Quality of Life for Patients with End Stage Renal Disease
Introduction
When patients suffer irreversible kidney failure there are only a few options left for survival, a patient might either obtain a kidney transplant, or perform continuous treatments of hemo/peritoneal dialysis. The life of an End Stage Renal Disease (ESRD) patient is not easy. There are many lifestyle changes that occur once a patient starts on dialysis. The most common modality for dialysis is hemodialysis (Queeley & Campbell, p. 118, 2018). Hemodialysis removes the patients’ blood and uses a machine to remove fluid and filter wastes that would normally be filtered by functioning kidneys. Peritoneal dialysis utilizes a catheter placed in the abdomen and uses the patient’s peritoneum to remove wastes from the patient’s blood. Peritoneal dialysis may be performed at home up to seven nights per week for approximately six to eight hours per night, hemodialysis on the other hand requires the patient to be dialyzed at the hospital or attend a hemodialysis center usually three times per week for about 3 to 4 hours per day. Length of treatment and dietary restrictions are different for each modality. This study aims to analyze if patients on peritoneal dialysis enjoy a better health-related quality of life in comparison to hemodialysis patients while being on dialysis treatments. Health-related quality of life “reflects the welfare of patients based on their functional status in the physical, mental, and social domains, balanced with expectations and experiences in the face of a changing health status” (Queeley & Campbell, p.118, 2018).
Overview of the Problem
With advancements in technology, science and medicine have been able to maintain more and more renal failure patients alive longer. Obesity, hypertension, and diabetes continue to propagate throughout the U.S and there are currently over 678,000 people with End Stage Renal Disease in America (Queeley & Campbell, p. 118, 2018). With 192 per 100,000 people dying from chronic kidney disease (CKD), CKD is 17th in order of causes of death worldwide (Ravindran, Sunny, Kunnath, & Divakaran, p. 47, 2020). Dialysis treatment is not easy. Patients are often left feeling weak after their dialysis treatments, which alters their daily living. Generalized weakness along with “protein energy wasting, frailty, malnutrition, anemia, bone disease, pain, and depression all exacerbate physical deterioration” (Jayaseelan, Bennett, Bradshaw, Wang, & Rawson, p.185, 2018). ESRD population can benefit from studies performed to assess which dialysis modality yields a better health-related quality of life for patients. The goal of this study is to identify which dialysis modality assists patients in achieving baseline levels of functioning. Currently, hemodialysis is the predominant modality of treatment but if scientifically informed data would reveal that peritoneal dialysis is just as efficient or even more beneficial in terms of health-related quality of life for ESRD patients, then such evidence could revolutionize nursing interventions and patient care for renal failure victims.
References
Jayaseelan, G., Bennett, P. N., Bradshaw, W., Wang, W., & Rawson, H. (2018). CNE. Exercise Benefits and Barriers: The Perceptions of People Receiving Hemodialysis. Nephrology Nursing Journal, 45(2), 185–219.
Queeley, G. L., & Campbell, E. S. (2018). Comparing Treatment Modalities for End-Stage Renal Disease: A Meta-Analysis. American Health & Drug Benefits, 11(3), 118–125.
Ravindran, A., Sunny, A., Kunnath, R. P., & Divakaran, B. (2020). Assessment of Quality of Life among End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis. Indian Journal of Palliative Care, 26(1), 47–53. https://doi.org/10.4103/IJPC.IJPC_141_19
Quality of Life for Patients with End Stage Renal Disease
Project Purpose Statement
The purpose of this project is to review data on ESRD patients’ experiences while on dialysis treatments and which modality (hemodialysis or peritoneal) is associated with higher levels of health-related quality of life. Proper education on benefits and side-effects of each modality can help newly diagnosed ESRD patients make informed decisions about their treatment of choice.
Background and Significance
Patients with End Stage Renal Disease would die within weeks if they don’t receive their dialysis treatments. Patients with ESRD have reached a stage in which their kidneys can no longer function and require life-saving interventions such as hemodialysis or peritoneal dialysis, some patients who are young and healthy enough to endure additional surgery will enlist in kidney transplant waiting lists. The kidneys perform several functions in the human body, they are in charge of expelling extra fluid from the body as well as excreting wastes and toxins. Additional work of the kidneys includes balancing minerals in the body, blood pressure control, as well as playing a key role in managing anemia and assisting with bone density. Libardi da Silva, Dos Santos Cargnin, Ventura, Ferraz de Paula, & Vanussa Groos (p. 4664, 2017) describe chronic renal failure as a silent, asymptomatic disease that causes irreversible kidney damage resulting in metabolic and hydroelectrolytic imbalances. Patients requiring dialysis are forced to face life-changing circumstances that can affect their “life, work, changes in diet, sex life, their body image due to catheters or arteriovenous fistulas used in dialysis, as well as changes in coloration in skin and hair” (Libardi da Silva, Dos Santos Cargnin, Ventura, Ferraz de Paula, & Vanussa Groos, p. 4664, 2017).
Kidney disease is a problem that affects millions of persons worldwide, approximately 10% of adult population have some sort of kidney damage, and the cost involved in treating renal failure patients is also quite costly. In the U.S. alone, costs may exceed forty-eight billion dollars per year, equating to 6.7% of the total Medicare budget (www.worldkidneyday.org/facts/chronic-kidney-disease/, para. 3, 2019). These figures are important because patients that are suffering less symptoms associated with chronic renal failure can signify stronger treatment adherence rates as well as more stable conditions and a reduction of complications. When comparing both modalities it is also important to note that peritoneal dialysis can cost around $53,000/ year while hemodialysis at an outpatient center can cost up to $72,000/year (Johnson, para. 14, 2014). Not only does hemodialysis cost more to begin with but if patients must skip work to attend treatments which are usually scheduled anytime between 05:00-17:00, then loss of wages also becomes inevitable therefore causing additional strain to the patient and their family’s financial wellbeing.
Patients receiving hemodialysis treatments usually attend dialysis centers three times per week from anywhere between three to four hours per day, if a patient is still working then their work life will suffer due to the inability to attend regularly scheduled work shifts. Some patients have even mentioned that they aren’t allowed to continue in their current position or continue with their current tasks at work once their employer finds out they have chronic renal failure and are receiving dialysis treatments. For employers that require their employees to complete full-time work, it can be difficult to accomplish this when patients require a minimum of twelve-plus hours out of their work week to perform dialysis treatments. Even if employers are willing to work around a patient’s dialysis schedule, other staff may interpret this as favoritism and create additional tension in the workplace. Properly assessing patient’s individual lives can help determine which modality and which schedule might accommodate the patients’ work-life balance the best.
Strict dietary restrictions also impact the lives of ESRD patients, many report being unable to eat outside their home due to street food having high contents of sodium and potassium. One patient stated “I’ll stay away from social events where I don’t know people very well. It just becomes awkward when they see you not eating the food” (Morris, Love, van Aar, Liles, & Roskell, p. 256, 2015). In hemodialysis three treatments per week attempt to make up work that the kidneys used to perform day and night, therefore the shift in wastes, toxins, and fluid in the body is drastic between pre and post hemodialysis treatments. In peritoneal dialysis, treatments are performed every night so patients’ toxins, wastes and extra fluid is removed more often when compared to hemodialysis. By performing daily treatments, patient can enjoy the benefits of a renal diet without so many restrictions. With ESRD patients having chronic anemia and high levels of wastes in the blood, fatigue also plays a role in their quality of life. Dialysis treatments may only last a few hours but if the patient is too tired to drive or to work then their whole day is gone. Another important aspect that plagues renal failure patients is disturbed body image, enlarged aneurysms from arteriovenous fistulas or foreign plastic tubes sticking out of the chest from central venous catheters can really affect a person’s self-image, sex life, and self-esteem.
Not every modality can work for every patient, if dealing with an elderly patient that lives alone at home then it might not be wise to recommend home or peritoneal dialysis, on the other hand if the patient is younger and stable then peritoneal dialysis treatments at home might suit his work and social life better. Just like medications and courses of action, providers and nurses will recommend modalities that they are familiar with, “some experts say more ESRD patients would be served by home dialysis if more clinicians recommended it and most programs that train nephrologists don’t have enough people who are on home dialysis” (Johnson, para. 8, 2014). This project is about providing service based on holistic and caring principles, clinical outcomes alone do not reflect patient experiences. Incorporating such evidence can revolutionize the nephrology world as well as open doors to much needed education for providers and nurses. By providing staff with cross-training opportunities so that they are aware of the benefits and limitations of each modality, they will be better prepared to make individualized assessments and help patients make informed decisions about their treatment of choice. Identifying if peritoneal dialysis yields improved levels of health-related quality of life for patients can generate the required evidence to implement educational and practice changes in a facility, local, community, regional, statewide, national, and even global level.
PICOt Question
Population: Adult patients over 18 years of age diagnosed with chronic End Stage Renal Failure
Intervention: Educating staff and patients on all available modalities for dialysis and identifying if current data supports peritoneal dialysis patients experiencing higher levels of health-related quality of life while on dialysis.
Comparison: Health-related quality of life of ESRD patients receiving hemodialysis treatments.
Outcome: Quantifiable and descriptive narratives from peritoneal dialysis patients will yields higher results in terms of satisfaction with their health-related quality of life.
Time: One year
References
Chronic Kidney Disease. (2019, June 07). Retrieved September 30, 2020, from https://www.worldkidneyday.org/facts/chronic-kidney-disease/
Jayaseelan, G., Bennett, P. N., Bradshaw, W., Wang, W., & Rawson, H. (2018). CNE. Exercise Benefits and Barriers: The Perceptions of People Receiving Hemodialysis. Nephrology Nursing Journal, 45(2), 185–219.
Johnson, S. R. (2014, October 11). Home dialysis grows despite cost and logistical hurdles. Retrieved September 30, 2020, from https://www.modernhealthcare.com/article/20141011/MAGAZINE/310119932/home-dialysis-grows-despite-cost-and-logistical-hurdles#:~:text=One%20year%20of%20hemodialysis%20can,the%20U.S.%20Renal%20Data%20System.
Libardi da Silva, K. A., dos Santos Cargnin, M. C., Ventura, J., Ferraz de Paula, S., & Vanusa Groos, J. (2017). Quality of Life of Patients with Renal Failure in Hemodialytic Treatment. Journal of Nursing UFPE / Revista de Enfermagem UFPE, 11, 4663–4670. https://doi.org/10.5205/reuol.11138-99362-1-SM.1111sup201716
Morris, A., Love, H., van Aar, Z., Liles, C., & Roskell, C. (2015). The Problematic World of Following a Renal Diet outside the Home. Journal of Renal Care, 41(4), 253–259. https://doi.org/10.1111/jorc.12134
Queeley, G. L., & Campbell, E. S. (2018). Comparing Treatment Modalities for End-Stage Renal Disease: A Meta-Analysis. American Health & Drug Benefits, 11(3), 118–125.
Ravindran, A., Sunny, A., Kunnath, R. P., & Divakaran, B. (2020). Assessment of Quality of Life among End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis. Indian Journal of Palliative Care, 26(1), 47–53. https://doi.org/10.4103/IJPC.IJPC_141_19
Rebollo Rubio, A., Morales Asencio, J. M., & Eugenia Pons Raventos, M. (2017). Depression, anxiety and health-related quality of life amongst patients who are starting dialysis treatment. Journal of Renal Care, 43(2), 73–82. https://doi.org/10.1111/jorc.12195
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