Living with End-Stage Renal Disease: Perceived Impact of Treatment in a Mexican Hemodialysis Clinic

Purpose: End-stage renal disease (ESRD) has great impact in patients’ health-related quality of life (HR-QOL), which is globally considered as a reliable measure of health outcome. In Mexico, the prevalence of type 2 diabetes, the leading cause of ESRD, is 14.4%; it is predicted that 18% of the adult population in Mexico will have type 2 diabetes by 2025. In 2006, Mexico reported the prevalence and incidence rates of ESRD of 510.4 and 345.9 per million population, respectively. The lack of a formal national registry system in Mexico, however, could result in underestimation of these rates.

Methods: Sixty-nine Mexican patients attending a hemodialysis clinic in Central Mexico where interviewed about their HR-QOL and disease impact in their daily lives based on the MEI adaptation of ENH's Spanish KDQOL 1.3 version (Benjamin Arnold). The KDQOL-SF assesses the functioning and well-being of people with kidney disease and on dialysis. It consists of 80 items divided into 19 dimensions: SF-36 (8 dimensions/36 items; 1 health transition item), kidney-disease-targeted items (11 dimensions/43 items). Scores presented are the Physical Component Summary (PCS), the Mental Component Summary (MCS), the health transition item and the 11 kidney-disease-targeted. The scores range from 0 to 100, with higher scores reflecting better HR-QOL. Data were analyzed using SPSS software (V21).

Results: Demographic data showed participants to be 43 ±19 years old, female (64%), married (49%), 5.±3 years of education, without monthly salary (40%), with health insurance (91%). Predominant comorbidity was diabetes (27%) and they attend to the clinic mostly mornings (45%) and evenings (43%), two-three (36%-62%) times a week, from three to four hours connected to the hemodialysis machine (96%) ; vascular access were a catheter (55%) and arterio-venous fistula (45%) installed less than a year (43%) or two (36%) ago. Forty-six percent of them reported at least one hospitalization during the last year from 1-3 days (43%); 71% referred to take hypertensive medications.

Low scores showed impairment in both physical and mental dimensions (PCS=439.9±10, MCS=40.3±8), as well as when questioned about health status compared with last year (26±33). Work status (36±37), burden of kidney disease (39±34), quality of social interaction (49±15) and effects of kidney disease on daily life (59±20) were found to be the most affected dimensions of HR-QOL for this population. Interestedly, dialysis staff encouragement (88±22) and social support (85±24) were the best scored dimensions in contrast with the health status reported in PCS and MCS scores. Factors related to this phenomena in PCS were years of education (p<0.01), marital status (p<0.05), comorbidity (p<0.01) and age (p<0.001). Factors related with MCS scores were marital status (p<0.01), hospitalization (p<0.01), antihypertensive medication (p<0.05). The health transition item was related with factors as insurance (p<0.05), comorbidity (p<0.01) and hospitalization (p<0.05). 

Conclusion: In this population, there is a high impact of disease and treatment on HR-QOL of persons with ESRD treated with hemodialysis. It is imperative to structure evidence-based and holistic-oriented health care strategies based in order to address best health outcomes.