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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
RENAL DATA FROM ASIA–AFRICA  
Year : 2017  |  Volume : 28  |  Issue : 3  |  Page : 609-614
Quality of life of hemodialysis patients in Togo: A single-center study on 64 hemodialysis patients at the Sylvanus Olympio University Hospital in Lomé, Togo


1 Department of Nephrology, Hemodialysis Unit, Sylvanus Olympio University Hospital Center, Lomé, Togo
2 Departement of Nephrology, Nephrology and Hemodialysis Clinic, CNHU, Cotonou, Benin

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Date of Web Publication18-May-2017
 

   Abstract 

This study aims at assessing patients’ quality of life during hemodialysis (HD) and determining influencing factors. This prospective study was conducted over a three-month period (December 1, 2012-February 28, 2013) at the Sylvanus Olympio University Hospital (CHU-SO) HD unit, the only center to provide such services in Togo. Respondents used the standard Medical Outcome Survey-Short Form 36 questionnaire. This study was conducted on 64 patients (44 males and 20 females = M/F ratio 2.2). Mean patient age was 45.51 ± 14.00 years old with the vast majority in the 16–44-year-old group (90.82%), and mean dialysis vintage was 2.84 ± 2.37 years (1 month to 9.5 years). The mean global quality of life score was 35.58 (standard deviation ± 15). Quality of life physical score and mental score were, respectively, 31.84 and 40.64. Physical limitation scores were 15.23, followed by general ill-health score 37.38 and poor physical function score 47.37. Mental limitation score was 30.20 and vitality score was 43.75. The quality of life was inversely proportional to patient age and the dialysis vintage, with female quality of life scores worse than male in all questionnaire parameters. Togolese dialysis patients suffer from poor quality of life. Factors underlying such poor quality of life include advanced age, female gender, long-standing history of dialysis, and patient profession.

How to cite this article:
Sabi KA, Noto-Kadou-Kaza B, Amekoudi EY, Vigan J, Ayamekpe K, Amedegnato D. Quality of life of hemodialysis patients in Togo: A single-center study on 64 hemodialysis patients at the Sylvanus Olympio University Hospital in Lomé, Togo. Saudi J Kidney Dis Transpl 2017;28:609-14

How to cite this URL:
Sabi KA, Noto-Kadou-Kaza B, Amekoudi EY, Vigan J, Ayamekpe K, Amedegnato D. Quality of life of hemodialysis patients in Togo: A single-center study on 64 hemodialysis patients at the Sylvanus Olympio University Hospital in Lomé, Togo. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2019 Nov 19];28:609-14. Available from: http://www.sjkdt.org/text.asp?2017/28/3/609/206463

   Introduction Top


The WHO defines quality of life as the individual’s perception of his/her place in existence - in the context of the culture and values he/she lives in - and one’s links to objectives, expectations, norms, and concerns. Over the past decades, quality of life and its links to health have become the new paradigm of medicine.[1] Several studies have also focused on chronic illnesses, chronic kidney disease (CKD), and dialysis in particular.[2],[3],[4],[5],[6],[7] However, no such study was previously conducted in Togo, which explains the focus of the current study on modifiable factors likely to affect the quality of life of Togolese hemodialysis (HD) patients.


   Methods Top


This prospective cross-sectional study spanned the period from December 1, 2012, to February 28, 2013, and included patients undergoing regular HD for more than one month at the only HD center in Togo - the Sylvanus Olympio University Hospital Center. Patients were required to fill in a biodata sheet and a 36-item Medical Outcome Survey Short Form SF-36.[8] The questionnaire covers eight aspects of patient quality of life with a maximum score of 100.

The patient’s profile is made based on the individual score of each aspect. Physical score drawn from US reference material is defined based on physical activity, limitations of pain, and general health, while a mental score is defined based on mental health, mental limitations, vitality, and life with others. The expected mean global score (MGS) calculated from various score means is 50 ± 10 [mean ± standard deviation (SD)]. Higher score values indicate better quality of life. For interpretation of the results, in Lean et al’s study,[9] MGS value of 66.7 was considered the cutoff score, below which quality of life is undermined. Initial MGS was standardized at 50 ± 10 (mean ± SD). This subjective study does not take into account some parameters such as anemia, cardiovascular status, nutrition, and quality of dialysis. Data processing and ana- ysis were performed using the Statistical Package for the Social Sciences (SPSS) software version 10.0 (SPSS Inc., Chicago, IL, USA) and group comparisons were performed using Chi-square test. Differences were considered statistically significant at P <0.05.


   Results Top


The current study was conducted on 75 dialysis patients, of which only 64 (85.33%) fulfilled inclusion criteria (44 males and 20 females - M/F sex ratio = 2.2). Mean dialysis duration was 2.84 ± 2.37 years (1 month-9.5 years). Mean patient age was 45.51 ± 14 years old (16–77 years, with the vast majority (90.6%) aged 16–44 years old.

The majority of patients had an active occupation (51 cases = 79.7%), with seven cases (10.9%) unemployed and six cases (9.4%) retired.

Duration of dialysis ranged from one month to 1.3 years in 22 cases (34%), 1.3–3 years in 19 cases (30%), three to six years in 17 cases (27%), and more than six years in six cases (9%).

The quality of life was negatively affected in most cases (global score 35.58 ± 15) with some variation in magnitude in various components. Physical scores were more affected than mental scores as follows (mean ± SD):

Physical activity 47.3770 ± 26.19807, limitations due to the mental status 30.2083 ± 44.33270, limitations due to physical status 15.2344 ± 32.91921, vitality 43.7500 ± 21.45501, mental health 57.2063 ± 17.01058, social life and relations with others 52.1825 ± 32.49842, physical pain 53.8281 ± 27.88144, and general health/well-being 37.3810 ± 16.50653. Physical score (PCS) was 31.84 ± 13.19, mental score was 40.64 ± 21.29, and MGS was 35.58 ± 15.08 (see above).

Physical components [Table 1] showed a lower quality of life in females, especially in limitations due to physical status. In addition, old age, unemployment, dialysis vintage beyond six years, and accompanying arterial hypertension were associated with a worse quality of life score in physical components.
Table 1: Determinants of quality of life: Physical component dimensions of the SF-36.

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Mental components [Table 2] also showed a lower quality of life in females in all components, particularly associated with old age (>75-year-old), long dialysis history (>6 years, and accompanying sickle cell anemia. On the other hand, neither the profession nor concomitant hypertension or the presence of diabetes had any statistically significant effect on the mental component of quality of life.
Table 2: Determinant of quality of life: Mental component dimensions.

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   Discussion Top


This study is the first of its kind in Togo. In addition, it has been conducted at the only avai- lable dialysis center in Togo and has a high rate of patient participation (85.33%). The questionnaire used was a generic questionnaire, which applies to miscellaneous pathological processes. It takes into account patient’s opinion, and the validated French version[8] has been particularly helpful both from the linguistic, cultural, and psychometric aspects, which allowed us to further validate the results and compare them with populations of different geographic and sociocultural background.

On the other hand, the current study is limited by the use of a subjective method, a relatively small sample population, and the use of a generic code, which might skip specific renal pathologies.

The mean patient age of 45.51 ± 14 years old is similar to patient age in the series from Morroco[10] and Tunisia.[5] The younger population was the most affected, as confirmed in the series of Diallo et al.[6]

The MGS of quality of life in the current our patients was 35.58 ± 15.08 (mean ± SD), which indicated a very poor quality of Nasr et al[5] reported a similarly poor but higher score of 51.45 ± 24.36 in patients from Tunisia. Lean et al[9] reported a considerably higher score of 66.7 than the current series figures.

Similar results were also reported in several studies,[1],[2],[6],[11],[12],[13],[14],[15],[16] with which confirmed poor quality of life among dialysis patients, but still better than the current series.

On the other hand, Diallo et al[6] reported satisfactory quality of life among thirty dialysis patients from Mali using the Choice Health Experience Questionnaire (CHEQ). Such difference may be explained by the smaller sample and the use of CHEQ which considers only six parameters of quality of life, whereas the SF-36 questionnaire covers eight parameters.

Several other studies have reported poorer physical components of quality of life (PCS score = 31.84) than the mental score (MCS = 40.64).[2],[5],[13],[17],[18] Several factors may be involved the physical limitations including frequency of dialysis, anemia, malnutrition, sedentary lifestyle, and locomotor system consequences of CKD,[5],[19] all of which are poorly managed in Togo given the limited resources and high costs.

Despite the more severe physical limitations and mental limitations scores in the current study, the mean dimensional scores of these components were similar to those of several other studies.[5],[9],[13],[17] The current study has also confirmed the poorer quality of life in women in all parameters of the SF-36 questionnaire, matching the findings form Tunisia[6] and France.[2] Such findings have been explained by an increased morbidity and mortality risks in women and the consequent higher rate of hospitalization,[20],[21],[22] in addition to the lower purchasing power of women in developing countries.

Quality of life decreased considerably in patients above 75 years old and in those with a history of dialysis beyond six years. These results concur with other studies.[5],[20],[21]

Diabetes and sickle cell disease may not be as influential on the mental components of SF- 36 as physical components, but hypertension causes considerable limitations on the physical components. These results are in accordance with those of several authors,[2],[6],[19],[20] especially of Patte[1] who associated comorbidity with the quality of life of dialysis patients. Other parameters such as anemia, nutrition, cardiovascular condition, and quality of dialysis are also known as factors related to quality of life.[19],[23],[24],[25]

In general, employees and freelance workers have a better quality of life than retired patients or other professional workers, probably because of their better socioeconomic status of employees and freelance workers. These results match other reports.[1],[2],[5],[20]


   Conclusion Top


Togolese dialysis patients are young but with very poor quality of life for their age compared to other studies, especially regarding the physical score. Factors such as old age, female gender, comorbid states, long-standing history of dialysis (>6 years), and absent professional activity are the factors of poor quality of life. The current study is the first of its kind in Togo and this should be a reference work for further studies on quality of life of Togolese HD patients.

Conflicts of interest: None declared.

 
   References Top

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Correspondence Address:
Kossi Akomola Sabi
Department of Nephrology, Hemodialysis Unit, Sylvanus Olympio University Hospital Center, Lomé
Togo
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DOI: 10.4103/1319-2442.206463

PMID: 28540900

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