Quality of Life and Health Status among those receiving Renal Replacement Therapy in Trinidad and Tobago. West Indies.

Abstract

\n Purpose:The determinants of quality of life for patients on renal replacement therapy vary across the world. In this cross sectional study, the factors accounting for a good quality of life in the resource-constrained twin-island of Trinidad and Tobago will be explored.Patients and methods:Five hundred and fifty three patients met inclusion criteria for the study. From the 103 patients receiving renal transplants, 100 participated and among the 84 on peritoneal dialysis, 80 took part in the study. Among the 1000-odd patients who were receiving hemodialysis, 350 were studied using convenience sampling. To be included, one had to be on renal replacement therapy for 3 months or more and at least 18 years of age. The Kidney Disease Quality of Life (KDQOL-36) and the EuroQol (EQ-5D-3L) instruments were administered after demographic data was collected. Transplant recipients were further evaluated with the Kidney Transplant Questionnaire (KTQ). Inferential analysis of data included 95% confidence intervals, ordinary least squares regression, analysis of variance, pairwise correlation and Pearson’s bivariate analysis. SPSS24, STATA14 and MINITAB18 were used.Results:Of the 530 patients, 52.5% were male, 37.5% were in the 56-65 years age group and 51.3% were of Indo-Trinbagonian descent. Hypertension (25.5%) and type 2 diabetes mellitus (62.0%) were reported as the main causes of kidney disease in the dialysis group. In the transplant category, chronic glomerulonephritis (45%) was the main aetiology of kidney disease. The KDQOL-36 domain scores and significantly associated variables included modality of renal replacement, Charlson’s Comorbidity Index, ethnicity, income and employment status. Transplant patients performed the best in the KDQOL-36 and EQ-5D-3L. Patients on peritoneal dialysis had a better quality of life than hemodialysis patients. Increasing patients’ access to renal transplantation or peritoneal dialysis will markedly improve health status for the number of years on renal replacement therapy. Among patients on hemodialysis, an arteriovenous fistula or graft significantly impacted on quality of life.Conclusion:Renal transplant recipients enjoy the best quality of life and health state among patients on renal replacement therapy in Trinidad and Tobago. Given the limitations in resources, patients on peritoneal dialysis also enjoy a good quality of life while the presence of an arteriovenous fistula or graft improved quality of life scores for those receiving hemodialysis. Policies should be implemented to achieve an acceptable quality of life for all patients receiving renal replacement therapy.