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Purpose: To review and compare published literature on quality of life measured by the MOS 36-item short form health survey (SF-36) in hemodialysis and peritoneal-dialysis patients and renal-transplant recipients.
Methods: An English literature search was performed using Medline and PsycINFO. Studies were included if they reported SF-36-dimension scores of hemodialysis, peritoneal-dialysis and/or transplant recipients and included at least ten patients per treatment group. Demographic, clinical and quality-of-life data were extracted. We calculated means and 95%-confidence intervals for age, gender, and SF-36 scores using random-effects models for the three patient groups separately and we tested for statistically significant differences between the groups.
Results: 36 studies, reporting on the quality of life in 30,405 patients on renal replacement therapy measured with the SF-36, were included in the analysis. Mean age was 59.3 years for hemodialysis, 53.3 years for peritoneal-dialysis and 43.7 years for transplant recipients. The majority of patients were male: 57% of hemodialysis, 55% of peritoneal-dialysis and 60% of transplant recipients. Comparing the eight SF-36 dimensions, all patient groups reported lowest scores on the Role-Physical dimension (mean scores: 34.9 among hemodialysis, 33.0 among peritoneal-dialysis and 52.1 among transplant recipients). Highest scores were reported on the Mental-Health dimension for hemodialysis (mean score 67.3) and peritoneal-dialysis (mean score 69.3) patients and on the Physical-Functioning dimension for transplant recipients (mean score 66.0). In general, SF-36-dimension scores were significantly lower for hemodialysis and peritoneal-dialysis compared to transplanted patients, except for the Role-Emotional dimension (peritoneal-dialysis scores not significantly different from scores of transplant recipients) and the Mental-Health dimension (hemodialysis and peritoneal-dialysis scores significantly higher than scores of transplant recipients). Scores of hemodialysis compared to peritoneal-dialysis patients were significantly lower for the Physical-Functioning, Bodily-Pain and Mental-Health dimensions. For the other scales no statistically significant differences were found.
Conclusion: Based on this meta-analysis we conclude that hemodialysis and peritoneal-dialysis patients tend to have a lower quality of life than transplant recipients. Quality of life seems equal or slightly worse for hemodialysis compared to peritoneal-dialysis. Age, duration of therapy, co-morbidity, and other potential predictors of quality of life in patients on renal replacement therapies need to be explored in future studies.
See more of Poster Session - Clinical Strategies; Judgment and Decison Making
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)