Health related quality of life of patients undergoing in- centre maintenance hemodialysis in Rwanda: a cross sectional study

Abstract

Background: The limited access to renal replacement therapy increases the burden of end stage kidney disease (ESKD) in resource limited setting. For the majority of patients reaching hemodialysis, there are environmental and individual factors which affect their health related quality of life (HRQOL). Improving the quality of life should be the primary outcome of end stage kidney disease patients on hemodialysis in Rwanda.

Objectives: To describe the health related quality of life of patients undergoing in-centre maintenance hemodialysis in Rwanda using the KDQOL™-36 and determine sociodemographic and clinical characteristics associated with their quality of life.

Methods: The study was a multicenter prospective cross-sectional study of 89 patients on maintenance hemodialysis at the hospitals—CHUK, CHUB, RMH and KFH—where in- centre hemodialysis is provided. Demographic and clinical information were collected between September 2020 and March 2021 for all patients aged >18 years receiving in-centre hemodialysis for at least three months and health related quality of life scores was measured using the KDQOL™-36 questionnaire which assesses physical (PCS) and mental (MCS) health functioning, the effect, burden and symptoms and problem of kidney disease. Mixed effects linear regression models were fitted to explore factors associated with overall KDQOL and its domains, while accounting for clustering of patients within hemodialysis units.

Results: The overall mean (SD) quality of life score was 48.92 (18.84), PCS score 37.33 (10.66) and MCS 44.74 (9.98). Symptoms and problem of kidney disease, effect of kidney disease, and burden of kidney disease scored 58.22 (27.44), 53.48 (17.14) and 20.01 (18.27) respectively. The majority of participants were younger than 60 years old (69.7%), male (66.3%), married or living with a partner (53.9%) and unemployed (56.2%). Approximately 70% had secondary school education or greater and 67.4% were fully covered by medical insurances bearing no out of pocket payments for dialysis. Factors associated with overall quality of life include male sex (a ß: 8.54, 95% CI: 2.77, 14.26); being employed (a ß: 8.16, 95% CI: 2.18, 14.29); dialysis vintage of 13-24 months (a ß: 10.47, 95% CI: 3.57, 17.58), hemoglobin of 10-11g/dl (a ß: 7.27, 95% CI (0.70, 13.72)) and comorbidities (e.g., 4 comorbidities vs none; a ß: -29.76, 95% CI: -41.47, -18.32).

Conclusion: Patients on in-centre hemodialysis in Rwanda have reduced HRQOL scores with the burden of kidney disease and physical composite domains being most affected. Higher overall KDQOL mean score was associated with male sex, being employed, dialysis vintage of 13-24 months, hemoglobin of 10-11g/dl and absence of comorbidities.

Key words: Health related quality of life, end stage kidney disease, in-centre hemodialysis, kidney disease quality of life