Comparison of the Quality of Life in Peritoneal Dialysis and Hemodialysis Patients

Chronic kidney disease (CKD) has a profound impact on patients' health-related quality of life (QoL). Particular problems are caused by the end-stage disease, which leads to the need for renal replacement therapy (RRT). Physicians and patients face the challenge of choosing a type of RRT. In this case, it is necessary to take into account not only survival rates but also the quality of life of patients who undergo the therapy, because the ability to function and maintain well-being is one of the treatment goals recommended by the World Health Organization. Therefore, assessing QoL and identifying factors influencing it becomes increasingly important in terms of therapy effectiveness and measures aimed at improving outcomes.

The purpose of this work was to review recent scientific studies assessing the quality of life among peritoneal dialysis (PD) and hemodialysis (HD) patients, as well as identifying the better RRT type and risk factors that affect the quality of life. In order to identify the most relevant RRT type, the general questionnaires SF-36 and EQ-5D were used. A search for scientific studies was carried out in the international PubMed/MEDLINE database in April 2024 using the keywords: chronic kidney disease, quality of life, SF-36, EQ-5D, hemodialysis, and peritoneal dialysis. We selected papers published from 2018 to 2024 where the quality of life of patients with CKD re[1]ceiving such RRT types as hemodialysis and peritoneal dialysis was studied.

The results showed that PD is more preferable than HD. To achieve a high quality of life, it is also necessary to carefully treat disorders of calcium and phosphate metabolism and anemia, adequately manage concomitant diseases, assist patients with medical care provided at home, organize educational programs to increase patients’ self-efficacy and self-management, and provide psychological assistance if necessary

1. Raoofi S, Pashazadeh Kan F, Rafiei S, et al. Hemodialysis and peritoneal dialysis-health-related quality of life: systematic review plus meta-analysis. BMJ Support Palliat Care. 2023;13(4):365-373. doi:10.1136/bmjspcare-2021-003182

2. Thurlow JS, Joshi M, Yan G, et al. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol. 2021;52(2):98-107. doi:10.1159/000514550

3. Lv JC, Zhang LX. Prevalence and Disease Burden of Chronic Kidney Disease. Adv Exp Med Biol. 2019;1165:3-15. doi:10.1007/978-981-13-8871-2_1

4. Chuasuwan A, Pooripussarakul S, Thakkinstian A, Ingsathit A, Pattanaprateep O. Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis: a systematic review and metaanalysis. Health Qual Life Outcomes. 2020;18(1):191. Published 2020 Jun 18. doi:10.1186/s12955-020-01449-2

5. Schouten RW, Nadort E, Harmse V, et al. Symptom dimensions of anxiety and their association with mortality, hospitalization and quality of life in dialysis patients. J Psychosom Res. 2020;133:109995. doi:10.1016/j.jpsychores.2020.109995

6. Ibrahimou B, Albatineh AN. Predictors of Quality of Life among Peritoneal Dialysis Patients with EndStage Renal Disease in Kuwait. Perit Dial Int. 2019;39(2):180-182. doi:10.3747/pdi.2018.00140

7. Kularatna S, Senanayake S, Gunawardena N, Graves N. Comparison of the EQ-5D 3L and the SF-6D (SF-36) contemporaneous utility scores in patients with chronic kidney disease in Sri Lanka: a cross-sectional survey. BMJ Open. 2019;9(2):e024854. Published 2019 Feb 15. doi:10.1136/bmjopen-2018-024854

8. Bastos MAP, Reis IA, Cherchiglia ML. Health-related quality of life associated with risk of death in Brazilian dialysis patients: an eight-year cohort. Qual Life Res. 2021;30(6):1595-1604. doi:10.1007/s11136-020-02734-9

9. Peipert JD, Bentler PM, Klicko K, Hays RD. Psychometric Properties of the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36) in the United States. Am J Kidney Dis. 2018;71(4):461-468. doi:10.1053/j.ajkd.2017.07.020

10. Hall RK, Luciano A, Pieper C, Colón-Emeric CS. Association of Kidney Disease Quality of Life (KDQOL-36) with mortality and hospitalization in older adults receiving hemodialysis. BMC Nephrol. 2018;19(1):11. Published 2018 Jan 15. doi:10.1186/s12882-017-0801-5

11. Liem YS, Bosch JL, Hunink MG. Preference-based quality of life of patients on renal replacement therapy: a systematic review and meta-analysis. Value Health. 2008;11(4):733-741. doi:10.1111/j.1524-4733.2007.00308.x

12. Hiragi S, Goto R, Tanaka Y, et al. Estimating the Net Utility Gains Among Donors and Recipients of Adult Living Donor Kidney Transplant. Transplant Proc. 2019;51(3):676-683. doi:10.1016/j.transproceed.2019.01.049

13. Hakamäki M, Järvisalo MJ, Lankinen R, et al. Evolution of Quality of Life in Chronic Kidney Disease Stage 4-5 Patients Transitioning to Dialysis and Transplantation. Nephron. 2022;146(5):439-448. doi:10.1159/000521771

14. Zhang L, Guo Y, Ming H. Effects of hemodialysis, peritoneal dialysis, and renal transplantation on the quality of life of patients with end-stage renal disease. Rev Assoc Med Bras (1992). 2020;66(9):1229-1234. doi:10.1590/1806-9282.66.9.1229

15. Boateng EA, East L. The impact of dialysis modality on quality of life: a systematic review. J Ren Care. 2011;37(4):190-200. doi:10.1111/j.1755-6686.2011.00244.x

16. Surendra NK, Abdul Manaf MR, Hooi LS, et al. Health related quality of life of dialysis patients in Malaysia: Haemodialysis versus continuous ambulatory peritoneal dialysis. BMC Nephrol. 2019;20(1):151. Published 2019 Apr 30. doi:10.1186/s12882-019-1326-x

17. Tran PQ, Nguyen NTY, Nguyen B, Bui QTH. Quality of life assessment in patients on chronic dialysis: Comparison between haemodialysis and peritoneal dialysis at a national hospital in Vietnam. Trop Med Int Health. 2022;27(2):199-206. doi:10.1111/tmi.13709

18. Rini IS, Rahmayani T, Sari EK, Lestari R. Differences in the quality of life of chronic kidney disease patients undergoing hemodialysis and continuous ambulatory peritoneal dialysis. J Public Health Res. 2021;10(2):2209. Published 2021 Apr 14. doi:10.4081/jphr.2021.2209

19. Hiramatsu T, Okumura S, Asano Y, Mabuchi M, Iguchi D, Furuta S. Quality of Life and Emotional Distress in Peritoneal Dialysis and Hemodialysis Patients. Ther Apher Dial. 2020;24(4):366-372. doi:10.1111/1744-9987.13450

20. Sitjar-Suñer M, Suñer-Soler R, Bertran-Noguer C, et al. Mortality and Quality of Life with Chronic Kidney Disease: A Five-Year Cohort Study with a Sample Initially Receiving Peritoneal Dialysis. Healthcare (Basel). 2022;10(11):2144. Published 2022 Oct 28. doi:10.3390/healthcare10112144

21. Tanaka M, Ishibashi Y, Hamasaki Y, et al. Health-related quality of life on combination therapy with peritoneal dialysis and hemodialysis in comparison with hemodialysis and peritoneal dialysis: A cross-sectional study. Perit Dial Int. 2020;40(5):462-469. doi:10.1177/0896860819894066

22. Küçük O, Kaynar K, Arslan FC, et al. Comparison of mental health, quality of sleep and life among patients with different stages of chronic kidney disease and undergoing different renal replacement therapies. Hippokratia. 2020;24(2):51-58

23. Yang YF, Li TC, Li CI, et al. Visit-to-Visit Glucose Variability Predicts the Development of End-Stage Renal Disease in Type 2 Diabetes: 10-Year Follow-Up of Taiwan Diabetes Study. Medicine (Baltimore). 2015;94(44):e1804. doi:10.1097/MD.0000000000001804

24. Imai R, Higuchi T, Morimoto M, Koyamada R, Okada S. Iron Deficiency Anemia Due to the Long-term Use of a Proton Pump Inhibitor. Intern Med. 2018;57(6):899-901. doi:10.2169/internalmedicine.9554-17

25. Wasserfallen JB, Halabi G, Saudan P, et al. Quality of life on chronic dialysis: comparison between haemodialysis and peritoneal dialysis. Nephrol Dial Transplant. 2004;19(6):1594-1599. doi:10.1093/ndt/gfh175

26. Wong B, Ravani P, Oliver MJ, et al. Comparison of Patient Survival Between Hemodialysis and Peritoneal Dialysis Among Patients Eligible for Both Modalities. Am J Kidney Dis. 2018;71(3):344-351. doi:10.1053/j.ajkd.2017.08.028

27. Neumann D, Mau W, Wienke A, Girndt M. Peritoneal dialysis is associated with better cognitive function than hemodialysis over a one-year course. Kidney Int. 2018;93(2):430-438. doi:10.1016/j.kint.2017.07.022

28. Griva K, Stygall J, Hankins M, Davenport A, Harrison M, Newman SP. Cognitive impairment and 7-year mortality in dialysis patients. Am J Kidney Dis. 2010;56(4):693-703. doi:10.1053/j.ajkd.2010.07.003

29. Palmer S, Vecchio M, Craig JC, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int. 2013;84(1):179-191. doi:10.1038/ki.2013.77

30. Brito DCS, Machado EL, Reis IA, Carmo LPFD, Cherchiglia ML. Depression and anxiety among patients undergoing dialysis and kidney transplantation: a cross-sectional study. Sao Paulo Med J. 2019;137(2):137-147. Published 2019 Jul 15. doi:10.1590/1516-3180.2018.0272280119

31. Polikandrioti M, Koutelekos I, Gerogianni G, et al. Factors Associated with Hemodialysis Machine Dependency. Med Arch. 2017;71(2):122-127. doi:10.5455/medarh.2017.71.122-127

32. Pretto CR, Winkelmann ER, Hildebrandt LM, Barbosa DA, Colet CF, Stumm EMF. Quality of life of chronic kidney patients on hemodialysis and related factors. Rev Lat Am Enfermagem. 2020;28:e3327. doi:10.1590/1518-8345.3641.3327

33. Ramezani T, Sharifirad G, Rajati F, Rajati M, Mohebi S. Effect of educational intervention on promoting self-care in hemodialysis patients: Applying the self-efficacy theory. J Educ Health Promot. 2019;8:65. Published 2019 Mar 14. doi:10.4103/jehp.jehp_148_18