Decrease in Quality of Life and Functional Assessment in Elder Patients with End-Stage Renal Disease after Two Years of Hemodialysis Therapy

Introduction: Hemodialysis improves survival rates of Chronic Kidney Disease (CKD) patients but not Quality of Life (QoL) which decreases in a more aggressive way in the elderly population. We describe the reduction and impact in QoL and functional assessment at 6 months, 1 and 2-years of treatment in hemodialysis. Methods: We performed a single center prospective study, applying the Kidney Disease Quality of Life (KDOQOL-36 TM) in Spanish, Katz Index, Barthel Index, Lawton and Brody Scale and Karnofsky Performance Status to patients with CKD KDIGO 5D, aged 65 years or older at our hemodialysis center on October 2016. During the study, patients received hemodialytic and pharmacological treatment. We applied the surveys again on May 2017, October 2017 and October 2018 to the same population. Results were presented using mean and standard deviation and were analyzed using a Student's t-test. Results: At the beginning of the study 22 elder patients in hemodialysis were included, 59% of them were men with an average age of 72.9 (±5.9) years, and an average time in hemodialysis of 27.1 (±24.1) months. After a two-year follow up 36% of the patients died, 9% changed their residency and 55% remained active at our center. We compared the media of each subscale after six months, one and two years with Student's t-test, finding a significant decrease only at the 2-years evaluation in Effects and Burden of kidney disease subscales compared with the previous ones (p<0.01), but no difference on the rest of subscales. Conclusion: We observed a decrease in all subscales of KDOQOL-36TM and functional assessment evaluation with statistical difference in the Effects and Burden of kidney disease subscales at the second year. The decrease was not as pronounced as expected, possibly because the patients who died probably had the lowest scores at the beginning of the study.