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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2014  |  Volume : 25  |  Issue : 2  |  Page : 432-437
Impact of demographic and comorbid conditions on quality of life of hemodialysis patients: A cross-sectional study

1 College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
2 Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia
3 Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia
4 King Abdulaziz University Hospital, Jeddah, Saudi Arabia

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Date of Web Publication11-Mar-2014


To assess the quality of life (QOL) of Saudi Arabian patients undergoing hemo­dialysis (HD) and to determine the impact of gender, age, education and comorbidities on the QOL of these patients, we conducted a cross-sectional study and used the short form-36 (SF-36) questionnaire, a generic instrument for measuring QOL. This questionnaire is composed of eight scales that summarize the physical component scale (PCS) and mental component scale (MCS) of health status. We calculated the PCS and MCS scores for each patient. We studied 205 HD patients (123 men; ages 18-75 years) from the King Fahd General Hospital, Jeddah, Saudi Arabia. The mean SF-36 score was 59.4 ± 21.7 in men and 41.9 ± 20.9 in women (P <0.0001). Patients older than 60 years had the worst score (41.5 ± 21.2), followed by patients aged 40-59 years (53.6 ± 22.8); patients aged 18-39 years had the best SF-36 score (57.5 ± 22.5; P <0.0001). Education had a positive impact on QOL (P <0.0001), whereas comorbid conditions had a nega­tive impact. Peripheral vascular disease was associated with the worst outcome (SF-36 score, 40.4 ± 23.0; P <0.0001), followed by dyslipidemia (42.9 ± 22.4; P = 0.001) and diabetes mellitus (45.0 ± 22.0; P = 0.012). Among the comorbid conditions, hypertension was associated with the best SF-36 score (50.6 ± 22.7; P = 0.034). We conclude that old age, female gender, poor education and comorbid conditions have a negative impact on the QOL of HD patients in Saudi Arabia. These findings indicate a general need for social support for female patients on HD and early diagnosis and management of comorbid conditions.

How to cite this article:
Mandoorah QM, Shaheen FA, Mandoorah SM, Bawazir SA, Alshohaib SS. Impact of demographic and comorbid conditions on quality of life of hemodialysis patients: A cross-sectional study. Saudi J Kidney Dis Transpl 2014;25:432-7

How to cite this URL:
Mandoorah QM, Shaheen FA, Mandoorah SM, Bawazir SA, Alshohaib SS. Impact of demographic and comorbid conditions on quality of life of hemodialysis patients: A cross-sectional study. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2023 Feb 4];25:432-7. Available from: https://www.sjkdt.org/text.asp?2014/25/2/432/128613

   Introduction Top

Quality of life (QOL) parameters are now recognized as important outcome measures in health care; these parameters influence the selection of dialysis treatments. [1] The concept of health-related quality of life (HRQOL) and its determinants have evolved over the last 30 years to encompass those aspects of the overall QOL that can be clearly shown to affect phy­sical, mental or social health. [2] Chronic kidney disease requiring dialysis has a great impact on HRQOL; such patients go from living a nor­mal life to being in a state of mortal danger. [3] The incidence of end-stage renal disease (ESRD) has been increasing progressively in Saudi Arabia [4] and, at present, the incidence and pre­valence of ESRD is 10-15-fold that in 1983. [5]

Dialysis patients must learn to live with the limitations due to their condition and by the application of the different methods of treat­ment, all of which will modify their lifestyle to a great extent. [6] Health economic studies use QOL as an indicator of the benefits and utility of certain interventions (such as medical and social care). Research on QOL is also an important topic for clinical practice, [7] and low QOL has a negative impact on the entire com­munity.

To assess the QOL of dialysis patients and the outcome of dialysis, we must identify the factors that have the greatest impact on the QOL, e.g. comorbidity, education and age.

In this study, we aimed to evaluate the QOL of Saudi patients on hemodialysis (HD) and to determine the impact of gender, age, educa­tion and comorbid conditions on the QOL of these patients.

   Materials and Methods Top

This cross-sectional study was conducted in one of the biggest dialysis centers in Jeddah, Saudi Arabia, from July 1 to September 10, 2011, which was approved by the Ethics Com­mittee of the King Abdulaziz University, Unit of Biomedical Ethics, by professor, and the patients signed written informed consents to participate in the study. The patients were selected from the dialysis center, provided they met the following inclusion criteria: They were outpatients who had been undergoing HD for at least three months and were above 18 years of age. Patients with dementia or mental retardation and those who were unable to com­municate were excluded.

We used an interview questionnaire called the Short Form-36 (SF-36), a generic instru­ment for measuring HRQOL that was deve­loped for the Medical Outcome Study. [8] It com­prises eight scales that measure the physical and mental dimensions of health status: Phy­sical functioning, role-physical, body pain, general health perceptions, vitality, social functioning, role-emotional and mental health [Table 1]. The scales are scored on a range from 0 to 100. The above scales can be sum­marized into component summary scores, which aggregate the physical and mental com­ponents of the eight scales of the SF-36 ques­tionnaire into the physical component scale (PCS) and mental component scale (MCS) scores. The PCS score reflects physical morbi­dity and adaptation to disease, whereas the MCS score reflects psychological or mental morbidity and adaptation. The component sum­mary scores are positively scored and norm­alized to a general population mean of 50 and a standard deviation of 10. We calculated the PCS and MCS scores for each patient by follo­wing the user's manual for the SF-36 ques­tionnaire. Higher transformed scores indicate a better HRQOL. [8] Previous experiences with the Arabic version of the SF-36 instrument have proved it as a valid and robust method. [9],[10]

We recorded the following demographic data: Age, sex and level of education. We used three age groups: 18-39, 40-59 and 60 years. The level of education was categorized as elemen­tary school, intermediate school, secondary school, bachelor's degree, master's degree and uneducated. The following comorbid condi­tions were included: Hypertension, diabetes mellitus, dyslipidemia, dialysis line sepsis and peripheral vascular disease.
Table 1: Summary of the Short Form-36 questionnaire.*

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   Statistical Analysis Top

Data were entered in a Microsoft Excel file and analyzed with the Statistical Package for the Social Sciences (SPSS), version 13. The non-parametric Mann-Whitney and Kruskal-Wallis tests were used to compare all ordinal data measured on Likert-type scales, whereas the Chi-square test was used to assess the relationship between categorical variables. The independent samples t test and analysis of variance (ANOVA) were used to compare two or more groups of parametric data. Differences with P-values of <0.05 were considered statistically significant.

   Results Top

We studied 205 chronic HD patients, of whom 123 (60%) were men. The mean SF-36 score of the patients was 47 ± 22.9; the score in men was 59.4 ± 59.4 and that in women was 41.9 ± 41.9 (P <0.0001; [Table 2]. Overall, 36.6%, 42% and 21% of the subjects were in the age groups of 18-39, 40-59 and 60 years, res­pectively. The corresponding SF-36 scores for these age groups were 57.5 ± 22.5, 53.6 ± 22.8 and 41.5 ± 21.2. We found that the older the age, the worse was the SF-36 score.
Table 2: Impact of demographic and comorbid conditions on the quality of life of dialysis patients.

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Of the total sample, 20.5% of the patients who had never attended school had a mean SF score of 35.9 ± 18.7, whereas 15.6% of the patients who had a bachelor's degree of the total sample had a mean SF score of 62.7 ± 23.7 [Table 2]. Uneducated patients had worse SF-36 scores than educated patients.

Hypertension was the most common comorbid condition (77.6%), followed by peri­pheral vascular disease (25.9%), dyslipidemia (24.4%) and diabetes mellitus (22.4%). Hyper­tensive patients had the best SF-36 score (50.6 ± 22.7), whereas those with peripheral vas­cular disease had the worst SF-36 score (40.4 ±23).

We compared the SF scores of subjects with comorbid conditions to those of subjects with­out any comorbidity. The greatest difference in SF scores was found in the case of patients with peripheral vascular disease (16.2), fol­lowed by those with dyslipidemia (12.6), dia­betes mellitus (9.6), hypertension (8.2) and dialysis line sepsis (5.2). These findings indi­cate that the peripheral vascular disease has the greatest impact on the QOL of HD patients.

The lowest SF-36 score (32.2 ± 39.9) was obtained for the role-physical scale, followed by the vitality scale (44.3 ± 23.3) and physical functioning scale (46.7 ± 31.9); the mental health scale had the highest score (66.4 ± 22.1) [Table 3].
Table 3: Mean scores for each scale.

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   Discussion Top

In this study, low scores were obtained for the role-physical, vitality and physical func­tioning scales; the highest score was obtained for the mental health scale. These findings could be explained by the high prevalence of comorbid conditions, particularly the peripheral vascular disease. The "social functioning" and "mental health" scales scored high, which might be attributed to the strong family bond in Saudi culture.

The patients in our study have been found to score significantly higher on "mental health" but lower on "physical functioning" than the Lebanese population. [9] Moreover, compared with the Korean population, Saudis scored sig­nificantly higher on "social functioning" and "mental health," but significantly lower on "physical functioning." [11] The present study describes in detail the QOL scores of a group of Saudi patients on HD and the impact of certain factors on their QOL.

In our study, women had significantly lower "physical functioning" scores. This difference could stem from the fact that 44% of the women in our study were uneducated, whereas only 5% of the men were uneducated. Other studies in Saudi Arabia have also showed that men tend to have better QOL scores than women. [12] Similar results have also been re­ported from the USA and Italy. [13],[14] A study in the UK, however, reported lower SF-36 scores in the male patients. [15]

In our study, patients aged 60 years or older had significantly lower scores in all QOL dimensions; in addition, patients aged 18-39 years scored better than those aged 40-59 years; older patients were found by other studies to have worse scores for physical function as expected. [15] In contrast, a US study compared groups of dialysis patients with age-matched healthy subjects and found that com­pared with young dialysis patients, older pa­tients obtained scores that were nearer to those of the healthy subjects, suggesting better accep­tance of the limitations of illness in older patients. [16]

In our study, education had a positive impact on QOL. The uneducated patients had the worst SF-36 scores, whereas those with a bachelor's degree had the best scores. A study in Lebanon using the same tool also found that education had a positive impact on QOL. [9]

The presence of comorbid conditions had a negative impact on the QOL. In our study, peripheral vascular disease was associated with the worst outcome, followed by dyslipidemia, diabetes mellitus and line sepsis; hypertension was associated with the best SF-36 score. We found that hypertension, diabetes and dyslipi­demia were more common among uneducated patients who may not undergo regular check-ups to monitor their blood pressure or glucose levels.

Compared with patients from different coun­tries, the Saudi patients in our study had lower scores on the "physical functioning," "role physical" and "vitality" scales, [11],[17],[18] but higher scores on the "mental health" and "social functioning" scales [Table 4].
Table 4: Mental component scale and physical component scale scores obtained using SF-36 in this study and seven other studies.

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We conclude that our study suggests that older age, female gender, poor education and comorbid conditions have a negative impact on the QOL of dialysis patients in Saudi Arabia. The Saudi patients scored the lowest in the "physical functioning" and the "role-physical" scales and highest on the "mental health" and "social functioning" scales.[22]

Conflict of Interest

All authors declare no conflict of interest related to this study.

   References Top

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11.Park HJ, Kim S, Yong JS, et al. Reliability and validity of the Korean version of Kidney Disease Quality of Life instrument (KDQOL-SF). Tohoku J Exp Med 2007;211:321-9.  Back to cited text no. 11
12.AL-Jumaih A, Al-Onazi K, Binsalih S, Hejaili F, Al-Sayyari A. A Study of Quality of Life and its Determinants among Hemodialysis Patients Using the KDQOL-SF Instrument in One Center in Saudi Arabia. Arab J Nephrol Transplant 2011; 4:125-30.  Back to cited text no. 12
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14.Mingardi G, Cornalba L, Cortinovis E, Ruggiata R, Mosconi P, Apolone G. Health-related quality of life in dialysis patients. A report from an Italian study using the SF-36 Health Survey. DIA-QOL Group. Nephrol Dial Transplant 1999; 14:1503-10.  Back to cited text no. 14
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17.Lopes AA, Bragg-Gresham JL, Satayathum S, et al. Health-related quality of life and associated outcomes among hemodialysis patients of diffe­rent ethnicities in the United States: The Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2003;41:605-15.  Back to cited text no. 17
18.Duarte PS, Ciconelli RM, Sesso R. Cultural adaptation and validation of the "Kidney Disease and Quality of Life-Short Form (KDQOL-SF 1.3)" in Brazil. Braz J Med Biol Res 2005;38: 261-70.  Back to cited text no. 18
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21.Yildirim A, Ogutmen B, Bektas G, Isci E, Mete M, Tolgay HI. Translation, cultural adaptation, initial reliability, and validation of the Kidney Disease and Quality of Life-Short Form (KDQOL-SF 1.3) in Turkey. Transplant Proc 2007;39:51-4.  Back to cited text no. 21
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Correspondence Address:
Qusay Mohammed Mandoorah
College of Medicine, King Abdulaziz University, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-2442.128613

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  [Table 1], [Table 2], [Table 3], [Table 4]

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