Although there have been several studies about quality of life in patients on hemodialysis globally, only few studies have been conducted in the Sub-Saharan Africa (SSA). It has been suggested that nephrologists must look not only at the biological outcomes but also at the patient’s perceptions of their quality of life to properly assess patient status [13]. Thus, the use of measuring HRQOL as a primary outcome of various interventions in ESKD treatment regimens is increasingly being accepted [14].
The principal findings of this study was that a substantial proportion of the patients with ESKD on hemodialysis in Addis Ababa, Ethiopia had lower HRQOL. From the subscales, consistent with the study findings from Kenya and Chile [13, 15], the patients had lower mean scores in the PCS, SF-12, and MCS. The highest scores were observed on the BKD and Symptom/Problem list subscales which is consistent previous studies conducted in Kenya, India, Chile and Malaysia [13, 15 – 18]. The findings of this study underscore that there is a need to assess the patients’ quality of life during the follow up and appropriate measures have to be taken to reassure the patients.
Consistent with previous studies [15-18, 20], patients on hemodialysis in this study showed higher scores in MCS than in PCS. This means, despite the worsening of the physical health status, the mental health of dialysis patients is relatively preserved. This may reflect the ability of ESKD patients to adapt psychologically to their situation over time. Moreover, consistent to the study conducted in Netherlands [21], it was found that in patients who stayed on their initial dialysis modality, the physical QOL decreased over time, whereas the mental QOL tended to remain stable.
HRQOL was found to be associated with unemployment status of the patients and frequency of the hemodialysis. Similar findings have been also reported by previously conducted studies [15–17]. The findings of this association might imply that financial hardships to cover the expenses of hemodialysis could have attributed to the lower HRQOL. In the further subgroup analysis, older age (>50 years) patients had higher BKD compared to the younger patients. The subscale of BKD indicates that how much kidney disease interfere with daily life about time taking, frustration and making the respondent feel like a burden [11]. Thus, this finding showed that the kidney disease is more burdensome for the elderly patients on maintenance dialysis, compared to younger patients. This finding is consistent with many previous studies done in UAE, Chile, Romania, Korea and India [15, 17, 20-22]. This finding underscores that there is need for special attentions for the care and reassurance of the elderly patients. Moreover, the present study showed that patients with 2 times of hemodialysis per week were more likely to have lower HRQOL in Burden of Kidney disease. It is in the same line that 3 times weekly hemodialysis has been standard way of treatment to control uremia [23-26].
To our knowledge, while there are few studies done for all stages of CKD patients, this study specifically targeted only for ESKD patients on maintenance dialysis as a first time in Ethiopia. Besides, this study was done in both private and governmental (public) hospitals where the payment of dialysis has huge difference. By covering both types of hospitals, it can show relatively generalized information possibly from the people who can afford hemodialysis payment without difficulty for the private hospital to the people who has had difficulty to pay for the governmental hospital. We have used a standard tool (KDQOL-36TM ) to assess the HRQOL in our study, which is useful to make international comparisons of our findings. However, this study could be limited in several regards. The sample size included in the study was minimal and might be underpowered to detect associations. Furthermore, there are some missing variables which has been known as important factors for dialysis patients such as Calcium, Phosphorus level and dialysate flow rate on Kt/V, which might give us additional information for the chronic dialysis patients. Due to the nature of interview-based data collecting, there might be reporting bias by data collectors or social desirability bias and recall bias by the patients.
In conclusion, this study showed that a substantial proportion of the patients with ESKD on hemodialysis in Addis Ababa had lower overall HRQOL which associated with their unemployment status and frequency of hemodialysis per week. Therefore, not only clinical treatment but also quality of life of patients with chronic dialysis should be given special attentions during the hemodialysis patients’ care.