Living with End-Stage Renal Disease: Perceived Impact of Treatment in a Mexican Hemodialysis Clinic
Vera-Delgado, Karla Susana
Baldwin, Carol M.
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Session presented on Sunday, July 27, 2014: Purpose: End-stage renal disease (ESRD) has great impact in patients' health-related quality of life (HR-QOL), which is globally considered as a reliable measure of health outcome. In Mexico, the prevalence of type 2 diabetes, the leading cause of ESRD, is 14.4%; it is predicted that 18% of the adult population in Mexico will have type 2 diabetes by 2025. In 2006, Mexico reported the prevalence and incidence rates of ESRD of 510.4 and 345.9 per million population, respectively. The lack of a formal national registry system in Mexico, however, could result in underestimation of these rates. Methods: Sixty-nine Mexican patients attending a hemodialysis clinic in Central Mexico where interviewed about their HR-QOL and disease impact in their daily lives based on the MEI adaptation of ENH's Spanish KDQOL 1.3 version (Benjamin Arnold). The KDQOL-SF assesses the functioning and well-being of people with kidney disease and on dialysis. It consists of 80 items divided into 19 dimensions: SF-36 (8 dimensions/36 items; 1 health transition item), kidney-disease-targeted items (11 dimensions/43 items). Scores presented are the Physical Component Summary (PCS), the Mental Component Summary (MCS), the health transition item and the 11 kidney-disease-targeted. The scores range from 0 to 100, with higher scores reflecting better HR-QOL. Data were analyzed using SPSS software (V21). Results: Demographic data showed participants to be 43 '19 years old, female (64%), married (49%), 5.'3 years of education, without monthly salary (40%), with health insurance (91%). Predominant comorbidity was diabetes (27%) and they attend to the clinic mostly mornings (45%) and evenings (43%), two-three (36%-62%) times a week, from three to four hours connected to the hemodialysis machine (96%) ; vascular access were a catheter (55%) and arterio-venous fistula (45%) installed less than a year (43%) or two (36%) ago. Forty-six percent of them reported at least one hospitalization during the last year from 1-3 days (43%); 71% referred to take hypertensive medications. Low scores showed impairment in both physical and mental dimensions (PCS=439.9'10, MCS=40.3'8), as well as when questioned about health status compared with last year (26'33). Work status (36'37), burden of kidney disease (39'34), quality of social interaction (49'15) and effects of kidney disease on daily life (59'20) were found to be the most affected dimensions of HR-QOL for this population. Interestedly, dialysis staff encouragement (88'22) and social support (85'24) were the best scored dimensions in contrast with the health status reported in PCS and MCS scores. Factors related to this phenomena in PCS were years of education (p<0.01), marital status (p<0.05), comorbidity (p<0.01) and age (p<0.001). Factors related with MCS scores were marital status (p<0.01), hospitalization (p<0.01), antihypertensive medication (p<0.05). The health transition item was related with factors as insurance (p<0.05), comorbidity (p<0.01) and hospitalization (p<0.05).' Conclusion: In this population, there is a high impact of disease and treatment on HR-QOL of persons with ESRD treated with hemodialysis. It is imperative to structure evidence-based and holistic-oriented health care strategies based in order to address best health outcomes.