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Aging and Disease    2015, Vol. 6 Issue (1) : 17-26     DOI: 10.14336/AD.2014.0514
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Effect of Aging in the Perception of Health-Related Quality of Life in End-Stage Renal Disease Patients under Online-Hemodiafiltration
Alexandra Moura1, José Madureira2, Pablo Alija2, João Carlos Fernandes3, José Gerardo Oliveira4, Martin Lopez5, Madalena Filgueiras6, Leonilde Amado7, Maria Sameiro-Faria7, Vasco Miranda7, Alice Santos-Silva8, 9, Elísio Costa8, 9, *
1Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Porto, Portugal
2Clínica de Hemodiálise NefroServe, Barcelos, Portugal
3Clínica de Hemodiálise NefroServe, Viana do Castelo, Portugal
4Centro Hospitalar do Porto, Porto, Portugal
5Clínica de Hemodiálise de Felgueira, Felgueiras, Portugal
6Clínica de Hemodiálise de Gondomar, Gondomar, Portugal
7Clínica de Hemodiálise NephroCare, Maia, Portugal
8Laboratório de Bioquímica, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, Portugal
9Instituto de Biologia Molecular e Celular, Universidade do Porto, Portugal.
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Abstract  

This work aimed to evaluate how aging could influence patients’ perception of health quality of life (HRQOL), as well as, the effect of aging on dialysis adequacy and in hematological, iron status, inflammatory and nutritional markers. In this transversal study were enrolled 305 ESRD patients under online-hemodiafiltration (OL-HDF) (59.67% males; 64.9 ± 14.3 years old). Data about comorbidities, hematological data, iron status, dialysis adequacy, nutritional and inflammatory markers were collected from patient’s records. Moreover, HRQOL score, by using the Kidney Disease Quality of Life-Short Form (KDQOL-SF), was assessed. Analyzing the results according to quartiles of age, significant differences were found for some parameters evaluated by the KDQOL-SF instrument, namely for work status, physical functioning and role-physical, which decreased with increasing age. We also found a higher proportion of diabetic patients, a decrease in creatinine, iron, albumin serum levels, transferrin saturation and nPCR, with increasing age. Moreover, significant negative correlations were found between age and mean cell hemoglobin concentration, iron, transferrin saturation, albumin, nPCR, work status, physical functioning and role-physical. In conclusion, our results showed that aging is associated with a decreased work status, physical functioning and role-physical, with a decreased dialysis adequacy, iron availability and nutritional status, and with an increased proportion of diabetic patients and of patients using central venous catheter, as the vascular access. The knowledge of these changes associated with aging, which have impact in the quality of life of the patients, could be useful in their management.

Keywords Health-related quality of life      on-line hemodiafiltration      aging      gender      dialysis adequacy      iron availability      nutritional status     
Corresponding Authors: Elísio Costa   
Just Accepted Date: 25 November 2014   Online First Date: 23 November 2014    Issue Date: 02 February 2015
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Alexandra Moura
José Madureira
Pablo Alija
João Carlos Fernandes
José Gerardo Oliveira
Martin Lopez
Madalena Filgueiras
Leonilde Amado
Maria Sameiro-Faria
Vasco Miranda
Alice Santos-Silva
Elísio Costa
Cite this article:   
Alexandra Moura,José Madureira,Pablo Alija, et al. Effect of Aging in the Perception of Health-Related Quality of Life in End-Stage Renal Disease Patients under Online-Hemodiafiltration[J]. Aging and Disease, 2015, 6(1): 17-26.
URL:  
http://www.aginganddisease.org/EN/10.14336/AD.2014.0514     OR     http://www.aginganddisease.org/EN/Y2015/V6/I1/17
Figure 1.  Correlations between age and MCHC, iron, transferrin saturation, albumin and nPCR in ESRD patients.
ESRD patients 1st quartile (< 56 years old) (n=77)ESRD patients 2nd quartile (57–68 years old) (n=86)ESRD patients 3rd quartile (69–75 years old) (n=70)ESRD patients 4th quartile (>75 years old) (n=72)P value (ANOVA analysis)
Clinical data, and dialysis adequacy markers
CVC use, n (%)14 (17.1)18 (20.5)11 (15.3)26 (34.2)
AVF use, n (%)68 (82.9)70 (79.5)61 (84.7)50 (65.8)0.02#
Diabetic patients, n (%)21 (25.6)35 (39.7)33 (45.8)27 (35.5)0.04#
Hypertensive patients, n (%)16 (19.5)9 (10.2)10 (13.9)11 (14.4)0.40#
Previous time on dialysis, months73.45 (153.70)59.24 (100.67)64.53 (139.66)58.13 (91.28)0.85
URR, %76.75 (5.08)76.99 (5.93)76.34 (6.64)76.93 (7.56)0.92
KT/Ve1.55 (0.34)1.54 (0.32)1.47 (0.25)1.55 (0.38)0.41
Creatinine, mg/dL9.16 (2.81)7.88 (2.92)7.14 (2.76)6.22 (2.41)<0.001
Darbepoeitin, μg/kg/week0.32 (0.43)0.41 (0.69)0.39 (0.44)0.36 (0.40)0.70
Hematological data
Hemoglobin, g/dL11.67 (1.46)11.61 (1.44)11.69 (1.20)11.56 (1.38)0.93
Hematocrit, %35.70 (4.50)35.81 (4.37)36.24 (3.74)35.88 (4.31)0.88
Erythrocytes, x1012 /L3.75 (0.49)3.77 (0.54)3.85 (0.45)3.74 (0.52)0.56
MCV, fl95.47 (5.46)95.61 (5.87)94.46 (5.81)96.31 (6.10)0.28
MCH, pg31.21 (2.01)30.27 (5.05)30.05 (4.17)30.99 (2.14)0.13
MCHC, g/dL32.69 (0.97)32.39 (1.12)32.26 (1.16)32.18 (1.08)0.20
RDW, %14.60 (1.50)14.46 (1.36)14.93 (1.49)14.99 (1.64)0.30
White blood cells, ×109/L6.76 (1.95)6.26 (1.81)7.17 (2.78)6.65 (2.79)0.11
Neutrophil/Lymphocyte ratio2.68 (1.62)2.98 (1.42)2.90 (1.27)2.84 (1.29)0.55
Iron status
Iron, mg/dL74.53 (31.99)74.91 (33.09)63.04 (24.52)61.91 (23.51)0.01
Transferrin, mg/dL194.26 (43.18)209.59 (121.84)185.62 (40.21)204.12 (97.38)0.31
Transferrin saturation, %28.94 (14.81)30.34 (13.80)25.23 (11.53)24.47 (9.64)0.01
Ferritin, ng/mL355.69 (213.85)430.21 (238.55)408.79 (267.16)413.11 (239.42)0.22
Inflammatory markers
CRP, mg/dL6.53 (11.28)10.02 (18.36)13.77 (19.67)8.72 (12.04)0.13
Nutritional markers
Albumin, g/dL45.04 (13.61)43.59 (10.52)41.57 (7.92)39.37 (8.01)0.01
BMI, Kg/m224.80 (4.33)26.46 (5.05)26.54 (4.08)24.82 (4.08)0.01
nPCR, g/kg/day1.51 (0.75)1.43 (0.61)1.34 (0.62)1.17 (0.35)0.01
Table 1.  Clinical data, hematological and biochemical data, nutritional markers and dialysis adequacy for total ESRD patients on OL-HDF, according to age (quartiles)
ESRD patients 1st quartile:<56 years oldESRD patients 2nd quartile: 57 – 68 years oldESRD patients 3rd quartile: 69 – 75 years oldESRD patients 4th quartile: >75 years oldP value (ANOVA analysis) womenP value (ANOVA analysis) men
Women (n=25)Men (n=52)Women (n=32)Men (n=54)Women (n=31)Men (n=39)Women (n=35)Men (n=37)
Clinical data, and dialysis adequacy markers
CVC use, n (%)4 (15.4)10 (17.9)12 (36.4)6 (10.9)6 (18.8)5 (12.5)18 (47.4)8 (21.1)0.02#0.52#
FAV use, n (%)22 (84.6)46 (82.1)21 (63.6)49 (89.1)26 (81.3)35 (87.5)20 (52.6)30 (78.9)
Diabetic patients, n (%)6 (23.1)15 (26.8)16 (48.5)18 (52.9)14 (43.8)19 (47.5)10 (26.3)17 (44.7)0.51#0.15*
Hypertensive patients, n (%)6 (23.1)10 (17.9)0 (0)9 (16.4)2 (6.25)8 (20.0)4 (10.5)7 (18.4)0.22#0.97
Previous time on dialysis, months110.08 (254.28)56.74 (69.43)49.42 (65.75)65.20 (11.73)75.50 (202.50)55.75 (72.37)59.32 (122.04)56.95 (44.63)0.550.93
URR, %80.57 (3.59)75.00 (4.71)80.33 (4.59)75.06 (5.85)*78.91 (5.20)74.34 (7.01)*78.12 (7.72)75.74 (7.31)0.250.79
KT/Ve1.71 (0.23)1.47 (0.36)*1.67 (0.24)1.47 (0.34)*1.58 (0.27)1.39 (0.21)*1.61 (0.44)1.49 (0.29)0.430.51
Creatinine, mg/dL8.06 (2.33)9.62 (2.88)*6.46 (2.57)8.68 (2.81)*6.51 (2.68)7.62 (2.76)5.66 (2.38)6.79 (2.32)0.005<0.001
Darbepoeitin, μg/kg/week0.41 (0.44)0.28 (0.42)0.60 (0.97)0.30 (0.39)0.43 (0.39)0.36 (0.46)0.44 (0.40)0.30 (0.39)0.560.79
Hematological data
Hemoglobin, g/dL11.40 (1.72)11.79 (1.32)11.20 (1.44)11.86 (1.42)11.52 (1.16)11.82 (1.23)11.40 (1.42)11.71 (1.33)0.830.96
Hematocrit, %35.11 (5.15)35.97 (4.19)34.99 (4.68)36.31 (4.19)36.04 (3.60)36.39 (3.88)35.60 (4.54)36.15 (4.12)0.770.95
Erythrocytes, ×1012/L3.64 (0.49)3.80 (0.48)3.67 (0.52)3.84 (0.54)3.87 (0.47)3.83 (0.44)3.68 (0.53)3.81 (0.51)0.210.97
MCV, fl96.43 (4.88)95.03 (5.70)97.18 (6.75)94.59 (5.11)93.43 (6.58)95.25 (5.07)97.29 (5.82)95.32 (6.30)0.420.91
MCH, pg31.22 (1.85)31.21 (2.10)29.13 (7.83)30.90 (1.97)28.93 (5.81)30.95 (1.73)31.17 (2.02)30.81 (2.26)0.120.777
MCHC, g/dL32.36 (0.90)32.84 (0.97)31.93 (1.07)32.65 (1.08)31.94 (1.14)32.51 (1.13)32.04 (1.02)32.32 (1.13)0.380.12
RDW, %15.43 (1.80)14.31 (1.31)14.78 (1.78)14.30 (1.07)14.97 (1.60)14.91 (1.46)14.79 (1.40)15.32 (1.99)0.790.79
White blood cells, ×109/L6.39 (1.63)6.93 (2.07)6.04 (1.74)6.40 (1.86)7.07 (2.70)7.26 (2.88)6.94 (3.52)6.37 (1.79)0.370.16
Neutrophil/Lymphocyte ratio2.92 (2.19)2.56 (1.29)3.06 (1.57)2.95 (1.35)2.69 (1.13)3.06 (1.36)2.91 (1.35)2.78 (1.24)0 830.26
Iron status
Iron, mg/dL83.35 (42.19)70.91 (26.33)75.26 (33.94)75.26 (0.89)63.50 (27.72)62.70 (22.18)57.11 (19.53)66.97 (26.42)0.0050.17
Transferrin, mg/dL201.43 (43.50)191.31 (43.09)215.75 (169.97)215.75 (86.81)182.21 (40.02)188.18 (40.66)216.77 (116.62)190.78 (71.01)0.570.44
Transferrin saturation, %29.57 (13.02)28.68 (15.58)32.81 (15.17)32.81 (12.89)26.46 (14.69)24.24 (8.24)22.54 (9.01)26.51 (9.98)0.110.23
Ferritin, ng/mL360.24 (259.14)353.78 (194.25)472.94 (267.15)406.19 (220.43)409.82 (248.99)407.98 (283.99)400.41 (197.62)426.51 (279.13)0.350.47
Inflammatory markers
CRP, mg/dL5.43 (4.78)6.94 (12.89)13.37 (26.27)8.40 (12.56)14.04 (19.84)13.59 (19.91)9.41 (12.42)8.09 (11.91)0.490.27
Nutritional markers
Albumin, g/dL40.44 (12.46)47.06 (13.70)*41.75 (10.69)44.31 (10.04)*39.58 (5.74)43.10 (9.03)37.35 (9.03)41.40 (8.64)*0.240.86
BMI, Kg/m226.18 (5.15)24.17 (3.79)27.77 (5.72)25.66 (4.52)26.88 (4.47)26.27 (3.77)25.38 (4.59)24.27 (3.46)0.230.26
nPCR, g/kg/day1.52 (0.60)1.50 (0.81)1.34 (0.52)1.47 (0.65)1.25 (0.56)1.41 (0.66)1.18 (0.32)1.16 (0.37)0.630.81
Table 2.  Clinical data, hematological and biochemical data, nutritional markers and dialysis adequacy for Total ESRD patients on OLHDF, according to age (quartiles) and gender
ESRD patients 1st quartile (< 56 years old) (n=77)ESRD patients 2nd quartile (57–68 years old) (n=86)ESRD patients 3rd quartile (69–75 years old) (n=70)ESRD patients 4th quartile (>75 years old) (n=72)P value (ANOVA analysis)
ESRD–targeted Areas
Symptoms/problem list76.68 (17.83)76.60 (14.63)74.35 (16.80)76.39 (17.02)0.81
Effects of kidney disease65.22 (23.33)63.28 (21.51)66.32 (22.04)71.78 (15.79)0.09
Burden of kidney disease29.01 (26.60)23.22 (22.40)26.19 (25.65)22.86 (23.27)0.35
Work status21.95 (36.09)10.67 (26.67)7.97 (22.07)8.90 (22.58)0.01
Cognitive function80.78 (19.38)78.25 (16.89)74.62 (22.04)77.37 (22.04)0.31
Quality of social interaction82.81 (18.90)83.94 (17.01)80.99 (19.10)77.74 (22.42)0.20
Sexual function83.23 (23.15)68.94 (30.16)85.00 (21.23)75.00 (34.46)0.09
Sleep36.10 (13.62)41.93 (15.30)42.33 (16.56)40.02 (15.29)0.07
Social support77.71 (29.37)82.01 (27.94)82.63 (28.79)83.56 (28.26)0.58
Dialysis care
Staff encouragement86.09 (25.78)90.59 (17.09)91.12 (19.66)89.93 (19.97)0.42
Patient satisfaction63.62 (24.86)57.30 (22.47)55.71 (24.22)60.31 (20.90)0.15
36-item health survey (SF-36)
Physical functioning59.39 (28.70)44.61 (29.77)40.69 (32.21)32.17 (26.39)<0.001
Role-physical36.97 (37.90)23.37 (28.47)20.71 (30.68)26.40 (31.23)0.01
Pain69.55 (26.34)60.92 (29.93)64.36 (28.39)57.33 (33.49)0.06
General health34.94 (22.48)33.45 (21.35)35.41 (22.86)37.43 (20.96)0.72
Emotional well-being62.80 (24.28)61.07 (23.83)59.08 (26.16)63.11 (26.10)0.75
Role-emotional49.14 (30.41)43.18 (34.08)47.89 (30.43)42.02 (31.33)0.42
Energy/Fatigue50.73 (19.66)47.87 (17.60)49.30 (21.63)45.75 (20.54)0.45
Social function70.78 (33.49)74.15 (31.93)64.06 (36.15)63.82 (35.51)0.15
Table 3.  HRQOL results based on the KDQOL-SF instrument for ESRD patients on OL-HDF, according to age (quartiles)
ESRD patients 1st quartile: < 56 years oldESRD patients 2nd quartile: 57–68 years oldESRD patients 3rd quartile:69–75 years oldESRD patients 4th quartile: > 75 years oldP value (ANOVA analysis) womenP value (ANOVA analysis) men
Women (n=25)Men (n=52)Women (n=32)Men (n=54)Women (n=31)Men (n=39)Women (n=35)Men (n=37)
ESRD-targeted Areas
Symptoms/problem list74.13 (17.69)77 83 (17.94)69.65 (17.19)80.11 (11.61)*70.31 (13.22)77.74 (18.81)*71.14 (17.96)81.09 (14.84)*0.770.69
Effects of kidney disease63.07 (21.60)66.07 (24.11)59.48 (23.90)65.50 (20.07)63.23 (21.19)68.83 (22.67)69.94 (14.98)73.57 (16.56)0.220.31
Burden of kidney disease31.25 (26.45)28.07 (26.83)28.07 (26.83)17.38 (18.83)20.83 (21.67)30.43 (27.96)21.61 (22.86)24.01 (23.90)0.140.655
Work status19.23 (31.87)23.21 (38.10)1.52 (8.70)15.45 (33.16)*8.06 (22.72)7.89 (21.83)10.00 (23.64)7.89 (21.83)0.030.50
Cognitive: function76.11 (19.11)82.83 (19.31)75.98 (18.59)79.72 (15.95)70.04 (25.10)78.32 (18.75)73.51 (22.93)81.02 (20.83)0.670.67
Quality of social interaction82.36 (20.81)82.99 (18.22)81.05 (15.81)85.41 (17.65)80.32 (18.31)81.52 (19.92)70.70 (23.62)84.60 (19.10)*0.680.76
Sexual function76.39 (28.26)85.16 (21.64)65.63 (31.87)68.75 (30.17)72.50 (25.62)91.25 (16.72)100.00 (0.00)62.50 (36.80)0.500.25
Sleep37.31 (15.94)35.55 (12.55)45.55 (14.09)40.12 (15.70)43.89 (11.89)41.13 (19.49)43.65 (17.07)36.58 (12.68)0.180.21
Social support71.15 (35.76)80.70 (25.74)82.83 (28.71)81.17 (27.86)81.18 (30.04)83.75 (28.11)88.89 (24.88)78.38 (30.65)0.140.86
Dialysis care
Staff encouragement88.94 (23.27)84.72 (27.00)90.53 (16.25)90.45 (17.83)95.56 (8.87)87.50 (24.83)88.89 (22.52)90.97 (17.32)0.440.48
Patient satisfaction71.79 (23.93)59.82 (24.57)*57.58 (23.60)56.36 (21.39)58.33 (21.59)53.51 (26.33)58.77 (17.21)61.84 (24.17)0.040.41
36-item health survey (SF-36)
Physical functioning46.54 (25.56)65.36 (28.31)*31.97 (30.15)52.45 (27.23)*35.78 (31.21)44.63 (32.84)30.00 (28.95)34.34 (23.74)0.14<0.00l
Role-physical35.58 (37.24)37.61 (38.52)16.41 (25.39)27.61 (29.77)*13.67 (20.66)26.64 (36.32)*26.32 (33.49)26.48 (29.26)0.020.27
Pain60.19 (29.15)73.82 (24.03)*49.30 (33.11)67.36 (25.89)*52.06 (30.09)74.39 (22.75)*47.08 (34.39)67.58 (29.58)*0.420.37
General health32.24 (21.48)36.14 (23.00)28.24 (21.41)36.52 (21.08)27.13 (19.05)42.21 (23.69)*35.97 (24.85)38.84 (16.55)0.320.52
Emotional well-being58.00 (25.33)64.91 (23.73)53.48 (20.71)65.82 (24.72)*52.50 (26.61)64.49 (24.84)59.72 (26.62)66.32 (25.54)0.580.98
Role-emotional40.51 (30.40)53.21 (29.83)36.57 (35.36)47.30 (32.93)38.54 (28.62)55.56 (30.06)*41.58 (33.01)42.46 (29.99)0.920.21
Energy/Fatigue49.60 (20.96)51.23 (19.23)44.70 (17.04)49.55 (17.91)42.34 (21.74)55.00 (20.07)*44.72 (20.97)46.76 (20.35)0.600.29
Social function66.83 (34.99)72.59 (32.94)68.75 (35.50)77.50 (29.79)59.77 (38.85)67.50 (33.94)57.57 (37.28)70.07 (32.95)0.540.47
Table 4.  HRQOL results based on the KDQOL-SF instrument for ESRD patients on OL-HDF, according to age (quartiles) and gender.
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