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Our purpose in this study was to evaluate the health-related QOL in four groups of CKD patients &#40;CKD stages 1-4&#44; kidney recipients&#44; haemodialysis and peritoneal dialysis patients&#41;&#44; using validated and applicable instruments&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">POPULATION AND METHODS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Thirty of the 821 CKD patients stages 1-4 &#40;CKD 1-4&#41; and 30 of the 117 transplanted patients followed at our Nephrology Department were randomly selected&#46; Patients at our Haemodialysis Unit &#40;37&#47;43&#41; and Peritoneal Dialysis Unit &#40;14&#47;17&#41; with the capacity of answering to the questionnaires were also admitted in the study&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The instruments applied were the SF-36 &#40;<span class="elsevierStyleItalic">Medical Outcomes Study Short-Form 36&#41; </span>and KDQOL-SF 1&#46;3 &#40;<span class="elsevierStyleItalic">Kidney Disease and Quality of Life Short-Form</span>&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The SF-36 is a generic questionnaire translated in more than 40 languages and already validated in Portugal<span class="elsevierStyleSup">2-5</span>&#46; It consists of 36 items grouped in eight scales that evaluate different areas of health&#58; Physical Functioning&#44; Role Physical&#44; Bodily Pain&#44; General Health&#44; Vitality&#44; Social Functioning&#44; Role Emotional and Mental Health&#46; These scales are grouped in two summary measures&#58; Physical Health and Mental Health&#46; This instrument was applied in the CKD stages 1-4 and kidney transplanted patients &#40;KT&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">KDQOL-SF 1&#46;3 is a questionnaire that includes not only the SF-36 scales but also specific dimensions of chronic kidney disease&#46; This dimensions include 43 items that can be summarized in 12 scales&#58; Symptom&#47;problem list&#44; Effects of kidney disease&#44; Burden of kidney disease&#44; Work status&#44; Cognitive function&#44; Quality of social interaction&#44; Sexual function&#44; Sleep&#44; Social support&#44; Dialysis staff encouragement&#44; Overall health and Patient satisfaction&#46; It&#8217;s a reproducible questionnaire that was validated by the KDQOL Working Group studies<span class="elsevierStyleSup">6</span>&#46; It was applied in our study to haemodialysis &#40;HD&#41; and peritoneal dialysis &#40;PD&#41; patients&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The two cited instruments have punctuation from zero to 100&#44; directly related with the QOL&#46; In resume&#44; higher punctuations relate to better quality of life&#46; Our data was analyzed in a program produced by the KDQOL Working Group &#40;<a href="http&#58;&#47;&#47;www&#46;gim&#46;med&#46;ucla&#46;edu&#47;kdqol&#47;" class="elsevierStyleCrossRefs"><span class="elsevierStyleBold">www&#46;gim&#46;med&#46;ucla&#46;edu&#47;kdqol&#47;</span></a>&#41;&#46; The remaining statistical analysis was performed with the program <span class="elsevierStyleItalic">Statistical Package of Social Sciences </span>&#40;SPSS 18&#46;0&#41;&#46; The quantitative variables were expressed as mean &#177; standard deviation and qualitative variables as absolute &#160;numbers and percentages&#46; We studied the association between the groups in qualitative variables by chi-square test or the contingency coefficient&#44; as appropriate&#46; For the quantitative variables&#44; after checking normality with the Kolmogorov-Smirnov test&#44;&#160;the T-Student test or Mann-Whitney were used for two groups and the table ANOVA or Kruskal-Wallis for the four groups&#44; as appropriate&#46; Finally&#44; we performed a multivariate linear regression analysis in each of the groups for those variables significant in the univariate analysis or clinically relevant&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">The peritoneal dialysis patients were younger than the other patients &#40;38&#46;9 &#177; 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but the prevalence of diabetes was not different between the groups &#40;p &#61; 0&#46;175&#41;&#46; On the other hand&#44; the prevalence of heart failure was tendencially higher in the haemodialysis group &#40;HD&#58; 40&#46;5&#37;&#59; CKD&#58; 23&#46;3&#37;&#59; PD&#58; 14&#46;3&#37;&#59; KT&#58; 13&#46;3&#37;&#59; p &#61; 0&#46;050&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The dialysis dose was adequate in the two groups under dialytic treatment &#40;HD&#58; spKt&#47;V &#61; 2&#46;08 &#177; 0&#46;54&#59; PD&#58; weekly urea Kt&#47;V &#61; 2&#46;25 &#177; 0&#46;48 and weekly creatinine clearance &#61; 85 &#177; 30 L&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#47;week&#41;&#46; The creatinine clearance was 59&#46;3 &#177; 34&#46;6 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span> in CKD 1-4 and 74&#46;5 &#177; 42&#46;5 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span> in the transplanted patients &#40;p &#61; 0&#46;132&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">All patients presented a similar albuminemia level &#40;CKD&#58; 3&#46;71 &#177; 0&#46;40 g&#47;dl&#44; KT&#58; 3&#46;56 &#177; 0&#46;46 g&#47;dl&#44; HD&#58; 3&#46;36 &#177; 0&#46;44 g&#47;dl&#44; PD&#58; 3&#46;35 &#177; 0&#46;33&#59; p &#61; 0&#46;231&#41;&#46; The mean haemoglobin level of the CKD 1-4 &#40;13&#46;2 &#177; 1&#46;7 g&#47;dl&#41; and transplanted patients &#40;13&#46;1 &#177; 1&#46;9 g&#47;dl&#41; was higher than that of the haemodialysis &#40;11&#46;9 &#177; 1&#46;2 g&#47;dl&#41; and peritoneal dialysis patients &#40;11&#46;5 &#177; 1&#46;8 g&#47;dl&#44; p &#60;0&#46;001&#41;&#46; The majority of haemodialysis &#40;81&#46;1&#37;&#41; and peritoneal dialysis patients &#40;64&#46;3&#37;&#41; were treated with recombinant erythropoietin &#40;EPO&#41;&#46; In contrast&#44; only 23&#46;3&#37; of CKD patients and 16&#46;7&#37; of transplanted patients were under that treatment&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The best results of the SF-36 in the four groups were found in the &#171;Social Functioning&#187; scale of the Mental Health Component &#40;PD&#58; 77&#46;68 &#177; 18&#46;46&#59; KT&#58; 74&#46;17 &#177; 29&#46;53&#59; CKD&#58; 66&#46;81 &#177; 31&#46;39&#59; HD&#58; 62&#46;16 &#177; 32&#46;84&#59; p &#61; 0&#46;192&#41;&#160;&#40;Table 2&#41;&#46; The worst results were related to the &#171;General Health&#187; scale of the Physical Health Component &#40;CKD&#58; 39&#46;92 &#177; 19&#46;12&#59; HD&#58; 45&#46;95 &#177; 21&#46;56&#59; KT&#58; 47&#46;13 &#177; 23&#46;15&#59; PD&#58; 51&#46;79 &#177; 18&#46;89&#59; p &#61; 0&#46;321&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Peritoneal dialysis patients accomplished better results in the Physical Health Component &#40;PD&#58; 44&#46;90 &#177; 5&#46;55&#59; KT&#58; 41&#46;88 &#177; 10&#46;45&#59; CKD&#58; 38&#46;34 &#177; 10&#46;30&#59; HD&#58; 5&#46;89 &#177; 9&#46;04&#59; p &#61; 0&#46;016&#41;&#46; They achieved the best results of this component in the following scales&#58; &#171;Physical Functioning&#187; &#40;PD&#58; 68&#46;32 &#177; 20&#46;09&#59; KT&#58; 59&#46;67 &#177; 27&#46;85&#59; CKD&#58; 46&#46;39 &#177; 32&#46;73&#59; HD&#58; 31&#46;89 &#177; 23&#46;99&#59; p &#60;0&#46;001&#41; and &#171;Bodily Pain&#187; &#40;PD&#58; 75&#46;54 &#177; 19&#46;84&#59; KT&#58; 67&#46;58 &#177; 27&#46;69&#59; HD&#58; 57&#46;63 &#177; 28&#46;49&#59; CKD 50&#46;67 &#177; 28&#46;36&#59; p &#61; 0&#46;018&#41;&#46; All scales of the Mental Health Component had similar punctuations in the four groups of patients &#40;p &#61; NS&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The second item of the SF-36 questionnaire&#44; that compares health in general relatively to the previous year&#44; was evaluated separately taking in consideration that is not included in the final score&#46; This item is punctuated from one to five according to the patient&#8217;s answer&#58; 1&#44;&#160;much better&#59; 2&#44; a little better&#59; 3&#44; almost the same&#59; 4&#44; a little worse&#59; 5&#44; much worse&#46; The peritoneal dialysis patients were the only ones to indicate an improvement in their health relatively to the previous year &#40;CKD&#58; 3&#46;0 &#177; 1&#46;1&#59; KT&#58; 3&#46;0 &#177; 1&#46;1&#59; HD&#58; 2&#46;9 &#177; 1&#46;0&#59; PD&#58; 2&#46;1 &#177; 0&#46;8&#59; p &#60;0&#46;05&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In the kidney disease specific dimensions of the KDQOL-SF 1&#46;3 &#40;Table 3&#41;&#44; the peritoneal dialysis patients had better results comparing to haemodialysis patients in the following scales&#58; &#171;Effects of kidney disease&#187; &#40;73&#46;83 &#177; 17&#46;89 vs 59&#46;38 &#177; 18&#46;76&#59; p &#61; 0&#46;019&#41;&#44; &#171;Burden of kidney disease&#187; &#40;58&#46;65 &#177; 27&#46;31 vs 26&#46;35 &#177; 18&#46;58&#59; p &#60;0&#46;001&#41;&#44; &#171;Work status&#187; &#40;50&#46;00 &#177; 44&#46;72 vs 19&#46;85 &#177; 9&#46;46&#59; p &#61; 0&#46;001&#41;&#44; &#171;Overall Health&#187; &#40;76&#46;67 &#177; 19&#46;69 vs 46&#46;49 &#177; 22&#46;51&#59; p &#61; 0&#46;021&#41; and &#171;Patient satisfaction&#187; &#40;84&#46;72 &#177; 20&#46;67 vs 70&#46;02 &#177; 20&#46;43&#59; p &#60;0&#46;001&#41;&#46; In the remaining scales&#44; values were similar for both groups&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">After adjustment in multivariate linear regression analysis for variables like age&#44; gender&#44; heart failure&#44; time on dialysis&#44; haemoglobin level and creatinine clearance&#44; the scales that remained unchanged were &#171;Effects of kidney disease&#187;&#44; &#171;Burden of kidney disease&#187; and &#171;Patient satisfaction&#187; of the KDQOL-SF 1&#46;3&#46; Age&#44; gender and haemoglobin level were the variables associated with the remaining scales that presented different results between groups in univariate analysis &#40;&#171;Physical Health Component&#187;&#44; &#171;Physical functioning&#187;&#44; &#171;Bodily pain&#187;&#44; &#171;Work status&#187; and &#171;Overall health&#187;&#41; &#40;Table 4&#41;&#46; Age was inversely related to the punctuation and haemoglobin level presented a direct relation with higher scores&#46; Male patients of the CKD 1-4 group presented worst results than females in the &#171;Bodily pain&#187; scale &#40;p &#61; 0&#46;039&#41;&#46;&#160;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Finally&#44; we evaluated the association between the Mental Health Component and the treatment with antidepressants&#46; The patients under antidepressant treatment &#40;four patients with CKD stages 1-4&#44; three transplanted patients&#44; seven haemodialysis patients and one patient in peritoneal dialysis&#41; had worst results in the Mental Health Component when compared with the remaining patients&#44; not treated with antidepressants &#40;36&#46;62 &#177; 10&#46;96 vs 44&#46;17 &#177; 12&#46;03&#59; p &#60;0&#46;05&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">The two summary measures of the SF-36 allow a fast evaluation of the health-related QOL&#44; with scarce loss of information when the eight scales are resumed in the two main components&#44; Physical and Mental<span class="elsevierStyleSup">7&#44;8</span>&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Several studies have already compared the QOL of dialysis patients with the general population&#44; the majority disclosing the negative impact of chronic kidney disease and its treatments<span class="elsevierStyleSup">9-14</span>&#46; Those results are however&#44; not confirmed in other series<span class="elsevierStyleSup">15&#44;16</span>&#46; In our view&#44; the present study&#44; even with the limitation of being an observational cross-sectional study with a small number of patients&#44; has the particularity of evaluating the health-related QOL in four groups of patients with CKD in various phases and under different renal replacement treatments &#40;HD&#44; PD and kidney transplant&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The worst results were registered in the scale &#171;General Health&#187; of the Physical Health Component&#46; In other type of diseases&#44; a greater impact in Physical Health comparing to Mental Health was also found<span class="elsevierStyleSup">17</span>&#46; This situation can be explained by the psychological adaptation of the sick person to the chronic illness&#44; with a declining repercussion of the disease in its Mental Health&#46; In our study&#44; Physical Health was better in peritoneal dialysis patients but these differences disappeared after adjustment to confounding factors such as age and gender&#46; Curiously&#44; the transplanted patients didn&#180;t achieve better results in any scale of the Physical or Mental Health Components&#44; although these patients proved previously in other studies to have a better QOL comparing to dialysis patients<span class="elsevierStyleSup">18&#44;19</span>&#46; Transplanted patients received their new kidney 8&#46;7 years ago&#44; which implied a gradual adaptation and possibly the disappearance of the health improvement feeling relatively to the pre-transplantation period&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Comparisons of QOL between haemodialysis and peritoneal dialysis patients are not consensual<span class="elsevierStyleSup">20&#44;21</span>&#46; In our study&#44; the PD group achieved better scores in scales like &#171;Effects of kidney disease&#187;&#44; &#171;Burden of kidney disease&#187; and &#171;Patient satisfaction&#187; and these results were maintained after adjustment for confounding factors&#46; Our young peritoneal dialysis patients selected this dialytic technique to keep their active lives and the possibility to study or work&#46; So&#44; they are a more autonomous and motivated group&#46; On the other hand&#44; our haemodialysis patients are integrated in a Hospital Unit that selects older&#44; sicker and more dependent persons&#46; These facts may be a partial explanation for the better results of our PD patients&#46; Another factor that may contribute for the lesser effect of the kidney disease in the QOL and better patient satisfaction may be the continuous treatment of uremia in PD&#46; Individual characteristics of personality are obviously not evaluated in our study&#44; but must also be considered when analysing these results&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Variables like age&#44; gender and haemoglobin level were related with scales like &#171;Physical Health Component&#187;&#44; &#171;Physical functioning&#187;&#44; &#171;Bodily pain&#187;&#44; &#171;Overall health&#187; and &#171;Work status&#187;&#46; Although our PD patients had haemoglobin levels adequately corrected according to international guidelines&#44; this modifiable factor was associated with worst results in &#171;Work status&#187;&#46; Taking in consideration that this specific group of patients was young and more active&#44; the anemia correction for higher haemoglobin levels may help improve their QOL&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Health related QOL was better in peritoneal dialysis patients comparing to haemodialysis patients in scales such as &#171;Effects of kidney disease&#187;&#44; &#171;Burden of kidney disease&#187; and &#171;Patient satisfaction&#187;&#46; The worst results in the four groups were found in the Physical Health Component&#46; Variables found to be related with QOL were age&#44; gender and haemoglobin level&#46; Patients under antidepressant treatment had worst results in the Mental Health Component&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The adaptation to a chronic illness is a physical&#44; psychological and social process&#46; The attention of the health team to the patient&#8217;s subjective perception about his state of health can be determinant in achieving the best medical intervention and improving survival&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10483&#95;108&#95;5697&#95;en&#95;10483&#95;t1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10483_108_5697_en_10483_t1.jpg" alt="Demographic and clinical characteristics"></img></a></p><p class="elsevierStylePara">Table 1&#46; Demographic and clinical characteristics</p><p class="elsevierStylePara"><a href="grande&#47;10483&#95;108&#95;5698&#95;en&#95;10483&#95;t2&#46;jpg" class="elsevierStyleCrossRefs"><img src="10483_108_5698_en_10483_t2.jpg" alt="SF-36 results"></img></a></p><p class="elsevierStylePara">Table 2&#46; SF-36 results</p><p class="elsevierStylePara"><a href="grande&#47;10483&#95;108&#95;5699&#95;en&#95;10483&#95;t3&#46;jpg" class="elsevierStyleCrossRefs"><img src="10483_108_5699_en_10483_t3.jpg" alt="Results of KDQOL-SF 1&#46;3 &#40;specific scales of kidney disease&#41;"></img></a></p><p class="elsevierStylePara">Table 3&#46; Results of KDQOL-SF 1&#46;3 &#40;specific scales of kidney disease&#41;</p><p class="elsevierStylePara"><a href="grande&#47;10483&#95;108&#95;5700&#95;en&#95;10483&#95;t4&#46;jpg" class="elsevierStyleCrossRefs"><img src="10483_108_5700_en_10483_t4.jpg" alt="Significant results of the linear regression model after adjustment for age&#44; gender and haemoglobin level &#40;Hb&#41;"></img></a></p><p class="elsevierStylePara">Table 4&#46; Significant results of the linear regression model after adjustment for age&#44; gender and haemoglobin level &#40;Hb&#41;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> The evaluation of health-related quality of life &#40;QOL&#41; in chronic kidney disease intends to quantify its consequences&#44; according to the patient&#8217;s subjective perception&#46; <span class="elsevierStyleBold">Aim&#58;</span> To evaluate the health-related QOL in four groups of patients followed at our Nephrology Department&#58; chronic kidney disease &#40;CKD&#41; stages 1-4&#44; kidney transplant &#40;KT&#41;&#44; haemodialysis &#40;HD&#41; and peritoneal dialysis &#40;PD&#41; patients&#46; <span class="elsevierStyleBold">Patients and Methods&#58;</span> Thirty patients with CKD stages 1-4 and 30 KT patients were randomly selected&#46; All patients from our Haemodialysis and Peritoneal Dialysis Units with capacity to answer the inquiry &#40;37 and 14&#44; respectively&#41; were also selected&#46; The instruments applied were the SF-36 and KDQOL-SF 1&#46;3&#46; <span class="elsevierStyleBold">Results&#58;</span> The four groups presented better results in the &#171;Social Functioning&#187; scale &#40;77&#46;68 &#177; 18&#46;46 in PD&#59; 74&#46;17 &#177; 29&#46;53 in KT&#59; 66&#46;81 &#177; 31&#46;39 in CKD 1-4&#59; 62&#46;16 &#177; 32&#46;84 in HD&#59; p &#61; 0&#46;192&#41;&#46; The lowest results appeared in the &#171;General Health&#187; scale &#40;39&#46;92 &#177; 19&#46;12 in CKD&#59; 45&#46;95 &#177; 21&#46;56 in HD&#59; 47&#46;13 &#177; 23&#46;15 in KT&#59; 51&#46;79 &#177; 18&#46;89 in PD&#59; p &#61; 0&#46;321&#41;&#46; Peritoneal dialysis patients achieved the best results in the Physical Health Component&#44; but this difference disappeared after adjustment to confounding factors&#46; Age&#44; gender and haemoglobin level were the variables related with QOL&#46; However&#44; PD patients obtained better scores comparing to HD patients in the following KDQOL-SF scales&#58; &#171;Effects of kidney disease&#187;&#44; &#171;Burden of kidney disease&#187; and &#171;Patient satisfaction&#187; &#40;p &#60;0&#46;05&#41;&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> Health-related QOL was better in peritoneal dialysis patients comparing to haemodialysis patients in specific scales of chronic kidney disease&#46; Age&#44; gender and haemoglobin level interfered with health-related QOL&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara">Antecedentes&#58; La evaluaci&#243;n de la calidad de vida &#40;CV&#41; relacionada con la salud en la enfermedad renal cr&#243;nica pretende cuantificar sus consecuencias en funci&#243;n de la percepci&#243;n subjetiva del paciente&#46; Objetivo&#58; Evaluar la CV relacionada con la salud en cuatro grupos de pacientes controlados en nuestro Servicio de Nefrolog&#237;a&#58; pacientes con insuficiencia renal cr&#243;nica &#40;ERC&#41; en fases 1 - 4&#44; trasplante renal &#40;TR&#41;&#44; hemodi&#225;lisis &#40;HD&#41; y di&#225;lisis peritoneal &#40;DP&#41;&#46; Pacientes y m&#233;todos&#58; De forma aleatoria se incluyeron 30 pacientes con ERC en fases 1 &#8211; 4 y 30 trasplantados renales&#46; Tambi&#233;n se incluyeron todos aquellos pacientes de nuestras Unidades de Hemodi&#225;lisis y Di&#225;lisis Peritoneal que eran capaces de responder los cuestionarios &#40;37 y 14&#44; respectivamente&#41;&#46; Los cuestionarios que se utilizaron fueron el SF-36 y el KDQOL-SF 1&#46;3&#46; Resultados&#58; Los cuatro grupos obtuvieron mejores resultados en la dimensi&#243;n &#34;Funci&#243;n social&#34; &#40;77&#44;68 &#177; 18&#44;46 en DP&#59; 74&#44;17 &#177; 29&#44;53 en TR&#59; 66&#44;81 &#177; 31&#44;39 en ERC 1-4&#59; 62&#44;16 &#177; 32&#44;84 en HD&#59; p &#61; 0&#44;192&#41;&#46; Las puntuaciones m&#225;s bajas se obtuvieron en la dimensi&#243;n &#34;Salud general&#34; &#40;39&#44;92 &#177; 19&#44;12 en IRC&#59; 45&#44;95 &#177; 21&#44;56 en HD&#59; 47&#44;13 &#177; 23&#44;15 en TR&#59; 51&#44;79 &#177; 18&#44;89 en DP&#59; p &#61; 0&#44;321&#41;&#46; Los pacientes con di&#225;lisis peritoneal presentaron los mejores resultados en cuanto a la Salud F&#237;sica&#44; sin que la diferencia se mantuviese tras la correcci&#243;n de los factores de confusi&#243;n&#46; La edad&#44; el sexo y la concentraci&#243;n de hemoglobina fueron las variables que se asociaron con la CV&#46; Sin embargo&#44; los pacientes con DP obtuvieron mejores puntuaciones que los pacientes con HD en las siguientes dimensiones del KDQOL-SF&#58; &#34;Efectos de la enfermedad renal&#34;&#44; &#34;Carga de la enfermedad renal&#34; y &#34;Satisfacci&#243;n del paciente&#34; &#40;p &#60; 0&#44;05&#41;&#46; Conclusiones&#58; La CV relacionada con la salud medida mediante dimensiones espec&#237;ficas de la enfermedad renal cr&#243;nica fue mejor en pacientes con di&#225;lisis peritoneal que en pacientes con hemodi&#225;lisis&#46; La edad&#44; el sexo y la concentraci&#243;n de hemoglobina afectan la CV relacionada con la salud&#46;</p>"
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                  "referenciaCompleta" => "Sanjeev KM, Lori A, Edith F, John KM, Steven F. Self-assessed physical and mental function of haemodialysis patients. Nephrol Dial Transplant 2001;16:1387-94. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11427630" target="_blank">[Pubmed]</a>"
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Quality of life in chronic kidney disease
Calidad de vida en la enfermedad renal crónica
, M.. Fructuosob, R.. Castrob, L.. Oliveirab, C.. Pratab, T.. Morgadob
b Nephrology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro EPE, Vila Real, Portugal,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">BACKGROUND</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Health-related quality of life &#40;QOL&#41; assumes an increasing importance as a marker of treatment quality in many chronic diseases&#46; Its evaluation allows the quantification of the diseases consequences according to the patient&#8217;s subjective perception and enables adjustment of&#160; medical decisions to their physical&#44; emotional and social needs&#46; It also improves the adhesion to the therapeutic plan&#44; the quality of the health care provided and the patient survival&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The multiple limitations and complications of patients in advanced stages of chronic kidney disease &#40;CKD&#41; or under renal substitution treatment can contribute to this QOL impairment<span class="elsevierStyleSup">1</span>&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Diverse psychometric tests have been designed and validated to evaluate health-related QOL&#46; Our purpose in this study was to evaluate the health-related QOL in four groups of CKD patients &#40;CKD stages 1-4&#44; kidney recipients&#44; haemodialysis and peritoneal dialysis patients&#41;&#44; using validated and applicable instruments&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">POPULATION AND METHODS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Thirty of the 821 CKD patients stages 1-4 &#40;CKD 1-4&#41; and 30 of the 117 transplanted patients followed at our Nephrology Department were randomly selected&#46; Patients at our Haemodialysis Unit &#40;37&#47;43&#41; and Peritoneal Dialysis Unit &#40;14&#47;17&#41; with the capacity of answering to the questionnaires were also admitted in the study&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The instruments applied were the SF-36 &#40;<span class="elsevierStyleItalic">Medical Outcomes Study Short-Form 36&#41; </span>and KDQOL-SF 1&#46;3 &#40;<span class="elsevierStyleItalic">Kidney Disease and Quality of Life Short-Form</span>&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The SF-36 is a generic questionnaire translated in more than 40 languages and already validated in Portugal<span class="elsevierStyleSup">2-5</span>&#46; It consists of 36 items grouped in eight scales that evaluate different areas of health&#58; Physical Functioning&#44; Role Physical&#44; Bodily Pain&#44; General Health&#44; Vitality&#44; Social Functioning&#44; Role Emotional and Mental Health&#46; These scales are grouped in two summary measures&#58; Physical Health and Mental Health&#46; This instrument was applied in the CKD stages 1-4 and kidney transplanted patients &#40;KT&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">KDQOL-SF 1&#46;3 is a questionnaire that includes not only the SF-36 scales but also specific dimensions of chronic kidney disease&#46; This dimensions include 43 items that can be summarized in 12 scales&#58; Symptom&#47;problem list&#44; Effects of kidney disease&#44; Burden of kidney disease&#44; Work status&#44; Cognitive function&#44; Quality of social interaction&#44; Sexual function&#44; Sleep&#44; Social support&#44; Dialysis staff encouragement&#44; Overall health and Patient satisfaction&#46; It&#8217;s a reproducible questionnaire that was validated by the KDQOL Working Group studies<span class="elsevierStyleSup">6</span>&#46; It was applied in our study to haemodialysis &#40;HD&#41; and peritoneal dialysis &#40;PD&#41; patients&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The two cited instruments have punctuation from zero to 100&#44; directly related with the QOL&#46; In resume&#44; higher punctuations relate to better quality of life&#46; Our data was analyzed in a program produced by the KDQOL Working Group &#40;<a href="http&#58;&#47;&#47;www&#46;gim&#46;med&#46;ucla&#46;edu&#47;kdqol&#47;" class="elsevierStyleCrossRefs"><span class="elsevierStyleBold">www&#46;gim&#46;med&#46;ucla&#46;edu&#47;kdqol&#47;</span></a>&#41;&#46; The remaining statistical analysis was performed with the program <span class="elsevierStyleItalic">Statistical Package of Social Sciences </span>&#40;SPSS 18&#46;0&#41;&#46; The quantitative variables were expressed as mean &#177; standard deviation and qualitative variables as absolute &#160;numbers and percentages&#46; We studied the association between the groups in qualitative variables by chi-square test or the contingency coefficient&#44; as appropriate&#46; For the quantitative variables&#44; after checking normality with the Kolmogorov-Smirnov test&#44;&#160;the T-Student test or Mann-Whitney were used for two groups and the table ANOVA or Kruskal-Wallis for the four groups&#44; as appropriate&#46; Finally&#44; we performed a multivariate linear regression analysis in each of the groups for those variables significant in the univariate analysis or clinically relevant&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">The peritoneal dialysis patients were younger than the other patients &#40;38&#46;9 &#177; 13&#46;3 years in PD&#44; 51&#46;8 &#177; 10&#46;8 years in transplanted patients&#44; 62&#46;2 &#177; 18&#46;3 years in CKD 1-4&#44; 67&#46;3 &#177; 14&#46;9 years in HD&#59; p &#60;0&#46;001&#41;&#46; There was no gender predominance in the four groups &#40;43&#46;3&#37; of men in CKD&#44; 50&#46;0&#37; in KT&#44; 56&#46;8&#37; in HD and 57&#46;1&#37; in PD&#44; p &#61; 0&#46;702&#41;&#160;&#40;Table 1&#41;&#46; The mean time on dialysis was not significantly different in haemodialysis and peritoneal dialysis patients &#40;6&#46;1 &#177; 6&#46;5 <span class="elsevierStyleItalic">vs</span> 1&#46;9 &#177; 1&#46;3 years&#44; p &#61; 0&#46;40&#41;&#46; The mean time after kidney transplantation was 8&#46;7 &#177; 5&#46;4 years&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The majority of haemodialysis patients were treated with on-line hemodiafiltration &#40;56&#46;8&#37;&#41; and all patients in peritoneal dialysis&#44; except one&#44; were in automatic peritoneal dialysis&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Twenty three patients were diabetic &#40;20&#46;7&#37;&#41;&#44; but the prevalence of diabetes was not different between the groups &#40;p &#61; 0&#46;175&#41;&#46; On the other hand&#44; the prevalence of heart failure was tendencially higher in the haemodialysis group &#40;HD&#58; 40&#46;5&#37;&#59; CKD&#58; 23&#46;3&#37;&#59; PD&#58; 14&#46;3&#37;&#59; KT&#58; 13&#46;3&#37;&#59; p &#61; 0&#46;050&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The dialysis dose was adequate in the two groups under dialytic treatment &#40;HD&#58; spKt&#47;V &#61; 2&#46;08 &#177; 0&#46;54&#59; PD&#58; weekly urea Kt&#47;V &#61; 2&#46;25 &#177; 0&#46;48 and weekly creatinine clearance &#61; 85 &#177; 30 L&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#47;week&#41;&#46; The creatinine clearance was 59&#46;3 &#177; 34&#46;6 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span> in CKD 1-4 and 74&#46;5 &#177; 42&#46;5 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span> in the transplanted patients &#40;p &#61; 0&#46;132&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">All patients presented a similar albuminemia level &#40;CKD&#58; 3&#46;71 &#177; 0&#46;40 g&#47;dl&#44; KT&#58; 3&#46;56 &#177; 0&#46;46 g&#47;dl&#44; HD&#58; 3&#46;36 &#177; 0&#46;44 g&#47;dl&#44; PD&#58; 3&#46;35 &#177; 0&#46;33&#59; p &#61; 0&#46;231&#41;&#46; The mean haemoglobin level of the CKD 1-4 &#40;13&#46;2 &#177; 1&#46;7 g&#47;dl&#41; and transplanted patients &#40;13&#46;1 &#177; 1&#46;9 g&#47;dl&#41; was higher than that of the haemodialysis &#40;11&#46;9 &#177; 1&#46;2 g&#47;dl&#41; and peritoneal dialysis patients &#40;11&#46;5 &#177; 1&#46;8 g&#47;dl&#44; p &#60;0&#46;001&#41;&#46; The majority of haemodialysis &#40;81&#46;1&#37;&#41; and peritoneal dialysis patients &#40;64&#46;3&#37;&#41; were treated with recombinant erythropoietin &#40;EPO&#41;&#46; In contrast&#44; only 23&#46;3&#37; of CKD patients and 16&#46;7&#37; of transplanted patients were under that treatment&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The best results of the SF-36 in the four groups were found in the &#171;Social Functioning&#187; 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5&#44; much worse&#46; The peritoneal dialysis patients were the only ones to indicate an improvement in their health relatively to the previous year &#40;CKD&#58; 3&#46;0 &#177; 1&#46;1&#59; KT&#58; 3&#46;0 &#177; 1&#46;1&#59; HD&#58; 2&#46;9 &#177; 1&#46;0&#59; PD&#58; 2&#46;1 &#177; 0&#46;8&#59; p &#60;0&#46;05&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In the kidney disease specific dimensions of the KDQOL-SF 1&#46;3 &#40;Table 3&#41;&#44; the peritoneal dialysis patients had better results comparing to haemodialysis patients in the following scales&#58; &#171;Effects of kidney disease&#187; &#40;73&#46;83 &#177; 17&#46;89 vs 59&#46;38 &#177; 18&#46;76&#59; p &#61; 0&#46;019&#41;&#44; &#171;Burden of kidney disease&#187; &#40;58&#46;65 &#177; 27&#46;31 vs 26&#46;35 &#177; 18&#46;58&#59; p &#60;0&#46;001&#41;&#44; &#171;Work status&#187; &#40;50&#46;00 &#177; 44&#46;72 vs 19&#46;85 &#177; 9&#46;46&#59; p &#61; 0&#46;001&#41;&#44; &#171;Overall Health&#187; &#40;76&#46;67 &#177; 19&#46;69 vs 46&#46;49 &#177; 22&#46;51&#59; p &#61; 0&#46;021&#41; and &#171;Patient satisfaction&#187; &#40;84&#46;72 &#177; 20&#46;67 vs 70&#46;02 &#177; 20&#46;43&#59; p &#60;0&#46;001&#41;&#46; In the remaining scales&#44; values were similar for both groups&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">After adjustment in multivariate linear regression analysis for variables like age&#44; gender&#44; heart failure&#44; time on dialysis&#44; haemoglobin level and creatinine clearance&#44; the scales that remained unchanged were &#171;Effects of kidney disease&#187;&#44; &#171;Burden of kidney disease&#187; and &#171;Patient satisfaction&#187; of the KDQOL-SF 1&#46;3&#46; Age&#44; gender and haemoglobin level were the variables associated with the remaining scales that presented different results between groups in univariate analysis &#40;&#171;Physical Health Component&#187;&#44; &#171;Physical functioning&#187;&#44; &#171;Bodily pain&#187;&#44; &#171;Work status&#187; and &#171;Overall health&#187;&#41; &#40;Table 4&#41;&#46; Age was inversely related to the punctuation and haemoglobin level presented a direct relation with higher scores&#46; Male patients of the CKD 1-4 group presented worst results than females in the &#171;Bodily pain&#187; scale &#40;p &#61; 0&#46;039&#41;&#46;&#160;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Finally&#44; we evaluated the association between the Mental Health Component and the treatment with antidepressants&#46; The patients under antidepressant treatment &#40;four patients with CKD stages 1-4&#44; three transplanted patients&#44; seven haemodialysis patients and one patient in peritoneal dialysis&#41; had worst results in the Mental Health Component when compared with the remaining patients&#44; not treated with antidepressants &#40;36&#46;62 &#177; 10&#46;96 vs 44&#46;17 &#177; 12&#46;03&#59; p &#60;0&#46;05&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">The two summary measures of the SF-36 allow a fast evaluation of the health-related QOL&#44; with scarce loss of information when the eight scales are resumed in the two main components&#44; Physical and Mental<span class="elsevierStyleSup">7&#44;8</span>&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Several studies have already compared the QOL of dialysis patients with the general population&#44; the majority disclosing the negative impact of chronic kidney disease and its treatments<span class="elsevierStyleSup">9-14</span>&#46; Those results are however&#44; not confirmed in other series<span class="elsevierStyleSup">15&#44;16</span>&#46; In our view&#44; the present study&#44; even with the limitation of being an observational cross-sectional study with a small number of patients&#44; has the particularity of evaluating the health-related QOL in four groups of patients with CKD in various phases and under different renal replacement treatments &#40;HD&#44; PD and kidney transplant&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The worst results were registered in the scale &#171;General Health&#187; of the Physical Health Component&#46; In other type of diseases&#44; a greater impact in Physical Health comparing to Mental Health was also found<span class="elsevierStyleSup">17</span>&#46; This situation can be explained by the psychological adaptation of the sick person to the chronic illness&#44; with a declining repercussion of the disease in its Mental Health&#46; In our study&#44; Physical Health was better in peritoneal dialysis patients but these differences disappeared after adjustment to confounding factors such as age and gender&#46; Curiously&#44; the transplanted patients didn&#180;t achieve better results in any scale of the Physical or Mental Health Components&#44; although these patients proved previously in other studies to have a better QOL comparing to dialysis patients<span class="elsevierStyleSup">18&#44;19</span>&#46; Transplanted patients received their new kidney 8&#46;7 years ago&#44; which implied a gradual adaptation and possibly the disappearance of the health improvement feeling relatively to the pre-transplantation period&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Comparisons of QOL between haemodialysis and peritoneal dialysis patients are not consensual<span class="elsevierStyleSup">20&#44;21</span>&#46; In our study&#44; the PD group achieved better scores in scales like &#171;Effects of kidney disease&#187;&#44; &#171;Burden of kidney disease&#187; and &#171;Patient satisfaction&#187; and these results were maintained after adjustment for confounding factors&#46; Our young peritoneal dialysis patients selected this dialytic technique to keep their active lives and the possibility to study or work&#46; So&#44; they are a more autonomous and motivated group&#46; On the other hand&#44; our haemodialysis patients are integrated in a Hospital Unit that selects older&#44; sicker and more dependent persons&#46; These facts may be a partial explanation for the better results of our PD patients&#46; Another factor that may contribute for the lesser effect of the kidney disease in the QOL and better patient satisfaction may be the continuous treatment of uremia in PD&#46; Individual characteristics of personality are obviously not evaluated in our study&#44; but must also be considered when analysing these results&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Variables like age&#44; gender and haemoglobin level were related with scales like &#171;Physical Health Component&#187;&#44; &#171;Physical functioning&#187;&#44; &#171;Bodily pain&#187;&#44; &#171;Overall health&#187; and &#171;Work status&#187;&#46; Although our PD patients had haemoglobin levels adequately corrected according to international guidelines&#44; this modifiable factor was associated with worst results in &#171;Work status&#187;&#46; Taking in consideration that this specific group of patients was young and more active&#44; the anemia correction for higher haemoglobin levels may help improve their QOL&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Health related QOL was better in peritoneal dialysis patients comparing to haemodialysis patients in scales such as &#171;Effects of kidney disease&#187;&#44; &#171;Burden of kidney disease&#187; and &#171;Patient satisfaction&#187;&#46; The worst results in the four groups were found in the Physical Health Component&#46; Variables found to be related with QOL were age&#44; gender and haemoglobin level&#46; Patients under antidepressant treatment had worst results in the Mental Health Component&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The adaptation to a chronic illness is a physical&#44; psychological and social process&#46; The attention of the health team to the patient&#8217;s subjective perception about his state of health can be determinant in achieving the best medical intervention and improving survival&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10483&#95;108&#95;5697&#95;en&#95;10483&#95;t1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10483_108_5697_en_10483_t1.jpg" alt="Demographic and clinical characteristics"></img></a></p><p class="elsevierStylePara">Table 1&#46; Demographic and clinical characteristics</p><p class="elsevierStylePara"><a href="grande&#47;10483&#95;108&#95;5698&#95;en&#95;10483&#95;t2&#46;jpg" class="elsevierStyleCrossRefs"><img src="10483_108_5698_en_10483_t2.jpg" alt="SF-36 results"></img></a></p><p class="elsevierStylePara">Table 2&#46; SF-36 results</p><p class="elsevierStylePara"><a href="grande&#47;10483&#95;108&#95;5699&#95;en&#95;10483&#95;t3&#46;jpg" class="elsevierStyleCrossRefs"><img src="10483_108_5699_en_10483_t3.jpg" alt="Results of KDQOL-SF 1&#46;3 &#40;specific scales of kidney disease&#41;"></img></a></p><p class="elsevierStylePara">Table 3&#46; Results of KDQOL-SF 1&#46;3 &#40;specific scales of kidney disease&#41;</p><p class="elsevierStylePara"><a href="grande&#47;10483&#95;108&#95;5700&#95;en&#95;10483&#95;t4&#46;jpg" class="elsevierStyleCrossRefs"><img src="10483_108_5700_en_10483_t4.jpg" alt="Significant results of the linear regression model after adjustment for age&#44; gender and haemoglobin level &#40;Hb&#41;"></img></a></p><p class="elsevierStylePara">Table 4&#46; Significant results of the linear regression model after adjustment for age&#44; gender and haemoglobin level &#40;Hb&#41;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> The evaluation of health-related quality of life &#40;QOL&#41; in chronic kidney disease intends to quantify its consequences&#44; according to the patient&#8217;s subjective perception&#46; <span class="elsevierStyleBold">Aim&#58;</span> To evaluate the health-related QOL in four groups of patients followed at our Nephrology Department&#58; chronic kidney disease &#40;CKD&#41; stages 1-4&#44; kidney transplant &#40;KT&#41;&#44; haemodialysis &#40;HD&#41; and peritoneal dialysis &#40;PD&#41; patients&#46; <span class="elsevierStyleBold">Patients and Methods&#58;</span> Thirty patients with CKD stages 1-4 and 30 KT patients were randomly selected&#46; All patients from our Haemodialysis and Peritoneal Dialysis Units with capacity to answer the inquiry &#40;37 and 14&#44; respectively&#41; were also selected&#46; The instruments applied were the SF-36 and KDQOL-SF 1&#46;3&#46; <span class="elsevierStyleBold">Results&#58;</span> The four groups presented better results in the &#171;Social Functioning&#187; scale &#40;77&#46;68 &#177; 18&#46;46 in PD&#59; 74&#46;17 &#177; 29&#46;53 in KT&#59; 66&#46;81 &#177; 31&#46;39 in CKD 1-4&#59; 62&#46;16 &#177; 32&#46;84 in HD&#59; p &#61; 0&#46;192&#41;&#46; The lowest results appeared in the &#171;General Health&#187; scale &#40;39&#46;92 &#177; 19&#46;12 in CKD&#59; 45&#46;95 &#177; 21&#46;56 in HD&#59; 47&#46;13 &#177; 23&#46;15 in KT&#59; 51&#46;79 &#177; 18&#46;89 in PD&#59; p &#61; 0&#46;321&#41;&#46; Peritoneal dialysis patients achieved the best results in the Physical Health Component&#44; but this difference disappeared after adjustment to confounding factors&#46; Age&#44; gender and haemoglobin level were the variables related with QOL&#46; However&#44; PD patients obtained better scores comparing to HD patients in the following KDQOL-SF scales&#58; &#171;Effects of kidney disease&#187;&#44; &#171;Burden of kidney disease&#187; and &#171;Patient satisfaction&#187; &#40;p &#60;0&#46;05&#41;&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> Health-related QOL was better in peritoneal dialysis patients comparing to haemodialysis patients in specific scales of chronic kidney disease&#46; Age&#44; gender and haemoglobin level interfered with health-related QOL&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara">Antecedentes&#58; La evaluaci&#243;n de la calidad de vida &#40;CV&#41; relacionada con la salud en la enfermedad renal cr&#243;nica pretende cuantificar sus consecuencias en funci&#243;n de la percepci&#243;n subjetiva del paciente&#46; Objetivo&#58; Evaluar la CV relacionada con la salud en cuatro grupos de pacientes controlados en nuestro Servicio de Nefrolog&#237;a&#58; pacientes con insuficiencia renal cr&#243;nica &#40;ERC&#41; en fases 1 - 4&#44; trasplante renal &#40;TR&#41;&#44; hemodi&#225;lisis &#40;HD&#41; y di&#225;lisis peritoneal &#40;DP&#41;&#46; Pacientes y m&#233;todos&#58; De forma aleatoria se incluyeron 30 pacientes con ERC en fases 1 &#8211; 4 y 30 trasplantados renales&#46; Tambi&#233;n se incluyeron todos aquellos pacientes de nuestras Unidades de Hemodi&#225;lisis y Di&#225;lisis Peritoneal que eran capaces de responder los cuestionarios &#40;37 y 14&#44; respectivamente&#41;&#46; Los cuestionarios que se utilizaron fueron el SF-36 y el KDQOL-SF 1&#46;3&#46; Resultados&#58; Los cuatro grupos obtuvieron mejores resultados en la dimensi&#243;n &#34;Funci&#243;n social&#34; &#40;77&#44;68 &#177; 18&#44;46 en DP&#59; 74&#44;17 &#177; 29&#44;53 en TR&#59; 66&#44;81 &#177; 31&#44;39 en ERC 1-4&#59; 62&#44;16 &#177; 32&#44;84 en HD&#59; p &#61; 0&#44;192&#41;&#46; Las puntuaciones m&#225;s bajas se obtuvieron en la dimensi&#243;n &#34;Salud general&#34; &#40;39&#44;92 &#177; 19&#44;12 en IRC&#59; 45&#44;95 &#177; 21&#44;56 en HD&#59; 47&#44;13 &#177; 23&#44;15 en TR&#59; 51&#44;79 &#177; 18&#44;89 en DP&#59; p &#61; 0&#44;321&#41;&#46; Los pacientes con di&#225;lisis peritoneal presentaron los mejores resultados en cuanto a la Salud F&#237;sica&#44; sin que la diferencia se mantuviese tras la correcci&#243;n de los factores de confusi&#243;n&#46; La edad&#44; el sexo y la concentraci&#243;n de hemoglobina fueron las variables que se asociaron con la CV&#46; Sin embargo&#44; los pacientes con DP obtuvieron mejores puntuaciones que los pacientes con HD en las siguientes dimensiones del KDQOL-SF&#58; &#34;Efectos de la enfermedad renal&#34;&#44; &#34;Carga de la enfermedad renal&#34; y &#34;Satisfacci&#243;n del paciente&#34; &#40;p &#60; 0&#44;05&#41;&#46; Conclusiones&#58; La CV relacionada con la salud medida mediante dimensiones espec&#237;ficas de la enfermedad renal cr&#243;nica fue mejor en pacientes con di&#225;lisis peritoneal que en pacientes con hemodi&#225;lisis&#46; La edad&#44; el sexo y la concentraci&#243;n de hemoglobina afectan la CV relacionada con la salud&#46;</p>"
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ISSN: 20132514
Original language: English
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