title: How much is enough? An investigation of the relationship between haemodialysis adequacy and quality of life of elderly patients.
abstract: OBJECTIVE
  The average age of patients requiring haemodialysis is on the rise and has resulted in an increase in the number of elderly people receiving dialysis. While haemodialysis is one of the treatment options for this patient group, questions about its effectiveness have been raised. A second question centres on how much haemodialysis is actually needed to maintain quality of life (QoL). This study examined the relationship between dialysis adequacy and the QoL of elderly patients on haemodialysis.
  
  
  METHODS
  A prospective cohort of 40 haemodialysis patients aged 75 years and above was recruited and studied over 3 months. Quality of life was assessed with the European Quality of Life-5 Dimensions questionnaire and dialysis adequacy with the urea reduction ratio (URR), and the relationship between the two examined using a simple linear regression model.
  
  
  RESULTS
  The average age of the participants was 79.8 ± (3.9 years; 45% were women, and diabetes was the main cause of kidney disease (42.5%). The mean URR, visual analogue scale, European Quality of Life-5 Dimensions indices score and Charlson comorbidity index scores were 78.1 ± (5.5)%, 65.4 ± (13.7)%, 0.7 ± (0.27) and 6.3 ± (2.15), respectively. There was no clear relationship between dialysis adequacy and QoL, r = 0.093. Dialysis adequacy did not significantly predict QoL (P = 0.09).
  
  
  CONCLUSIONS
  There was no evidence for an association between haemodialysis adequacy and QoL in elderly patients receiving haemodialysis across a URR range of 64.0% to 88.9%. Attempts to improve dialysis adequacy beyond these levels may not be necessary for maintaining the QoL of elderly patients on dialysis.
  
  
  CONCLUSIONS
  Modern therapy should embrace the concept of quality of life and focus more on symptom relief and optimization of self-management skills to improve the well-being of the elderly patients with ESKD.
authors.affiliation: Department of Nephrology, Monash Health and Monash University, Melbourne, Victoria, Australia.|Monash Centre for Health Research and Implementation - MCHRI, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Edward
authors.initials: E
authors.lastname: Zimbudzi
authors.affiliation: Department of Nephrology, Monash Health and Monash University, Melbourne, Victoria, Australia.
authors.forename: Reggie
authors.initials: R
authors.lastname: Samlero
authors.affiliation: Department of Nephrology, Monash Health and Monash University, Melbourne, Victoria, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kerr
authors.affiliation: Monash Centre for Health Research and Implementation - MCHRI, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia, Australia.|The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D016014:Linear Models; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
chemical_list: D015415:Biomarkers; D014508:Urea
keywords: comorbidity; dialysis adequacy; elderly; quality of life; urea reduction ratio