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Quality of life in advanced renal disease managed either by haemodialysis or conservative care in older patients
  1. Clare McKeaveney1,
  2. Miles Witham2,
  3. Abrar O Alamrani1,
  4. Alexander Peter Maxwell3,4,
  5. Robert Mullan5,
  6. Helen Noble1,
  7. Joanne Shields4 and
  8. Joanne Reid1
  1. 1School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
  2. 2NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
  3. 3Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland
  4. 4Regional Nephrology Unit, Belfast City Hospital, Belfast Health Social Care Trust, Belfast, Northern Ireland
  5. 5Department of Nephrology, Antrim Area Hospital, Northern Health Social Care Trust, Antrim, Northern Ireland
  1. Correspondence to Professor Joanne Reid, School of Nursing and Midwifery, Queen's University Belfast, Belfast BT9 7BL, UK; j.reid{at}


Objective Consideration of quality of life (QoL) in people with end-stage renal disease has become an important part of treatment decision-making. The aim of this study was to report on QoL and other functional outcomes in patients with advanced chronic kidney disease (CKD).

Method This was a cross-sectional study. Two samples of older patients (>60 years old) either conservatively managed (CM) or receiving hospital-based haemodialysis (HD), compared Kidney Disease Quality of Life (KDQoL-36) outcomes.

Results Data from 263 CM patients (CKD 4 n=188, mean age 73.6 years, 48 women; CKD 5 n=75, mean age 74.4 years, 26 women) and 74 patients on HD (mean age 73.8 years, 24 women) were analysed. Significant group differences were identified for two subscales of KDQoL-36. Symptoms/Problems List subscale was significantly better for those receiving HD compared with those CM with CKD 5 (p=<0.001). Symptom/Problem List scores of CM CKD stage 4 patients were not significantly different compared with HD patients but were significantly better than CM CKD stage 5 patients (p<0.001). Burden of Kidney Disease subscale was significantly better for both CKD 4 (p<0.001) and CKD 5 (p<0.001) CM patients when compared with those receiving HD.

Conclusion Symptoms of advanced CKD significantly impact QoL for patients CM with CKD stage 5. Conversely, QoL is significantly impacted for those in receipt of HD due to the burden of treatment. These findings provide evidence for the use of QoL tools to help with clinical prognostication in advanced CKD. Using QoL tools will ensure specialist support is available for appropriate management of patients with CKD.

  • renal failure
  • supportive care
  • clinical decisions
  • quality of life

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  • Contributors JR is the principal investigator of the HD study and MW is the principal investigator of the CK study. CK completed data analysis. CK, JR and MW completed the initial draft of this manuscript.

  • Funding Study 1 was funded by the Public Health Agency (STL/5179/15) and the Northern Ireland Kidney Research Fund. Study 2 was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme (project reference 10/71/01). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Governance approval for the HD study was obtained from the Office of Research Ethics Committees Northern Ireland (ORECNI; HD study 1- REC reference: 16/NI/0233) and was funded by the Northern Ireland Public Health Agency/Northern Ireland Kidney Research Fund. The BicARB trial, from which the CM data were obtained, was approved by the East of Scotland National Health Service research ethics committee (approval 12/ES/0023), the Medicines and Healthcare Regulatory Authority (EudraCT number 2011-005271-16; Clinical Trial Authorisation number 41692/0001/001–0001) and was funded by the National Institute for Health Research Health Technology Assessment programme (reference 10/71/01).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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