Browsing by Author "Dumaine, Chance Skylar"

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    How Do Transitions Within End-Stage Renal Disease Impact Health-Related Quality of Life?
    (2018-08-31) Dumaine, Chance Skylar; MacRae, Jennifer; Ravani, Pietro; Santana, Maria Jose; Samuel, Susan M.
    Dialysis is used to sustain life for patients with end-stage renal disease (ESRD). While dialysis prolongs length of life, numerous studies have shown that dialysis patients have significantly reduced health-related quality of life (HRQoL). The degree of impairment seems to be partially related to dialysis modality [in-centre hemodialysis (IHD), peritoneal dialysis (PD), or home hemodialysis (HHD)], as patients on PD/HHD often have higher HRQoL scores than IHD patients. Patients may change dialysis modalities a number of times during their life. Each change is accompanied by a “transition period” (period of time in which patients adapt to life on their new modality). These transition periods are often marked by high rates of anxiety, depression, morbidity, and mortality, and are periods when HRQoL may change rapidly. However, few studies have examined the magnitude of change in HRQoL during transition periods or what the drivers of change are. Such studies are necessary to ensure that patients are provided with the necessary supports during their modality transition to prevent declines in HRQoL. In this pilot project, we tested the methodology of combining kidney disease-specific HRQoL questionnaires (Kidney Disease Quality of Life surveys) with semi-structured interviews in patients undergoing dialysis modality transitions. Patients completed KDQOL surveys prior to and 3 months after initiating a new dialysis modality and participated in semi-structured interviews to describe changes in HRQoL that occurred during the transition period. Regardless of dialysis modality being initiated, mean HRQoL scores as measured by the five domains of the KDQOL-36 improved over the initial 3 months of the transition period. Scores in additional domains of the KDQOL-Short Form were more variable, with improvements in some domains but reductions in others. Patient interviews highlighted many factors that negatively impacted HRQoL which may be amenable to intervention. Overall, combining the KDQOL tools with semi-structured patient interviews proved to be an effective method of studying changes in HRQoL that occur during modality transitions. Future studies may consider implementation of this model on a larger scale in order to better understand transition periods and to test interventions to prevent declines in HRQoL.