QUALITY OF LIFE IN CHRONIC HEMODIALYSIS PATIENTS

THE AIM of the investigation was to compare quality of life (QL) indices of patients on hemodialysis (HD) and healthy subjects, to compare QL indices of Russian HD patients and those from other countries, to determine factors influencing QL of HD patients. PATIENTS AND METHODS. 1047 chronic hemodialysis patients were examined. To assess the healthrelated QL the Russian language version of the SF36 Health Status Survey was used. The indices of depression, asthenia, anxiety, personality features, life purposes and values, cliniclaboratory parameters were also determined for the assessment of their influence on patients’ QL. RESULTS. Patients on HD were found to have all indices of their physical functioning considerably lower than those in healthy subjects. It concerns the resistance to physical loads (PF), restricting effects of the physical state on the everyday activities (RP), general health condition (GH), intensity of pain (BP). According to the indices of mental health the decrease was less pronounced than normal. In Russian HD patients the tolerance indices to physical loads (PF), general activity (V) and the total index of physical health (PCS) were reliably higher than in US patients. The US patients possess an advantage in mental health (MH), total mental health index (MCS), freedom from pain (BP), general health condition (GH). Patients from Great Britain have lower rates of the majority of scales of the SF36 questionnaire than those from Russia and USA that seems to be associated with the lower level of hemoglobin in this group of patients. The blood serum albumin level is an independent predictor of safety of the total index of physical health (PCS). The degree of depression, patient’s age, duration of HD, number of days at the hospital for the last 6 months, and a coexisting pathology have negative influence on the total index of physical health (PCS). The total index of physical health (PCS) is dependent on the level of personal anxiety, depression and asthenia, age and time of HD treatment. CONCLUSION. QL of HD patients is substantially lower as compared to healthy subjects mainly at the expense of the indices of physical health. QL of HD patients is liable to effects of clinical and mental variables. It should be studied in future what underlies the established differences in QL between HD patients from different countries cultural, socialeconomic factors or the medical care quality.

1. World Health Organization: Constitution of the World Health Organization. Basic Documents, Geneva, 1948

2. Ware JE, Snow KK, Kosinski M et al. SF36 Health Survey Manual and Interpretation Guide. Boston, MA, The Health Institute, New England Medical Center, 1993; 3143

3. Aaronson NK, Muller M, Cohen PAD et al. Translation, validation, and norming of the Dutch language version of the SF36 health survey in community and chronic disease populations. J Clin Epidemiol 1998; 51(11): 10551068

4. Thumboo J, Fong KY, Machin D et al. A community based study of scaling assumptions of the English (UK) and Chinese (HK) SF36 in Singapore. Qual Life Res 2001; 10 (2): 175188

5. Fukuhara S, Bito S, Green J et al. Translation, adaptation, and validation of the SF36 Health Survey for use in Japan. J Clin Epidemiol 1998; 51(11): 10371044

6. Alonso J, Prieto L, Anto JM. La version espanola del SF 36 Health Survey (Cuestionario de Salud SF36): Un instrumento para la medida de los resultados clinicos. Med Clin (Barc) 1995; 104: 771776

7. Petrova NN, Varshavsky S, Vasilyeva I. Translation of a quality of life questionnaire: first experience in Russia.In: 2nd meeting of International Society for Quality of Life Research, Canada, Montreal, 1417 October, 1995: 498

8. Mingardi G, Cornalba L, Cortinovis E et al. Healthrelated quality of life in dialysis patients. A report from an Italian study using the SF36 Health Survey. Nephrol Dial Transplant 1999; 14 (6): 15031510

9. Groothoff JW, Grootenhuis MA, Offringa M et al. Quality of life in adults with endstage renal disease since childhood is only partially impaired. Nephrol Dial Transplant 2003; 18 (2): 310317

10. Molsted S, Aadahi M, Schou L et al. Selfrated health and employment status in chronic haemodialysis patients. Scand J Urol Nephrol 2004; 38 (2): 99105

11. Rebollo P, Ortega F, Baltar JM et al. Is the loss of health related quality of life during renal replacement therapy lower in elderly patients than in younger ones? Nephrol Dial Transplant 2001; 16 (8): 16751680

12. Unruh M, Benz R, Greene T et al. Effects of hemodialysis dose and membrane flux on healthrelated quality of life in the HEMO Study. Kidney Int 2004; 66 (1): 355366 13. Jiang MM, Li L. Assessment of healthrelated quality of life in hemodialysis patients with SF36. Zhejiang Da Xue Xue Bao Yi Xue Ban] 2004; 33 (6): 546549, 560

13. Mittal SK, Ahern L, Flaster E et al. Selfassessed physical and mental function of haemodialysis patients. Nephrol Dial Transplant 2001; 16 (7): 13871394

14. Chiang CK, Peng YS, Chiang SS et al. Other health related quality of life in hemodialysis patients in Taiwan. Hemodialysis Int 2004; 8 (1): 106

15. KalantarZadeh K, Kopple JD, Block G et al. Association among SF36 Quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol 2001; 12 (12): 27962806

16. Kirmizis D, Belechri AM, Giamalis P et al. Quality of life in chronic hemodialysis patients. Hemodialysis Int 2004; 8 (1): 105

17. Turk S, Guney I, Altintepe L et al. Quality of life in male hemodialysis patients. Nephron Clin Pract 2004; 96 (1): 2127

18. Valderrabano F. Quality of life benefits of early anaemia treatment. Nephrol Dial Transplant 2000; 15 [Suppl 3]: 2328

19. Шило ВЮ, Горин АА, Денисов АЮ. Трудовая реаби литация пациентов на программном гемодиализе. Нефрология и диализ 2002; 4 (4): 274276

20. Ware JE, Kosinski M, Keller SD. SF 36 physical and mental health summary scales: a user’s manual (4th printing, revised). Boston, MA, The Health Institute, 1994

21. Zung WWK. A Selfrating Depression Scale. Arch Gen Psychiat 1965; 12: 6370

22. Spielberger CD et al. Manual for the State Trait Anxiety Inventory (STAI). Palo Alto, CA. Consulting Psychologists Press, 1983

23. Вассерман ЛИ, Вукс АЯ, Иовлев БВ и др. Шкала для психологической диагностики уровня невротической астении. Методические рекомендации. Психоневрологический институт им. В. М. Бехтерева, СПб., 1998: 18

24. Cattell RB, Cattell AK, Cattell HE. Sixteen Personality Factor Questionnaire, Fifth edition. Champaign, IL: Institute for Personality and Ability Testing, 1993

25. Леонтьев ДА. Тест смысложизненных ориентаций (СЖО). М.: «Смысл»,1992:16

26. Новик АА, Ионова ТИ. Руководство по исследованию качества жизни в медицине. Издательский Дом «Нева», СПб., «ОЛМАПРЕСС Звездный мир», М. 2002; 114124

27. Perelman RL, Finkelstein FO, Liu L et al. Quality of life in chronic kidney disease (CKD): a crosssectional analysis in the Renal Research Institute – CKD study. Am J Kidney Dis 2005; 45 (4): 658666

28. John R, Stevens P, Webb M et al. Quality of life assessment in patients with unreferred chronic renal failure. Nephrol Dial Transplant 2002; 17 [Suppl 1]: 240

29. Васильева ИА, Бабарыкина ЕВ, Добронравов ВА. Возрастные аспекты качества жизни у пациентов на хрони ческом гемодиализе. Нефрология 2004; 8 (3): 3236

30. Sullivan M, Karlsson J. The Swedish SF36 Health Survey. III. Evaluation of criterionbased validity: results from normative population. J Clin Epidemiol 1998; 51 (11): 11051113

31. Held PJ, Brunner F, Odaka M et al. Fiveyear survival for endstage renal disease patients in the United States, Europe, and Japan, 19821987. Am J Kidney Dis 1990; 15 (5):451457

32. Bleyer AJ, Hylander B, Sudo H et al. An international study of patient compliance with hemodialysis. JAMA 1999; 281 (13): 12111213

33. Sehgal AR, Weisheit C, Miura Y et al. Advance directives and withdrawal of dialysis in the United States, Germany, and Japan. JAMA 1996; 276 (20): 16521656

34. Saran R, BraggGresham JL, Rayner HC et al. Non adherence in hemodialysis: Associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int 2003; 64 (1): 254262

35. Fukuhara S, Lopes AA, BraggGresham JL et al. Health related quality of life among dialysis patients on three continents: The Dialysis Outcomes and Practice Patterns Study. Kidney Int 2003; 64 (5): 19031910