Does Hemodialysis Patients Have A Better Quality of Life Than Peritoneal Dialysis Patients?

Abstract

Objective : To systematically evaluate the effect of peritoneal dialysis and hemodialysis on patients’ quality of life.

Methods : Computer searched the quality of life of patients comparing peritoneal dialysis and hemodialysis in CNKI, Wanfang database, VIP database, the Cochrane Library, PubMed and Web of Science database, searching the database until November 30,2023. Statistical analysis and mapping were performed using the Review Manager 5.3 software.

Results : A total of 26 articles were included for a total of 25501 study subjects. The results of the Meta-analysis showed that, Compared with the hemodialysis patients, The Peritoneal dialysis patients had better quality of life (MD= -9.36, 95%CI =-13.45~-5.26, P<0.001), In the physiological function (MD=2.34, 95%CI =0.134.56, P <0.05), physical pain (MD=3.82, 95%CI=0.836.81, P <0.05), general health (MD=1.57, 95%CI=1.052.08, P <0.05), psychological status (MD=1.94, 95%CI=0.033.85, P <0.05) and the domain differences were significant.

Conclusion: Peritoneal dialysis patients have better quality of life than hemodialysis patients

Keywords

• Peritoneal dialysis
• Hemodialysis
• Dialysis
• Quality of life
• Meta integration

Citation

Ruobing Z, Wei Z, Mengdi S, Chao Y (2024) Does Hemodialysis Patients Have A Better Quality of Life Than Peritoneal Dialysis Patients?. J Nephrol Kidney Dis 5: 7.

Introduction

In recent years, with the rapid development of social, medical and economic development around the world, the number of patients with end-stage renal disease (ESRD) is increasing year by year [1]. Renal replacement therapy (RRT) is an important life-sustaining treatment for patients with chronic end-stage renal disease (ESRD), among which peritoneal dialysis and haemodialysis are the main methods of RRT. The focus of research in the medical field has gradually shifted from “clinical outcomes” to “patient-centred outcomes”. Health-related quality of life (HRQoL) has become an important indicator for evaluating different modalities of renal replacement therapy (RRT) [2]. Health-related quality of life (HRQoL) is defined by the World Health Organisation as an individual’s subjective feelings and perceptions about their physical health, mental health, social functioning and environmental adaptability [3]. The results of studies on which alternative treatment modalities provide patients with a better quality of life are controversial [4]. Therefore, in this study, we objectively compared and assessed the effects of peritoneal dialysis (PD) and haemodialysis (HD) on patients’ quality of life by meta-analysis, and thoroughly investigated the advantages and disadvantages of dialysis modalities in terms of patients’ quality of life,
with the aim of providing patients and clinicians with more informed decision support.

Data and Methods

Inclusion and exclusion criteria
Inclusion criteria: 1) the type of study is case-control or cohort study; 2) domestic and foreign published literature on the quality of life of peritoneal dialysis and haemodialysis patients in both Chinese and English; 3) the outcome indicators are the scores of different dimensions, and the assessment tool is the Brief Health Status Questionnaire.
Exclusion criteria: (1) incomplete data; (2) duplicate publications, conference papers; (3) full text could not be obtained through various means.

Search strategy

We searched China Knowledge Network (CNN), Wanfang, Wipro, China Biomedical Literature Database (CBLD), PubMed, Embase, Cochrane, Web of Science, Scopus databases or platforms, and the search period was from the establishment of the databases to 30 November 2023, and we used a combination of subject terms and free words to search the databases. Searches were conducted using a combination of subject headings and free words.

Data extraction and quality assessment

Two reviewers independently extracted data and assessed the quality of the literature, and in case of disagreement, a third reviewer was asked for further discussion and decision, if necessary. The Methodological Index for Non-Randomised Studies (MINORS) [5] was used to assess the quality of the included literature, which included whether the purpose of
the study was clear, the consistency of the patients included, whether the expected data were collected, whether the outcome measures adequately reflected the purpose of the study, the objectivity of the assessment of the outcome measures, and the quality of the study results. The assessment included whether the purpose of the study was clear, whether the expected data were collected, whether the endpoint measures appropriately reflected the purpose of the study, whether the endpoint measures were objectively assessed, whether follow-up was adequate, whether the dropout rate was less than 5%, and whether the sample size was estimated; Each item was scored from 0 to 2, with 0 indicating no reporting, 1 indicating reporting but inadequate, and 2 indicating reporting and adequate, and an ideal score of 24 points was obtained, and a total score of 0-8 points was classified as low quality, 9-16 points as moderate quality, and 17-24 points as high quality.

Statistical methods

Meta-analyses of the relevant data were performed using RevMan 5.3 and R language software. Measurement data were expressed as mean difference (MD), and effect sizes were expressed as 95% confidence intervals (CI); the χ2 test was used to determine heterogeneity, and if P>0.05 and I 2 <50%, there was no statistically significant heterogeneity between studies and a fixed-effects model was used for meta-analysis; conversely, a random-effects model was chosen for meta-analysis.

Results

Results of the literature search
The preliminary search of the database yielded 1113 articles of relevant literature, and 26 articles were finally included according to the inclusion and exclusion criteria, with a total of 25,501 patients. The literature screening process and results are shown in Figure 1.

Main characteristics and quality assessment of the included studies
Of the 1113 studies published between 1997 and 2016, a total of 26 studies were eligible, as shown in Figure 1. The characteristics of the included studies are shown in Table 1.These studies included approximately 25,501 participants, and the study sample sizes ranged from 51 to 18,015 participants. Twenty-four of the 26 studies were crosssectional.
Twenty-six of the 26 studies assessed patients’ quality of life SF- 36 scale Twenty-six of the 26 studies were cross-sectional, and 26 studies assessed patients’ quality of life SF-36 scale scores on each dimension. Details of the included literature are shown in Table 1. 

Table 1: includes the basic characteristics of the included studies (n = 26).

Meta-analysis results
Twenty-six studies [6-31] reported scores on eight domains of the SF-36 scale between PD and HD, and the data were subjected to metaanalysis to calculate effect sizes for each dimension. The heterogeneity of I2 between different studies ranged from 82.0 to 92.0%, so a random effects model was used for all studies. The results showed that the effect scores of all domains were generally biased in favour of PD, but only for physiological functioning (MD = 2.34, 95% CI = 0.13-4.56, P < 0.05), bodily pain (MD = 3.82, 95% CI = 0.83-6.81, P < 0.05), general pain (MD = 3.82, 95% CI = 0.83-6.81, P < 0.05), general health (MD = 3.82, 95% CI = 0.83-6.81, P < 0.05), and general health (MD = 3.82, 95% CI = 0.83- 6.81, P < 0.05), general health (MD=1.57,95%CI=1.05~2.08,P<0.05) and mental health (MD=1.94, 95%CI=0.03~3.85, P<0.05) dimensions were significant, see Table 2.

Table 2: Summary of the results of Meta-analysis of SF-36 dimensions

Publication bias
In this study, a funnel plot was drawn for the physiological functions of patients. The results showed that the funnel plot was basically symmetrical, indicating that the possibility of publication bias in the included literature was small, see Figure 2.

Figure 2: Physiological function funnel diagram

Discussion

This study pooled the SF-36 scores of 26 studies [6-37] to compare the effects of different dialysis treatment modalities on patients’ quality of life. Most of the previously published studies conducted systematic reviews to clarify the current situation and summarise the effects of different dialysis treatment modalities on patients’ quality of life, and few studies conducted meta-analyses to investigate the differences in patients’ quality of life between abdominal dialysis and haemodialysis. In this study, based on a large amount of research data and direct and indirect comparative evidence, we obtained a comparative evaluation of the effects of different dialysis treatment modalities on patients’ quality of life, and the results of the meta-analysis showed that patients with abdominal dialysis were better than patients with haemodialysis in the areas of physiological function, bodily pain, general health and psychological status in the aspect of quality of life, thus providing a
certain reference value for the decision-making of patients on dialysis in the clinical setting.

Results of the meta-analysis

Some of the aspects in which patients with peritoneal dialysis are superior to those with haemodialysis may be due to the flexibility and autonomy of peritoneal dialysis treatment, which allows the patient to complete the treatment at home and reduces the need for frequent trips to the hospital, which may give the patient more autonomy and comfort [38]. Haemodialysis requires frequent intubation and blood circulation, which can sometimes cause discomfort and pain associated with venous access [39], whereas peritoneal dialysis may cause less physical pain to patients. Therefore, compared with haemodialysis, peritoneal dialysis may result in less physical pain and discomfort and to some extent improve the patient’s quality of life, including general health and work status [25]. This type of home treatment also has the potential to reduce the psychological burden on the patient and may have a positive impact on the patient’s mental health by reducing the psychological stress associated with frequent hospital visits compared with in-centre haemodialysis [40]. As peritoneal dialysis is a 24-hour continuous dialysis, the body is closer to the physiological state and maintains the stability of the internal environment; the haemodynamic effects are small, the incidence of cardiovascular, cerebral and haemorrhagic complications is low, there is no restriction of activities and the quality of life is higher, which is more suitable for patients with terminal illnesses [41]. However, different patient conditions and treatment settings may lead to different
treatment choices, so optimal treatment needs to be discussed between health professionals and patients and personalised according to individual circumstances.

Limitations of the study

It should be noted that the study is subject to a number of limitations. Firstly, despite the implementation of a comprehensive search strategy for this study, there is a possibility of omission due to the inherent limitations of any such strategy. Secondly, the majority of the data were derived from cross-sectional designs of observational studies, which may
be susceptible to selection and confounding bias and tend to diminish the strength of the evidence in this study. In conclusion, the aforementioned factors should be taken into account when applying the evidence from this study in practice, and it should be selected with great care. The present study can only draw an exploratory conclusion, and further highquality, directly comparable RCTs are required in the future to validate and complement the existing evidence.

Conclusion

This study showed that patients on peritoneal dialysis had a moderately better quality of life than patients on haemodialysis, as assessed by the SF-36 self-report instrument. Therefore, the results of this study can be used as a reference for the choice of dialysis modality, focusing on peritoneal dialysis according to the actual situation of the patients. However, in future studies, rigorous multicentre RCTs with large sample sizes should be designed to confirm the present findings and to examine the trends over time between PD and haemodialysis patients, as well as the relationship with clinical outcomes such as hospitalisation and mortality, in order to provide some reference for clinicians and patients in choosing the appropriate dialysis technique.

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