided complete data on the variables studied (March 2005 - February 2006). These patients consisted of 77 patients receiving HD and 58 patients on CAPD/PD, who had been treated by dialysis for varied lengths of time. They were sub-grouped into those who had recently commenced treatment (<4 years) and those on long term treatment (>4 years). The patient-reported assessment instruments included: WHOQOL-BREF, GHQ-28, CES-D, STAI, and the MHLC, which is a health locus of control inventory. The statistical significance level adopted was p<0.05. Results: Differences in mean scores were mainly observed in patients undergoing HD with >4 years of treatment, who provided lower mean scores in the QoL domains of physical health (11.95±3.76, p=0.03), social relationships (11.77±4.05, p=0.00) and environment (12.65±2.82, p=0.00), as well as in overall mental health (1.95±0.50, p=0.04). The differences between the sub-groups on the CAPD/PD treatment modality in the early and the later years of treatment were not found to be large and were non significant. With regards to illness beliefs, the patients undergoing HD who had recently commenced treatment provided higher mean scores in the dimension of internal health locus of control (27.82±6.20, p=0.04), while patients undergoing CAPD/PD in the later stage of treatment indicated higher mean scores in the dimension of chance (28.40±7.90, p=0.01). Conclusions: The findings provide evidence that the QoL of patients with ESRD on the HD treatment modality, particularly those with many years of treatment, was compromised to a greater degree than that of patients on the CAPD/PD treatment modality.