Comparison of quality of life in patients with advanced chronic kidney disease undergoing haemodialysis, peritoneal dialysis and conservative management in Johannesburg, South Africa: a cross-sectional, descriptive study.

introductionMental health and quality of life are under-appreciated clinical targets which affect patient and modality survival. Lack of dialysis availability in the resource-constrained public health sector in South Africa results in assignment to treatment modalities without regard to effects on these parameters. We assessed the effect of dialysis modality, demographic and laboratory parameters on mental health and quality of life measurements.

methodsSize-matched cohorts were recruited from patients on haemodialysis (HD), peritoneal dialysis (PD), and patients on conservative management (CM) between September 2020 and March 2021. Responses to the Hospital Anxiety and Depression Scale (HADS) and Kidney Disease Quality of Life Short Form 36 (KDQOL-SF36) questionnaires and demographic and baseline laboratory parameters were compared between modalities. Multivariate linear regression was used to evaluate independent effect of baseline characteristics on HADS and KDQOL-SF36 scores between treatment groups where significant difference was observed.

resultsAnxiety, depression, and reduced KDQOL measures were widespread amongst respondents. Dialyzed patients reported higher anxiety and depression scores than those on CM (p = 0.040 and p = 0.028). Physical composite (PCS), role-physical (RP), vitality (VS), and emotional well-being (EWB) KDQOL-SF36 scores were poorer in dialyzed patients (p < 0.001 for all). PCS (p = 0.005), pain (p = 0.030), vitality (p = 0.005), and social functioning KDQOL scores were poorer in PD compared to HD; HADS anxiety (p < 0.001) and KDQOL-SF36 EWB scores (p < 0.001) were better in PD. PD patients were more likely to be employed (p = 0.008). Increasing haemoglobin concentration reduced anxiety (p < 0.001) and depression scores (p = 0.004), and improved PCS (p < 0.001), and pain scores (p < 0.001). Higher serum albumin improved PCS (p < 0.001) and vitality (p < 0.001) scores.

conclusionAdvanced chronic kidney disease increases anxiety and depression and limits quality of life. PD improves mental health and emotional wellbeing and preserves the ability to undertake economic activity but limits social functioning and causes greater physical discomfort. Targeting haemoglobin may ameliorate modality effects on mental health and quality of life.