title: Impact of portable APD on patient perception of health-related quality of life.
abstract: We assessed the impact of the introduction of a portable automated peritoneal dialysis (APD) system (Homechoice, Baxter Healthcare) on health-related quality of life (HRQOL). We evaluated HRQOL in 26 patients using the RAND 36-item Health Survey 1.0, which measures physical functioning, role limitations (physical and emotional), social functioning, emotional well-being, pain, energy, and general health perceptions. Questionnaires were administered prior to changing to the new system and 3 months later. Kt/V and albumin levels were measured at both time points. Eight patients had been on continuous ambulatory peritoneal dialysis (CAPD), and 18 had been using other APD systems (PacXtra, Baxter and AMP80, Fresenius). Kt/V increased significantly (p = 0.026); albumin was unchanged (p = 0.09). There was an improvement in the pain score (p = 0.079), although this did not reach statistical significance in the overall sample. Subgroup analysis showed that most of the improvement was from the group that had used the AMP80. No other statistically significant differences were found overall in the domains of HRQOL. Questioning of a random sample of patients indicated that perceived advantages of the new system were ease of setup and portability within the home. Neither of these translated into improvement in role-functioning domains of HRQOL. The improvement in pain score may reflect the capacity of newer cyclers to switch from drain to fill after a set proportion of dialysate has drained, leaving the patient empty for less of the time. Portable APD systems did not bring about predicted improvements in HRQOL. The HRQOL instrument may be insensitive, but technologically convenient advances may have limited impact on HRQOL due to its multifactorial nature.
authors.affiliation: Department of Nursing, Kingston General Hospital, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: McComb
authors.forename: A R
authors.initials: AR
authors.lastname: Morton
authors.forename: M A
authors.initials: MA
authors.lastname: Singer
authors.forename: W M
authors.initials: WM
authors.lastname: Hopman
authors.forename: T
authors.initials: T
authors.lastname: MacKenzie
mesh_terms: D001294:Attitude to Health; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000523:psychology*; D011788:Quality of Life; D011795:Surveys and Questionnaires