The Course of Quality of Life in Patients on Peritoneal Dialysis: A 12-month Prospective Observational Cohort Study.

BACKGROUND: Quality of life (QOL) impairments are common in patients undergoing dialysis, and have been strongly associated with significant clinical outcomes like mortality and morbidity. Despite this, little is known about the course of QOL over time, especially for patients on peritoneal dialysis (PD). PURPOSE: This prospective study was set to explore course and determinants of QOL over 12 months in PD patients. METHODS: A total of 115 PD patients completed the SF-12 and Kidney Disease Quality of Life Short Form (KDQOL-SF) at baseline and 12 months later. Intra-individual changes in physical (physical component summary, PCS), mental (mental component summary, MCS), and Kidney Disease Component Summary scores (KDCS) were identified based on the minimally important clinical difference threshold. Clinical information was extracted from medical records. RESULTS: Of the patients, 74-80 % reported physical QOL impairments, as compared to 29-33 % who reported mental/emotional QOL impairments. PCS and MCS scores remained stable across 12 months. Significant deterioration was noted in the domains of patient satisfaction, staff encouragement, and social support, while there were significant increases in the perceived effects of kidney disease. Intra-individual trajectory analyses indicated that one in three patients reported deteriorating QOL. No sociodemographic or clinical variables were found to be associated with course of outcomes. CONCLUSIONS: Although PD offers the convenience of home-based care, it is associated with persisting QOL impairments and diminishing QOL over time, especially in domains related to quality of care and support. This highlights the need for improving or maintaining standards of care and support for PD patients as they become increasingly established on their regimes.

Age is not a contraindication to home-based dialysis - Quality-of-Life outcomes favour older patients on peritoneal dialysis regimes relative to younger patients.

AIM: To compare Quality of Life, anxiety and depression between older (≥65 years) and younger (<65 years) patients across automated peritoneal dialysis and continuous ambulatory peritoneal dialysis. BACKGROUND: There is a lack of studies as to whether the different peritoneal dialysis modalities confer similar outcomes in older and younger patients. DESIGN: Cross-sectional. METHODS: A total of 201 patients completed the Kidney Disease Quality of Life Short-Form, World Health Organization Quality of Life Instrument, Short Form and Hospital Anxiety and Depression Scale. Comorbidity and biochemical values were abstracted from medical records. RESULTS: Older patients reported significantly better quality of life than younger patients in the Kidney Disease Quality of Life Short-Form effects of kidney disease and patient satisfaction and the World Health Organization Quality of Life Instrument overall Quality-of-Life/health despite worse clinical profile. Quality of life outcomes were comparable between automated peritoneal dialysis and continuous ambulatory peritoneal dialysis with the exception of the Kidney Disease Quality of Life Short-Form symptoms in favour of automated peritoneal dialysis. Levels of anxiety and depression were equivalent for older and younger patients across peritoneal dialysis modalities. The observed quality-of-life advantages for older patients persisted after case-mix adjustments and extended to more quality-of-life domains and depression and anxiety. CONCLUSION: Our findings of superior quality of life in patients aged ≥ 65 support the expansion of peritoneal dialysis use in older patients. Patients across different age groups should be given non-biased information about both peritoneal dialysis modalities and individual preferences should be elicited and carefully considered by healthcare providers.

Room temperature synthesis of flower-like hollow covalent organic framework for efficient enrichment of microcystins.

The morphology of nanomaterials is one of essential factors for their unique properties. Herein, a hollow covalent organic framework with a flower-like structure (HFH-COF) was synthesized at room temperature. The synthesized HFH-COF has a very large specific surface area, mesoporous structure, excellent chemical stability, and good crystallinity. The special morphology endowed HFH-COF with high specific surface area utilization and rapid mass transfer rate, resulting in faster equilibration time and better extraction performance than spherical COF (S-COF). Subsequently, combined with high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), an efficient and sensitive method was established for microcystins (MCs) detection. The developed method has low detection limits (0.6-0.8 pg mL-1), wide linear ranges (1.5-1000.0 pg mL-1, R ≥ 0.9993), and acceptable reproducibility (RSD ≤ 7.6%, n = 6). Real biological samples were analyzed by the developed method, and trace levels of MC-YR, MC-RR and MC-LR were detected. The results indicate that the synthesized HFH-COF is an ideal sorbent for efficient extraction of MCs from complex biological samples.

Evaluating Burden and Quality of Life among Caregivers of Patients Receiving Peritoneal Dialysis.

Peritoneal dialysis (PD) is advocated as treatment of choice for most end-stage renal disease (ESRD) patients, including elderly and frail patients. It typically requires caregiver involvement to support care at home. The purpose of this study was to examine changes in burden and quality of life (QOL) in caregivers of prevalent PD patients over 12 months. Data were collected in 44 caregivers of PD patients (mean age 38.4 ± 6.3 years; 60% female) in Singapore at baseline and 12 months. Measures included demographics, the Lay Care-Giving for Adults Receiving Dialysis (LC-GAD), Zarit Burden Interview (ZBI), and the World Health Organization Quality of Life instrument (WHOQOL-BREF). Paired t-tests indicate a significant decrease in task-related aspects of caregiving (p = 0.04), particularly in relation to personal hygiene (p < 0.01), over time. Cognitive aspects of caregiving remained unchanged. Perceived burden, however, significantly increased (p < 0.01), with significantly more caregivers reporting moderate to severe caregiver burden at follow-up (28%) relative to baseline (13%; p < 0.01). There was a significant reduction in psychological health (under WHOQOL) (p = 0.01). Study findings indicate an increase in caregiver burden and a reduction in psychological health despite a reduction in task-related aspects of caregiving, supporting a further exploration of the "wear-and-tear" hypothesis among this population. Intervention strategies are needed.

Non-adherence in patients on peritoneal dialysis: a systematic review.

BACKGROUND: It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). METHODS: A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. RESULTS: The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6-53% for dialysis exchanges, 3.9-85% for medication, and 14.4-67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. CONCLUSION: Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population.