Quality of life and physical function in older patients on dialysis: a comparison of assisted peritoneal dialysis with hemodialysis

Picot question

I and my preceptor was working on my PICO question for the last few weeks. I was researching and interviewing patients about the choices of home peritoneal or hemodialysis. My Preceptor was helping me in researching and leadership skills by giving the patients information and evidence-based practice about HD/PD. It is huge for most of Patients with chronic renal failure who are always faced with questions on dialysis methods to choose from. Peritoneal dialysis and hemodialysis differ technically and their appeal to patients is also different. Without considering other factors patient preference for a certain modality should be considered. Although the major focus of the healthcare team is on patient’s survival rather than the quality of life, patients care about how they will live, for example, time flexibility and ability to travel and work, and not how long they will live (Zazzeroni, 2017).

Peritoneal dialysis treatment uses peritoneum and dialysate to clean the blood. Waste and fluid from the blood are absorbed by dialysate using peritoneum as the filter. Dextrose sugar in the dialysate pulls waste and excess fluid from the blood into the dialysate. Peritoneum function as the filter membrane an advantage of this treatment is that it is more flexible allowing freedom to work, travel and perform other activities. It can be performed at home or in any dry and clean place (Iyasere et al., 2016).

Hemodialysis uses a dialyzer to remove waste and excess fluid from the blood outside the patient’s body. To access the blood a minor surgery (arteriovenous fistula) is done. The dialyzer has two parts blood and dialysate separated by a thin membrane. Waste and excess fluid are filtered from the blood and washed away. Hemodialysis is done in hospitals or medical centers. It can be done 3-4 times a week (Iyasere et al., 2016).

According to studies patients under peritoneal dialysis treatment have indicated a higher quality of life compared to those receiving hemodialysis at the same time. According to study patients on hemodialysis have complained more about fluctuations in blood pressure and dry skin than peritoneal dialysis patients. Quality of sleep and problems in sexual activities has been reported to be worse in patients under hemodialysis. Peritoneal dialysis treatment has shown better life quality outcome although over time patients undergoing either peritoneal or hemodialysis experience worsening quality of life in different areas. Thus no dialysis modality can be said to have definite advantages in quality of life over a period of time (Dabrowska-Bender et al., 2018).

References

Dąbrowska-Bender, M., Dykowska, G., Żuk, W., Milewska, M., & Staniszewska, A. (2018). The impact on quality of life of dialysis patients with renal insufficiency. Patient preference and adherence, 12, 577.

Iyasere, O. U., Brown, E. A., Johansson, L., Huson, L., Smee, J., Maxwell, A. P., … & Davenport, A. (2016). Quality of life and physical function in older patients on dialysis: a comparison of assisted peritoneal dialysis with hemodialysis. Clinical Journal of the American Society of Nephrology, 11(3), 423-430.

Zazzeroni, L., Pasquinelli, G., Nanni, E., Cremonini, V., & Rubbi, I. (2017). Comparison of quality of life in patients undergoing hemodialysis and peritoneal dialysis: a systematic review and meta-analysis. Kidney and Blood Pressure Research, 42(4), 717-727.