The Influence of Different Kidney Replacement Modalities on Health-Related Quality of Life in ESKD Patients.

Background: Health-related quality of life (HRQOL) has gained increasing emphasis on the long-term outcome of patients taking sustained kidney replacement therapy (KRT). However, the influence of KRT modalities on patients' quality of life and their comparison needs further investigation.

Methods: This study included 267 patients: 101 under hemodialysis (HD), 87 under peritoneal dialysis (PD) and 79 received kidney transplantation (KT). HRQOL of patients were evaluated by KDQOL-36 and EQ-5D-3L scales. Inverse probability of treatment weighting (IPTW) was used to balance patients' demographic characteristics.

Results: KT improved physical activity of patients and reduce effect of kidney disease, as shown by the higher physical composite score (KT: 43.927±8.370 vs HD: 38.101±8.567 vs PD: 37.446±8.626, P<0.001) and effects of kidney disease (KT: 71.917±24.469 vs HD: 57.654±16.722 vs PD: 53.169±17.960, P<0.001), but did not improve mental composite score (MCS), burden of kidney disease (BKD) and symptoms/problems of kidney disease (SPKD). No differences were found between HD and PD. Patients under different KRT modalities had different symptom distribution, but had close overall score in symptom evaluation. SPKD had the strongest association with MCS among all dimensions (r=0.398, 95%CI: 0.274 to 0.509), explaining 15.8% variation in MCS.

Conclusions: KT recipients had significantly improved overall and physical aspect quality of life, meanwhile they still suffered similar mental problems and multiple discomforts like fatigue and skin problems, just as HD and PD patients. HD and PD patients' quality of life was similar. The impact of comorbidities and the underlying disease leading to end-stage kidney diseases on patients' quality of life should not be neglected.