Abstract
KEY POINTS: Patients receiving kidney transplantation had better overall and physical health-related quality of life, with higher EuroQoL 5-Dimension Utility Index and Physical Component Summary scores and less daily life effect from kidney disease. Mental health-related quality of life was similar among patients receiving hemodialysis, peritoneal dialysis, and kidney transplantation. Symptoms and problems of kidney disease were strongly linked to mental component summary, explaining 15.8% of mental component summary changes. BACKGROUND: Health-related quality of life has gained increasing emphasis on the long-term outcome of patients taking sustained KRT. However, the influence of KRT modalities on patients' quality of life and their comparison needs further investigation. METHODS: This study included 267 patients: 101 receiving hemodialysis, 87 receiving peritoneal dialysis (PD), and 79 who received kidney transplantation (KT). Health-related quality of life of patients was evaluated by Kidney Disease Quality of Life Instrument-36 and EuroQoL 5-Dimension 3-Level scales. Inverse probability of treatment weighting was used to balance patients' demographic characteristics. RESULTS: KT improved physical activity of patients and reduced the effect of kidney disease, as shown by higher physical component summary (KT, 43.927±8.370, versus hemodialysis, 38.101±8.567, versus PD, 37.446±8.626; P < 0.001) and effects of kidney disease (KT, 71.917±24.469, versus hemodialysis, 57.654±16.722, versus PD, 53.169±17.960; P < 0.001), but did not improve mental component summary (MCS), burden of kidney disease, and symptoms and problems of kidney disease. No differences were found between hemodialysis and PD. Patients under different KRT modalities had different symptom distribution, but had close overall score in symptom evaluation. Symptoms and problems of kidney disease had the strongest association with MCS among all dimensions (r=0.398; 95% confidence interval, 0.274 to 0.509), explaining 15.8% variation in MCS. CONCLUSIONS: KT recipients had significantly improved overall and physical aspect quality of life, meanwhile they still had similar mental problems and multiple discomforts, such as fatigue and skin problems, just as patients receiving hemodialysis and PD. The quality of life of patients receiving hemodialysis and PD was similar. The effect of comorbidities and the underlying disease leading to ESKDs on patients' quality of life should not be neglected.