Kidney dialysis patients should be educated about the
different health benefits of both hemodialysis and
peritoneal dialysis and then given a choice as to which
they would like to undergo, according to a study conducted
by researchers from the Johns Hopkins
Bloomberg School of Public
Health.
It is one of the most comprehensive studies of the
quality of life of patients with chronic kidney disease
ever conducted. The researchers expected to find that
peritoneal dialysis allowed patients to function better,
but, in fact, hemodialysis patients did better in some
areas, while peritoneal dialysis patients did better in
others. The study, "Changes in Quality of Life during
Hemodialysis and Peritoneal Dialysis Treatment: Generic and
Disease Specific Measures," is published in the March issue
of the Journal of the American Society of
Nephrology.
End stage renal disease patients, who now number more
than 400,000 annually in the United States and cost the
federal government more than $15 billion per year, require
life-saving therapy to replace the normal function of the
kidney, according to the researchers. Peritoneal dialysis
involves infusing fluid into the patient's abdomen through
a catheter and using the patient's tissues to filter toxins
and excess fluid from the blood. The procedure can be done
at the convenience of the patient four times each day for
30 minutes. Hemodialysis, in which the blood is circulated
through an artificial kidney machine, requires lengthy
visits to dialysis clinics three times each week for hours
at a time.
Albert Wu, associate professor in the school's
Department
of Health Policy and Management, said, "These findings
have important implications for physicians who evaluate and
treat patients with chronic kidney disease. This study also
provides a good public health lesson. When it comes to
kidney dialysis treatment, physicians should be discussing
the ways that the treatment will affect each patient. There
is no simple answer as to which treatment is better. What
patients value about their quality of life should be a
factor in the choice of different treatments. Physicians
should be doing what is best for each individual patient's
quality of life."
More than 900 patients (698 hemodialysis, 230
peritoneal) in 19 states were enrolled in the Choices for
Health Outcomes in Caring for ESRD study, known as CHOICE,
a national, prospective cohort study from 1995 to 1998. Wu
and his colleagues developed the CHOICE Health Experience
Questionnaire, or CHEQ, to comprehensively measure quality
of life of patients on dialysis using patients' reports of
the importance they attach to different aspects of their
life. Using the CHEQ, they assessed self-reported
health-related quality of life at the onset of dialysis
therapy and one year later. The researchers looked at
general domains, or the aspects of life anyone might be
concerned about, such as physical and social functioning,
and ESRD specific domains, which are problems specific to
dialysis patients, such as diet restrictions, body image
and problems with dialysis catheters.
The researchers found that both hemodialysis and
peritoneal dialysis patients had improvement in nearly all
aspects of general functioning and well-being. However,
peritoneal dialysis patients did better in some areas of
quality of life, while hemodialysis patients did better in
others. Peritoneal dialysis patients had improvement in
their finances; hemodialysis patients had improvements in
physical functioning and general health perceptions, and
better sleep.
A report by some of the same Johns Hopkins researchers
was published in the Feb. 11 issue of the Journal of the
American Medical Association. They found that when compared
to the more common hemodialysis, peritoneal dialysis
patients were 1.5 times more likely to rate their overall
care as excellent. Wu explained that this latest study
looked at the quality of life patients experienced at the
start of dialysis and one year later, whereas the previous
study looked at satisfaction with care. Both satisfaction
with care and quality of life are important to evaluate.
Patients could be satisfied with their initial choice, even
if their health outcomes are impaired later.
Wu said, "Health-related quality of life is a
multidimensional concept that includes physical
functioning, social and role functioning, mental health and
general health perceptions. It is an important outcome of
health care and one on which patients, if given the
opportunity, will base treatment decisions."
The study was supported by grants from the Agency for
Health Care Research and Quality and the National Institute
of Diabetes and Digestive and Kidney Diseases.
Co-authors from the School of Public Health were Nancy
E. Fink, Jane V.R. Marsh-Manzi and Neil R. Powe. Klemens B.
Meyer and Michelle M. Chapman, with Tufts-New England
Medical Center, and Frederic O. Finkelstein with New Haven
CAPD, also collaborated on this study.
GO TO