title: Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis.
abstract: OBJECTIVE
  In-center hemodialysis (HD) is often the default dialysis modality for older patients. Few centers use assisted peritoneal dialysis (PD), which enables treatment at home. This observational study compared quality of life (QoL) and physical function between older patients on assisted PD and HD.
  
  
  METHODS
  Patients on assisted PD who were >60 years old and on dialysis for >3 months were recruited and matched to patients on HD (needing hospital transport) by age, sex, diabetes, dialysis vintage, ethnicity, and index of deprivation. Frailty was assessed using the Clinical Frailty Scale. QoL assessments included Hospital Anxiety and Depression Scale (HADS), Short Form-12, Palliative Outcomes Symptom Scale (renal), Illness Intrusiveness Rating Scale, and Renal Treatment Satisfaction Questionnaire (RTSQ). Physical function was evaluated by Barthel Score and timed up and go test.
  
  
  RESULTS
  In total, 251 patients (129 PD and 122 HD) were recruited. In unadjusted analysis, patients on assisted PD had a higher prevalence of possible depression (HADS>8; PD=38.8%; HD=23.8%; P=0.05) and higher HADS depression score (median: PD=6; HD=5; P=0.05) but higher RTSQ scores (median: PD=55; HD=51; P<0.01). In a generalized linear regression model adjusting for age, sex, comorbidity, dialysis vintage, and frailty, assisted PD continued to be associated with higher RTSQ scores (P=0.04) but not with other QoL measures.
  
  
  CONCLUSIONS
  There are no differences in measures of QoL and physical function between older patients on assisted PD and comparable patients on HD, except for treatment satisfaction, which is higher in patients on PD. Assisted PD should be considered as an alternative to HD for older patients, allowing them to make their preferred choices.
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom;
authors.forename: Osasuyi U
authors.initials: OU
authors.lastname: Iyasere
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom; o.iyasere13@imperial.ac.uk.
authors.forename: Edwina A
authors.initials: EA
authors.lastname: Brown
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom;
authors.forename: Lina
authors.initials: L
authors.lastname: Johansson
authors.affiliation: Centre for Pharmacology and Therapeutics, Division of Experimental Medicine, Imperial College London, London, United Kingdom;
authors.forename: Les
authors.initials: L
authors.lastname: Huson
authors.affiliation: Cardiovascular and Renal Research Support Unit, Imperial College Healthcare National Health Service Trust, London, United Kingdom;
authors.forename: Joanna
authors.initials: J
authors.lastname: Smee
authors.affiliation: Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, United Kingdom;
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Maxwell
authors.affiliation: Renal Department, Lister Hospital, Stevenage, United Kingdom; and.
authors.forename: Ken
authors.initials: K
authors.lastname: Farrington
authors.affiliation: University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004739:England / Q000453:epidemiology; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods; D006304:Health Status; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland / Q000453:epidemiology; D017060:Patient Satisfaction; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000523:psychology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: anxiety; depression; hemodialysis; humans; peritoneal dialysis; personal satisfaction; prevalence; quality of life; questionnaires; renal dialysis