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Dialysis patients' quality-of-life concerns deserve greater attention from providers

Patients with end-stage renal disease (ESRD), that is, chronic kidney failure, apparently have concerns about the impact of dialysis treatment on the quality of their lives that are not fully appreciated by health care providers, concludes a study supported by the Agency for Health Care Policy and Research (HS08365). These patients usually receive hemodialysis (HD) for 3 to 4 hours three times a week at a dialysis center or peritoneal dialysis (PD) four times per day.

Dialysis functions like a kidney to remove waste products from the body and regulate chemical and water balance. In HD a machine filters impurities out of the blood from an arm or leg artery. The filtered blood is then returned to the body via an adjacent vein. PD involves inserting a catheter in the patient's abdomen to run dialysis fluid into the abdomen. The fluid is then drawn out along with excess water and waste products.

CHOICE (Choices for Healthy Outcomes in Caring for ESRD) researchers at the Johns Hopkins University, New England Medical Center, Tufts University, and the Independent Dialysis Foundation, in Baltimore, MD, conducted focus groups with adult patients receiving either HD or PD at four Baltimore dialysis centers. They conducted separate focus groups with nephrologists, nurses, dietitians, social workers, and/or medical technicians from the centers. The researchers audiotaped the focus groups, which concentrated on the impact of dialysis on patients' quality of life, and analyzed and compared group comments.

According to dialysis patients, ESRD and dialysis affected ten different areas of quality of life, yet health care professionals tended to focus on only five of these areas. Providers generally had a good understanding of patients' concerns about the effects of ESRD and dialysis, such as the loss of freedom and control patients feel. However, they made no comments about the effects of ESRD and dialysis on mental attitude and very few comments about their effects on anxiety levels, body image, sleep, and cognitive function. In contrast, some patients mentioned they became depressed, were anxious about getting an infection (from PD), had problems with body image, were weak and tired, didn't always sleep well or needed cat naps, and felt they forgot things or didn't think clearly. These findings may suggest ways to improve care delivered to dialysis patients, conclude the authors.

See "Use of focus groups to identify concerns about dialysis," by Eric B. Bass, M.D., M.P.H., Mollie W. Jenckes, M.H.Sc., Nancy E. Fink, M.P.H., and others, in the July 1999 Medical Decision Making 19, pp. 287-295.

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