Quality of life in advanced renal disease managed either by haemodialysis or conservative care in older patients

Clare McKeaveney, Miles Witham, Abrar Omran M. Alamrani, Peter Maxwell, Robert Mullan, Helen Noble, Joanne Shields, Joanne Reid

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Objective: Consideration of quality of life (QoL) in people with end-stage renal disease (ESRD) has become an important part of treatment decision-making. The aim of this study was to report on QoL and other functional outcomes in patients with advanced chronic kidney disease (CKD). Method: This was a cross-sectional study. Two samples of older patients (>60 years old) either conservatively managed (CM) or receiving hospital-based haemodialysis (HD), compared kidney disease quality of life (KDQoL-36) outcomes. Results: Data from 263 CM patients (CKD 4 n=188, 73.6 years, 48 females; CKD 5 n=75, mean age 74.4 years, 26 female) and 74 patients on HD (mean age 73.8 years, 24 female) were analysed. Significant group differences were identified for two subscales of KDQoL-36. Symptoms/Problems List subscale was significantly better for those receiving HD compared to those CM with CKD 5 (p=<.001). Symptom/Problem List scores of CM CKD 4 patients were not significantly different compared to HD patients but were significantly better than CM CKD 5 patients (p<.001). Burden of Kidney Disease subscale was significantly better for both CKD 4 (p<.001) and CKD 5 (p<.001) CM patients when compared to those receiving HD. Conclusion: Symptoms of advanced CKD significantly impact QoL for patients CM with CKD stage 5. Conversely, QoL is significantly impacted for those in receipt of haemodialysis due to the burden of treatment. These findings provide evidence for the use of QoL tools to help with clinical prognostication in advanced CKD. Utilising QoL tools will ensure specialist support is available for appropriate management of patients with CKD.
Original languageEnglish
JournalBMJ Supportive and Palliative Care
Early online date11 Sep 2020
Publication statusEarly online date - 11 Sep 2020


  • End-Stage Renal Disease
  • Haemodialysis
  • conservative care
  • Quality of life


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