title: Health related quality of life in patients with end stage kidney disease treated with haemodialysis in Malawi: a cross sectional study.
abstract: Haemodialysis in Malawi consumes a disproportionate amount of the national health budget, costing approximately $20,000 per patient per year. Adjunctive therapeutic agents for end stage kidney disease and laboratory services to measure standard dialysis outcomes are not routinely available. Therefore, alternative outcome measures of the efficacy of haemodialysis in Malawi are required. We measured health related quality of life of adult patients in Malawi treated with haemodialysis for end stage kidney disease.
  
  
  
  We performed a cross-sectional study of patients receiving haemodialysis for end stage kidney disease at 4 dialysis centres in Malawi between 24/10/2012 and 30/11/012. Patients were included if they were >18 years of age and had been receiving haemodialysis for >3 months. We used the Kidney Disease Quality of Life Instrument Short Form to assess health related quality of life.
  
  
  
  We recruited 22 of 24 eligible patients (mean age 44.8 ± 16.0 years, 59.1 % male, median duration on haemodialysis 12 months (Inter-quartile range 6-24 months)). Overall health related quality of life was low (mean score 59.9 ± 8.8, maximum possible score 100) with the lowest scores recorded for physical health component summary score (50.4 ± 22.8) compared to mental health component summary (61.3 ± 23.0) and kidney disease component summary (67.9 ± 13.2). Low household income (<$4000 per year) was associated with lower mental health component scores (adjusted r(2) = 0.413, p = 0.033).
  
  
  
  Quality of life of haemodialysis patients in Malawi can be easily measured using a validated questionnaire and provides an alternative and important measure of the efficacy of haemodialysis therapy. Physical health scores were particularly low and this may affect income generating capacity. Increased efforts are required to improve the quality of life of haemodialysis patients in Malawi with a particular focus on the burden of physical symptoms.
authors.affiliation: Malawi College of Medicine, Mahatma Gandhi Road, Ginnery Corner, Blantyre, Malawi. tchikondi@medcol.mw.|Department of Medicine, Queen Elizabeth Central Hospital, Mahatma Gandhi Road, Chihciri, Blantyre, Malawi. tchikondi@medcol.mw.
authors.forename: Thokozani
authors.initials: T
authors.lastname: Masina
authors.affiliation: Malawi College of Medicine, Mahatma Gandhi Road, Ginnery Corner, Blantyre, Malawi.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Chimera
authors.affiliation: Malawi College of Medicine, Mahatma Gandhi Road, Ginnery Corner, Blantyre, Malawi.
authors.forename: Martin
authors.initials: M
authors.lastname: Kamponda
authors.affiliation: Malawi College of Medicine, Mahatma Gandhi Road, Ginnery Corner, Blantyre, Malawi.|Department of Nephrology, Royal Free Hospital, London, UK.
authors.forename: Gavin
authors.initials: G
authors.lastname: Dreyer
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007182:Income; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008295:Malawi; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011788:Quality of Life; D006435:Renal Dialysis
keywords: Haemodialysis; Malawi; Quality of life