Patients both with CKD and with end-stage renal disease (ESRD) experience symptoms, although there are dialysis-specific symptoms related to the treatment itself. Recent studies have evaluated symptom burden in conservatively managed patients. Common symptoms including fatigue, itch, drowsiness, dyspnea, edema, pain, loss of appetite, dry mouth, and poor concentration at stage 5 CKD occur in 50–85% of conservatively managed patients. Psychosocial issues are usually not a prominent feature till close to end of life. There are a number of validated tools which can help in the assessment of symptoms including the second edition of the textbook 'Supportive Care for the Renal Patient'.
Health-related quality of life (HRQOL) has become an important clinical and research outcome for patients with advanced kidney disease. A number of dialysis-specific mediators have been identified as contributing to decrements in HRQOL, including rigors of dialysis treatment, psychosocial and vocational adjustments, loss of independence and functional status, and metabolic derangements as a result of kidney disease. Given the impact of dialysis on HRQOL, studies have examined whether patients not opting for dialysis experience similar derangements in quality of life.
De Biase et al. found that the quality of life in conservatively managed patients was comparable to that of patients on hemodialysis. In particular, though conservatively managed patients had worse unadjusted physical health (SF36), there was no difference in mental health scores between those receiving conservative management versus hemodialysis. In the UK, Da Silva-Gane et al. measured the quality of life [Short-Form, Hospital Anxiety and Depression Scale and Satisfaction with Life Scale (SWLS)] in elderly patients with advanced kidney disease who had opted either for dialysis or for conservative kidney management. Patients were followed every 3 months for up to 3 years. Baseline patients opting for conservative management were older, more dependent, and had higher comorbidities than those who opted for dialysis. Conservative patients had poorer physical health and higher levels of anxiety; however, mental health, depression symptoms, and global satisfaction with life were similar between groups. Importantly, patients who initiated dialysis experienced a significant decrease in global satisfaction with life score which did not subsequently recover (Fig. 3). For elderly patients with geriatric syndromes and poor functional status, it remains unclear whether dialysis initiation impacts life satisfaction.
kidneyhospitalabroad@hotmail.com
Health-related quality of life (HRQOL) has become an important clinical and research outcome for patients with advanced kidney disease. A number of dialysis-specific mediators have been identified as contributing to decrements in HRQOL, including rigors of dialysis treatment, psychosocial and vocational adjustments, loss of independence and functional status, and metabolic derangements as a result of kidney disease. Given the impact of dialysis on HRQOL, studies have examined whether patients not opting for dialysis experience similar derangements in quality of life.
De Biase et al. found that the quality of life in conservatively managed patients was comparable to that of patients on hemodialysis. In particular, though conservatively managed patients had worse unadjusted physical health (SF36), there was no difference in mental health scores between those receiving conservative management versus hemodialysis. In the UK, Da Silva-Gane et al. measured the quality of life [Short-Form, Hospital Anxiety and Depression Scale and Satisfaction with Life Scale (SWLS)] in elderly patients with advanced kidney disease who had opted either for dialysis or for conservative kidney management. Patients were followed every 3 months for up to 3 years. Baseline patients opting for conservative management were older, more dependent, and had higher comorbidities than those who opted for dialysis. Conservative patients had poorer physical health and higher levels of anxiety; however, mental health, depression symptoms, and global satisfaction with life were similar between groups. Importantly, patients who initiated dialysis experienced a significant decrease in global satisfaction with life score which did not subsequently recover (Fig. 3). For elderly patients with geriatric syndromes and poor functional status, it remains unclear whether dialysis initiation impacts life satisfaction.
kidneyhospitalabroad@hotmail.com
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