Quality of life in Sicilian Patients on PD. Clinical and psychological changes with age and duration of treatment

Abstract

Objective: In relation to chronological and dialytic age, we have studied for 6 months the quality of life (QoL) of 56 stable subjects on peritoneal dialysis (PD), and also nutritional, immunological, and dialytic efficiency factors, com- pared to psychological tests. Methods: We divided the patients (pts) into 4 age groups: G1 (up to 49 years), G2 (50–59 years), G3 (60–69 years), G4 (over 70 years). Age-based dialysis in months (m) in 3 groups: 1–12 m, 13–36 m, 37– 90 m. Clinical parameters: nutritional, immunological, and dialytic efficiency values: albumin, Hb, WBC, ferritin, C3, C4, BMI, IgG, IgA, IgM, C-reactive pro- tein (CRP), CA125, Ca19-9, GFR, Kt/V, CCL, PTH. Psychometric tests: SF-36, POMS, MHLCS, MPSS, COPE. Results: In all pts during the observations is detected: significant worsening of SF-36 AF (0.04) and SF-36 AS (0.02) and MHLC internal (0.05), that shows the tendency of pts to personally manage their health condition; decrease of GFR (0.00) and CCL Tot (0.00); increase of Ca19-9 (0.01); decrease of Kt/V close to significance (0.07); increase of C3 close to significance (0.07); an increase of BMI close to significance (0.06). Chronological age (yrs): G1 (up to 49): worsening levels of depression and anxiety (POMS) almost significant (0.07). Decrease of GFR values close to significance (0.07). G2 (up to 59): worsening of SF-36 AS (0.07), increased levels of anxiety and tension at the POMS (0.03), of research support-help (COPE; 0.05), of PCR (0.04), C3 (0.00), and IgM (0.04). G3 (60–69): increase of PCR (0.02) and Alb (0.04), no significant increase in BMI. G4 (over 70): no significant changes in studied parameters. Dialytic age (m): 1–12: increase of Ca19-9 (0.05), C3 (0.01), and PTH (0.04); 13–36: worsening of SF-36-AF (0, 05); 37–90: increase of C3 (0.01) and PTH (0.04). Conclusions: Our study suggests that PD pts, especially those of G2 and dialytic age 13–36 months, implement a worse QoL compared to the physical capabilities and the impact of pain (SF-36, POMS). Proinflammatory indices (C3, Ca19-9, PCR, PTH) vary with dialytic age, prob- ably for the current poor biocompatibility of PD. With the support of family and life expectancy, pts over 70 years are the only group without significant changes, confirming that the PD treatment is more convenient at this age.