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A Study on Patients Undergoing Dialysis

Erika Szabo; Henry Moody, MD; Tracy Hamilton; Chrizette Ang, RN; Carl Kovithavongs; Carl Kjellstrand, MD, PhD, FRCPC, FACP

Arch Intern Med. 1997;157(12):1352-1356.

Abstract
Background
Quality of life (QOL) is an important measure of the success of medicine. Choice of treatment is an important variable influencing QOL. We studied QOL in patients undergoing treatment for end-stage renal failure. Until June 1993 our patients needing dialysis could freely choose continuous ambulatory peritoneal dialysis (CAPD); however, since that time most patients have been forced to undergo CAPD because the hemodialysis program is full.

Methods
We compared QOL in patients accepted before or after June 1993. Forty-five patients undergoing CAPD were studied during the period of choice compared with 44 who had no choice. Quality of life was studied by Bradburn Affect Scale, Mental Health Scale, Campbell Life Satisfaction, Perceived Health, Karnofsky Scale, Activity Scale, Physical Symptoms Scale, and desire for treatment change.

Results
The patients undergoing CAPD in the no-choice group had a lower score than the choice population in 4 of the 7 QOL scales. The Mental Health Scale mean score was 18.4 compared with 15.5, and the patients ranking highest on the Mental Health Scale decreased from 33% to 18%, while those ranking lowest increased 7-fold from 2% to 14% comparing choice with no-choice group. The Bradburn Affect Scale score was +0.7 in the choice group compared with -0.3 in the no-choice group. There were no differences in age, sex, race, or treatment that explained the difference. Influence of other time-related factors is unlikely as there were no similar lower scores with time in the QOL reported by patients in the in-center or assisted self-care hemodialysis or transplant groups.

Conclusion
Once the freedom of choice of treatment is gone from the patients undergoing CAPD their psychological QOL deteriorates.

Arch Intern Med. 1997;157:1352-1356

Author Affiliations
From Division of Nephrology, Department of Medicine, University of Alberta, Edmonton (Mss Szabo, Hamilton, and Ang, Mr Kovithavongs, and Dr Kjellstrand), and Division of Nephrology, Sir Charles Gairdner Hospital, Perth, Australia (Dr Moody).; Dr Kjellstrand is now with Aksys Ltd, Lincolnshire, Ill.

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