QUALITY OF LIFE OF CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS.

Introduction:Chronic kidney disease (CKD) is a complex disease affecting more than twenty million individuals globally. CKD is now documented as a foremost health problem worldwide including India which has a negative impact on the quality of patients? life. Quality of life is one of the parameters to check the improvement of hemodialysis treatment among CKD patients. Objectives:The objectives of this study were i) To assess the quality of life of CKD patients undergoing maintenance hemodialysis ii) To find the association between Quality of life and socio demographic variables among CKD patients undergoing maintenance hemodialysis iii) To find the association between quality of life and clinical variable among CKD patients iv) To find the association between various domains of Quality of Life score and Socio demographic variables among CKD patients undergoing hemodialysis v) To find the correlation between domains of quality of life and Biochemical and Physiological Parameters vi) To prepare a booklet on Home Management Guidelines on Maintenance Hemodialysis for the patients attending hemodialysis unit of ILBS. Methods:A descriptive cross-sectional survey design was adopted using convenient sampling technique seventy patients having CKD and undergoing maintenance hemodialysis at dialysis unit of Institute of Liver and Biliary Sciences. The patients who were 18 years of age or above and who were able to communicate in Hindi and English were included in the study. The critically ill patients were not included in the present study. The reliability of the tool was established by parallel form method and the value was found to be 0.9 using SPSS Version 22. A structured questionnaire was used to collect the data related to demographic and clinical variable. Standardized test Kidney Disease Quality of Life-36 scale (KDQOL-36) was used to assess the Quality of life of CKD patients undergoing maintenance hemodialysis. The home management guideline for the patient was prepared and validated. Data was collected from the month of January and February 2018 at dialysis unit of ILBS Data was analyzed using descriptive and inferential statistics. The tests of significance used in the study are Student t-test, one way ANOVA, Post hoc analysis and Product moment coefficient of correlation. Results:The mean age of the study group was 48 percent with 54.3 percent of patients in the age group of 36 years to 59 years. Approximately 66 percent of the CKD patients were males. Nearly half the number of patients had been suffering from CKD for more than three years. More than half the number of patients (64.3 percent) found Hypertension as co-morbidity. The mean percent of QOL score was found to be 59.28 percent with a standard deviation of 14.58. The level of QOL was average in 61.4 percent of CKD patients. The QOL was above average in 20 percent of patients where as below average level of QOL was seen in 18.6 percent of the patients. Domain wise analysis of KDQOL revealed that highest mean percent score QOL was 67.4 percent in domain ?Symptoms of Kidney Disease?; followed by score of 42.14 percent in domain ?Effects of Kidney Disease?. The most affected domain was ?Burden of kidney disease? with a lowest mean percent QOL score of 26.43 percent. There was a significant negative correlation seen in domain Mental component with pre dialysis systolic blood pressure (r = - 0.241, p = 0.044). Conclusion:The present study findings indicate that CKD adversely affects the QOL of patients on maintenance hemodialysis. It revealed that the factors which affect the quality of life of CKD patients was age, gender, occupational status, presence of co-morbidity, duration of hemodialysis, Vascular access for hemodialysis. Further it was found that the QOL in occupation of CKD patients had been affected. Patients who were on Government service was better QOL as compared to patients who were unemployed/dependent, pensioners and self employed. The QOL in males were better as compared to females, the QOL of patients in the age group 18 years 35 years, 36 years to 59 years and above 60 years was affected with highest affected age group of 18-35 years also the QOL had been affected by presence of Anemia, Hypertension and Diabetes mellitus in CKD patients with highest impact by anemia as the co-morbidity. Home management guidelines for maintenance hemodialysis were prepared and given to the CKD patients undergoing hemodialysis at dialysis unit of ILBS.