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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
RENAL DATA FROM ASIA - AFRICA  
Year : 2014  |  Volume : 25  |  Issue : 6  |  Page : 1346-1351
Quality of life of patients with end-stage renal disease in Guinea


1 Nephrology Unit, Donka National Hospital, Conakry, Republic of Guinea
2 Service of Nephrology, Hemodialysis CHIVA, Foix cedex, France
3 Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France

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Date of Web Publication10-Nov-2014
 

   Abstract 

This questionnaire-based study included 69 patients from the Republic of Guinea with end-stage renal disease (ESRD) and was conducted over 12 months. The factors that affected their quality of life (QoL) were determined. The included ESRD patients had an estimated creatinine clearance (CCr) of <15 mL/minute using MDRD formula. We used the SF36 question­naire and classified the results into two groups: Scores <50/100 as poor QoL and scores 50/100 as good QoL. Factors that determined the QoL were cessation of all activities and additional effort required, severe or mild pain, good or bad health, and reduced or not reduced social and physical activities. Of the 69 patients, 32 (46.3%) had a good QoL and 37 (53.7%) had a poor QoL. The estimated CCr was similar in both groups. The average age of the poor QoL group was 54 ± 4 years, the good-QoL group's average age was of 47.6 ± 4 years (P = 0.01). Patients with a good QoL had better overall health, but this was not statistically significant [OR = 0.42 (0.14-1.28); P = 0.14]. Patients with a poor QoL had more severe pain (P = 0.002); however, good QoL did not protect against mental problems [OR = 46.67 (8.18-351.97); P = 0.0001]. Mental status (P = 0.01) and social activities (P = 0.001) were reduced, and there were more comorbidities in the poor-QoL group (29.7%, with >4, P = 0.01). Good QoL was associated with younger age, fewer comorbidities, less severe physical pain, and fewer physical or social limitations. QoL could be increased by improving comorbidity treatments, giving more effective pain control, and providing more assistance for social and physical limitations.

How to cite this article:
Bah AO, Nankeu N, Balde MC, Kaba ML, Bah BK, Rostaing L. Quality of life of patients with end-stage renal disease in Guinea. Saudi J Kidney Dis Transpl 2014;25:1346-51

How to cite this URL:
Bah AO, Nankeu N, Balde MC, Kaba ML, Bah BK, Rostaing L. Quality of life of patients with end-stage renal disease in Guinea. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Sep 18];25:1346-51. Available from: http://www.sjkdt.org/text.asp?2014/25/6/1346/144322

   Introduction Top


Chronic kidney failure is a progressive disease that results in significant limitations in the acti­vities of patients and causes many medical complications. With end-stage renal disease (ESRD) setting in, the daily life can be se­riously affected to the extent that most patients are unable to continue with their normal acti­vities, particularly patients who do not receive dialysis. The most used instrument for mea­suring health-related quality of life (QoL) in ESRD patients is the Short Form health-survey questionnaire (SF-36). [1],[2],[3],[4] Measures of health-related quality of life (HR QoL) have a signi­ficant predictive value on patient survival and the numbers and lengths of hospitalizations, especially in patients with chronic kidney disease (CKD). [5]

In ESRD patients, particularly in those receiving dialysis, HRQoL most affects the physical domains (e.g., physical abilities, vitality) and least affects the mental functioning (e.g., mental health, emotions). Nutritional biomarkers (e.g., albumin, creatinine, body mass index) are most closely associated with the physical domains, whereas, biological markers, such as Kt/V, mineral-metabolism indices, and inflammatory markers, are correlated weakly with the HRQoL. [6]

To assess if nationality has an effect on the QoL of ESRD patients, a study in the UK investigated the potential differences between the QoL of white European and Indo-Asian ESRD patients treated by dialysis or kidney transplantation. The study reported a lower perceived QoL in Indo-Asians compared with white Europeans; the analysis indicated that Indo-Asian patients, in particular, perceived kidney disease as a social burden, even if a transplant had been successful. [7] More recently, Cisse et al conducted a study on 60 chronic hemodialysis patients from Dakar (Senegal) and found that chronic kidney disease impaired the QoL of 90% of the patients, [8] a similar result to that of the European population.

It is known that patients with predialysis ESRD have higher SF-36 scores than hemo-dialysis or peritoneal dialysis patients, but lower scores than those reported for the general adult population; moreover, dialysis patients aged >65 years score significantly better than younger patients on scales that measure stress caused by dialysis, and are generally more satisfied with life. [5]

The purpose of our study is to examine the various social and therapeutic factors that affect the daily QoL of ESRD patients not yet recei­ving dialysis, in the Republic of Guinea. We hope our findings will enable the medical staff and other decision makers to improve communication between patients and physicians, and allow physicians and patients to focus on the most important elements that affect the patients' lives.


   Materials and Method Top


Our study took place in the Nephrology Depart­ment of the Donka National Hospital, Conakry, Republic of Guinea, is a country populated with approximately 10,500,000 inhabitants. The Nephrology Department here is the only one in the Republic of Guinea. It is composed of a Nephrology Unit with 15 beds and a hemo-dialysis facility that can treat a maximum of 30 patients per week. Most of the patients treated by hemodialysis are those presenting with acute renal failure. Currently, in the Republic of Guinea there is no data regarding the preva­lence of ESRD. However, the Department of Nephrology has, on a yearly basis, a maximum of 30 patients per week. Most of the patients treated by hemodialysis are those presenting with acute renal failure. Currently, in the Republic of Guinea there is no data regarding the prevalence of ESRD. However, in our Department of Nephrology, on a yearly basis, we hospitalize around 350 patients: Of these, around 60% present with CKD. This proportion has been very stable since 2006 (data not shown).

The Chronic Kidney Disease questionnaire-based report covered a 12-month period, from January-December, 2010. Our sample consis­ted of all adult ESRD patients admitted into our Nephrology Unit. None were on steroid the­rapy, and none had a history of psychiatric disorders. With regard to the nutritional status, we did not assess the albumin or pre-albumin serum levels. When anemia occurred, it was treated with oral iron therapy and blood trans­fusions if needed, because recombinant erythro-poietin was not available in the Republic of Guinea. The Glomerular filtration rate was esti­mated by the Modification of Diet in Renal Disease (MDRD) formula. All had a creatinine clearance of <15 mL/minute, that is, 14 had 10- 15 mL/minute, 36 had 5-10 mL/minute, and 19 had <5 mL/minute. However, patients who died upon arrival, patients suffering from acute renal failure, and those undergoing dialysis were excluded.

We used the SF-36 questionnaire, which had 36 items, which explored eight different domains: 'Physical activities', 'limitations linked to the physical state', 'physical pain', 'social and rela­tional life', 'mental health', 'limitations linked to mental health', 'energy level', and 'general health'. Each area was scored from 1-10. To simplify the outcomes, the domains were re­grouped into pairs to form limitations; these were: Cessation of activities and additional effort required; pain, which was described as severe or mild; health, which was good or bad; and social and physical activities, which were reduced or not reduced. The overall score could potentially total to 100, so we classified the re­sults into two groups: Scores <50/100 as poor Qo and those with 50/100 as good QoL, that is, the higher the score, the better the QoL. [1] Physicians were asked to list the comorbidities, which were classified from 0-4 and >4. These were hypertension, cardiomyopathy, diabetes, stroke, HIV infection, cancer, tuberculosis, pros­tate adenoma, and anemia.

The studied parameters were exclusively clin­ical. The outcomes were analyzed using the SPSS 16.1 software. A P-value of <0.05 was considered statistically significant.


   Results Top


Within 12 months, 224 patients were admitted into the Medicine Departments of our hospital; of these, the ESRD patients represented 30.8% of the admissions (that is, a total of 69 patients). When the questionnaire was filled in by the patient their estimated GFR was 7.54 ± 3.34 mL/minute, and their hemoglobin level was 8.2 ± 3.54 g/dL. Eleven (16%) patients had dia­betes; four (6%) were HIV positive, and eleven (16%) had comorbidities. Clinical malnutrition was present in 46% of the patients [Table 1].
Table 1: Demographic data.

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The mean age of the 69 included patients was 49 ± 13 years. There were 37 men. The average age of ESRD men was 51 ± 3 years (range: 15- 85 years) and for ESRD women it was 48 ± 3.1 years (range: 18-94 years). Thirty-two (46.3%) had good QoL and 37 (53.7%) had poor QoL. Their estimated glomerular function was similar, that is, eight (2-15) mL/minute versus. Six (2- 14) mL/ minute, respectively (P = ns). Those with a poor QoL had an average age of 54 ± 4 years, and there were 18 men and 19 women. The good-QoL group had an average age of 47.6 ± 4 years, and there were 19 men and 13 women (P = 0.01, between groups). There was no correlation between the cause of ESRD and QoL (data not shown). Conversely, there were significantly more patients with poor QoL (84%) in those having the worst renal function, as compared to less than 50% in those having e-GFR ≥ 5 mL/minute [Table 2].
Table 2: Level of renal function and quality of life.

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Patients in the good-QoL group had a better health status than the poor-QoL group, although this was not statistically significant [Table 3]. Physical pain was ranked as more severe in the poor-QoL group, that is, 56.7% (21/37) of the patients compared to 18.7% in the good-QoL group (6/32; P = 0.002) [Table 4]. The severity of physical pain in the poor-QoL group led to 81.25% of patients ceasing all activities, whereas, in the good-QoL group, only 18.2% had com­pletely ceased activities (P = 0.0001, [Table 5]). The impact of ESRD on the mental status led 16 patients (43.2%) from the poor-QoL group and four (12.5%) from the good-QoL group to cease daily activities (P = 0.011; [Table 5]) However, despite the impact of illness, most patients with a good QoL were able to continue their social activities.
Table 3: Present health status and outcomes.

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Table 4: Physical pain, mental status, and impact of illness on social activities.

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Table 5: Limitations caused by physical pain and mental status

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Only one out of 32 (3.1%) patients with a good QoL died during the follow-up period compared to 11 out of 37 (29.7%) in the poor-QoL group [Table 3]. Their estimated GFR was 10 mL/minute versus 8 (2-13) mL/minute, respectively, P = ns). Patients with poor QoL also had more comorbidities [Figure 1].
Figure 1: Comorbidity scores.

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   Discussion Top


The World Health Organization defines QoL as a person's perception of his/her place in society, their cultural context, and the value system in which he/she lives, in relation to their objectives, expectations, norms, and worries. [9] It is a very large concept, influenced in a complex manner by the physical health status of the patient, his/her psychological status, their level of independence, their social relationships, as well as their interactions with essential ele­ments of their environment. [9]

Quality of Life studies evaluate the effect of a disease on the daily life of a person, often out­side the viewpoint of professionals who provide care for the patient. Measures of QoL are obtained from the answers given by patients to the standardized questionnaires. These answers reflect their own opinion of their health status, as well as their satisfaction levels regarding their health and lives, including the effects of the disease and its associated treatment.

In our sample, we had more patients with poor QoL than with good QoL. The good-QoL group was younger, had a renal function that was less impaired, that is, very few had an e-GFR <5 mL/minute, and there were more men than women. The cause of ESRD had no impact upon the QoL. Most felt their general health status was poor (53.12%) and one patient died. On the physical side, they were able to maintain optimal social relationships and to take care of themselves. For the majority (81.25%), the pain was not severe, although most patients needed extra effort to achieve their professional or household duties. Indeed, about half of the patients needed additional effort to do their job (suspension: 12.9%; reduction in working days: 11.6%; reduction in the number of activities: 11.6%; additional effort: 8.7%). On a psycho­logical level, the mental health was precarious in both groups. However, the impact of this on their everyday activities and social activities was minimal in the good-QoL group.

The poor-QoL group was older, contained more women than men, had a lower level of renal function, their general health status was worse (72.97%), and 11 deaths were recorded. On the physical side, the reasons for their in­activity were: Reduced energy levels, inability to clothe themselves, to eat, to communicate or to relieve themselves without assistance. Pain was severe for most (56.75%) and most suf­fered considerable limitations (cessation of all activities 81%). On a psychological level, their mental health was very unstable, with 72.97% recording despair and nervousness as the most frequent effects. Although limitations caused by this state were difficult to evaluate, because professional activity was impossible and their low vitality reduced household duties to a mini­mum, 43.24% ceased activities of any kind. More than a third had more than four comorbidities.

The health outcomes of patients with a good QoL were better than those with a poor QoL; however, because no patients were receiving dialysis, both groups had poor health. Having a good QoL did not seem to prevent mental instability, which is not surprising, as uremia, daily pain, and the impossibility of getting into a dialysis program were factors that adversely affected the mental health of both the groups. We did not find a statistically meaningful link between gender and QoL. Comorbidities were more frequent in older poor-QoL patients.

From the results, it is obvious that the good-QoL group was younger, functioned better, required less additional effort for daily acti­vities, had fewer comorbidities, and fewer num­ber of them died during the study period. In contrast, the poor-QoL group was older, had many more comorbidities, their functional abi­lities were reduced, and the mortality rate was higher. This was not surprising, as chronic kid­ney disease is a well-known risk factor for cardiovascular disease, which is often a cause of death during stage-IV kidney disease and ESRD. [10]

Our results are consistent with the French literature, which reports that the main factors associated with QoL are gender, age, the presence of comorbidities, the length of illness, being involved in an occupational activity, and the duration of dialysis. Also, women had a poorer QoL as compared to men. [11] In addition, good nutritional status, measured by albuminemia, has been positively associated with improved QoL. [11]

As recombinant erythropoietin is not available in the Republic of Guinea, all our patients were anemic, and this might have impacted their QoL, particularly in those that were older. In addition, the prevalence of clinical malnutrition was high (46%), and might have been higher if we were able to monitor the biological para­meters of malnutrition. This might also have negative impact on the QoL.


   Conclusion Top


In our study, good QoL was associated with younger age, fewer comorbidities, less severe physical pain, and fewer physical and social limitations. QoL could be substantially improved by acting on the modifiable factors, such as, better treatment for the comorbidities, more effective pain control, and assistance with social and physical limitations.

 
   References Top

1.
Terada I, Hyde C. The SF-36: An instrument for measuring quality of life in ESRD patients. EDTNA ERCA J 2002;28:73-6, 83.  Back to cited text no. 1
    
2.
Edgell ET, Coons SJ, Carter WB, et al. A review of health-related quality-of-life measures used in end-stage renal disease. Clin Ther 1996;18:887-938.  Back to cited text no. 2
    
3.
Gentile S, Delarozière JC, Fernandez C, et al. Review of quality of life instruments used in end-stage renal disease. Néphrologie 2003;24:2 93-301.  Back to cited text no. 3
    
4.
Glover C, Banks P, Carson A, Martin CR, Duffy T. Understanding and assessing the impact of end-stage renal disease on quality of life: A systematic review of the content validity of self-administered instruments used to assess health-related quality of life in end-stage renal disease. Patient 2011;4:19-30.  Back to cited text no. 4
    
5.
Avramovic M, Stefanovic V. Health-related quality of life in different stages of renal failure. Artif Organs 2012;36:581-9.  Back to cited text no. 5
    
6.
Spiegel BM, Melmed G, Robbins S, Esrailian E. Biomarkers and health-related quality of life in end-stage renal disease: A systematic review. Clin J Am Soc Nephrol 2008;3:1759-68.  Back to cited text no. 6
    
7.
Bakewell AB, Higgins RM, Edmunds ME. Does ethnicity influence perceived quality of life of patients on dialysis and following renal transplant? Nephrol Dial Transplant 2001;16: 1395-401.  Back to cited text no. 7
    
8.
Cisse MM, Ka EF, Gueye S, et al. Quality of life in hemodialysis patients in Dakar: Differences for the tropics? Med Sante Trop 2012;22:198-202.  Back to cited text no. 8
    
9.
The World Health Organization Quality of Life assessment (WH OQOL): Position paper from the World Health Organization. Soc Sci Med 1995;41:1403-9.  Back to cited text no. 9
    
10.
Roy GC, Sutradhar SR, Barua UK, et al. Cardiovascular complications of chronic renal failure - an updated review. Mymensingh Med J 2012;21:573-9.  Back to cited text no. 10
    
11.
Gentile S, Boini S, Germain L, et al. Quality of life of dialysis and renal transplant patients: Results of two multiregional surveys, France. Bull Epidémiol Hebd 2010;9:94.  Back to cited text no. 11
    

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Correspondence Address:
Dr. Alpha Oumar Bah
Service de Néphrologie, CHU Donka, BP 234 Conakry
Republic of Guinea
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DOI: 10.4103/1319-2442.144322

PMID: 25394464

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