Quality of Life in CAPD, Transplant, and Chronic Renal Failure Patients with Diabetes

Figures & data

Table 1 Demographic data of all study groups

	CAPD: DM	CAPD: no DM	TXP	CKD: DM	p
Number of patients	19	26	20	20	NS
Age (years, M ± SD)	54.2 ± 13.9	53.6 ± 12.7	49.2 ± 11.4	53.4 ± 8.6	NS
Sex (M/F)	12/7	15/11	10/10	11/9	NS
Marital status (M/S/D/W), %	78/11/6/5	65/16/8/11	89/11/−/−	92/8/−/−	NS
Employment (E/UE/HW/R), %	22/33/6/39	46/11/19/24	50/−/17/33	42/17/25/16	NS
Type of diabetes (I/II), n	13/6	NA	15/5	7/13	0.03
Duration of diabetes (months)	21.5 ± 7.5	NA	23.1 ± 9.4	22.7 ± 8.9	NS
Treatment of diabetes (I/O/D), n	17/1/1	NA	19/−/1	14/6/−	NS
Duration of dialysis (months)	12 ± 10	24 ± 19	NA	NA	0.01
Hb (g/dL)	10.1 ± 1.2	11.1 ± 1.4	12.7 ± 1.8	11.5 ± 1.7	< 0.001
HbA1c (%)	8.3 ± 1.3	NA	8.7 ± 1.4	9 ± 1.3	NS
Urea (mmol/L)	22 ± 7.5	21 ± 4.5	13 ± 5.5	16 ± 6	< 0.001
Creatinine (mmol/L)	690 ± 188	856 ± 231	171 ± 45	209 ± 89	< 0.001
Albumin (g/L)	35 ± 3.4	37 ± 5.4	41 ± 2.9	41 ± 4.8	< 0.001
Ca (mmol/L)	2.5 ± 0.1	2.6 ± 0.1	2.4 ± 0.1	2.3 ± 0.1	< 0.001
PO4 (mmol/L)	1.6 ± 0.6	1.7 ± 0.4	1 ± 0.2	1 ± 0.3	< 0.001
HCO3 (mEq/L)	26 ± 2.6	27 ± 3.4	No data	27 ± 2.9	NS
Proteinuria (g/day)	NA	NA	No data	2.6 ± 2.6	NA
EPO treatment (Y/N)	8/11	11/15	NA	NA	NS
VPT	30 ± 10	13 ± 4	21 ± 11	28 ± 11	< 0.001
NDS	7.3 ± 2.8	1.8 ± 1.5	3.6 ± 2.6	6.7 ± 4.1	< 0.001
NSS	6.3 ± 2.1	1.6 ± 4	3.6 ± 3.8	4.3 ± 4.5	< 0.001
History of transplant (Y/N)	0/19	7/26	N	N	0.01

Abbreviations: M = married, S = single, D = divorced, W = widow/er, E = employed, UE = unemployed, HW = housekeeping, R = retired, Y = Yes, N = No, NA = Non-applicable, I = insulin, O = oral agents, D = Diet; for VPT, NDS, NSS see text.

Table 2 Presence of co-morbidity in all study groups

	CAPD: DM	CAPD: no DM	TXP	CKD-DM	p
Number of patients	19	26	20	20	NS
Diabetic retinopathy (Y/N)	17/2	NA	17/3	17/3	NS
Blindness (Y/N)	4/15	NA	1/19	2/18	NS
Diabetic neuropathy (Y/N)	15/4	NA	13/7	16/4	NS
Ischaemic heart disease (Y/N)	10/9	5/21	4/16	6/14	0.07
History of MI (Y/N)	3/16	4/22	0/20	1/19	NS
History of foot ulcer (Y/N)	4/15	NA	4/16	4/16	NS
Cerebrovascular accident (Y/N)	3/16	4/22	2/18	1/19	NS
Peripheral vascular disease (Y/N)	6/13	3/23	1/19	2/18	0.09
History of amputation (Y/N)	1/18	NO	1/19	NO	NS

Abbreviations: Y/N = Yes/No, NA = non-applicable.

Table 3 Scoring results of all groups: General questionnaire SF-36

SF-36	CAPD: DM	CAPD: no DM	TXP	CKD: DM	p
Physical functioning	23.7 ± 5	36 ± 4.7	51.5 ± 6.6	46.4 ± 8.4	0.01
Role limitation (physical problems)	16.2 ± 8	12 ± 3.8	47.5 ± 10	47.5 ± 0.2	0.001
Role limitation (mental)	33.3 ± 11	34.7 ± 8.6	76.7 ± 9	55 ± 10.6	0.007
Social functioning	42.1 ± 8.2	49.3 ± 4.7	76.7 ± 5	66.7 ± 6.8	0.001
Mental health	61 ± 5.8	61 ± 3.5	70.6 ± 4.4	63.8 ± 5.8	0.45
Energy and vitality	29.5 ± 5.1	32.4 ± 3.7	52.8 ± 4.4	45.8 ± 6.6	0.003
Pain	52.6 ± 7.8	52.4 ± 5.9	64.4 ± 5.3	49.4 ± 7.1	0.40
Health perceptions	23.3 ± 5.6	35 ± 4.5	39.2 ± 5	34 ± 6	0.20
Change in health	52.8 ± 5	52.9 ± 4.5	50 ± 4.3	52.5 ± 5.1	0.97

Note. Highest score = better quality of life.

^* The p value is for a one-way ANOVA between the four groups.

Table 4 Renal specific questionnaire (RQOLP, scoring of all groups)

RQOLP	CAPD: DM	CAPD: no DM	TXP	CKD: DM	p
Eating/drinking	51.5 ± 26	47.5 ± 21.7	13.8 ± 14	29.4 ± 24	0.001
Physical activity	71 ± 26	57 ± 19	35 ± 27	53.4 ± 36	0.003
Leisure activity	80 ± 25	63.3 ± 24	20.2 ± 24	34 ± 36	0.001
Psychosocial aspects	50 ± 31	45 ± 19	26 ± 16	39 ± 33	0.01
Treatment effects	45.5 ± 32.2	47.2 ± 18.2	33.7 ± 22.9	40.4 ± 32	0.31
Normal life (Y/N)	3/16	5/21	11/7	10/9	0.003
Stop working (Y/N/NA)	9/6/4	12/10/4	6/11/3	2/10/6	0.03

Higher score = worse quality of life.

Although each subscale of RQOLP questionnaire was tested (with Kolmogorov-Smirnov test) and found normally distributed, because of the high variation of the standard deviation, the comparisons between groups were made using the Kruskal-Wallis test.

Table 5 Spearman correlation coefficients in the whole sample of patients between the study domains of the two instruments

	RQOLP
SF-36	Eating/drinking	Physical activity	Leisure	Psychosocial aspects	Treatment effects
Physical functioning	0.2	0.73	0.52	0.46	0.38
Role limitation (physical)	0.27	0.5	0.46	0.39	0.3
Role limitation (mental)	0.2	0.37	0.36	0.4	0.24
Social functioning	0.4	0.6	0.64	0.68	0.55
Mental health	0.28	0.52	0.41	0.64	0.57
Energy/vitality	0.33	0.6	0.58	0.52	0.42
Pain	0.2	0.66	0.38	0.5	0.53
Health perceptions	0.29	0.64	0.43	0.58	0.58
Change in health	0.22	0.06	0.03	0.1	0.03

Table 6 Results of analysis of co-variance for comparisons of all patients, with the use of both instruments in respect to subscales of all their domains, adjusted for co-morbidity, age, sex, duration of dialysis, neuropathy, and laboratory variables

Variable	No adjustment	Adjustment for age, sex, co-morbidity, dialysis duration	Adjustment for age, sex, co-morbidity, dialysisduration, and VPT	Adjustment for age, sex, co-morbidity, dialysis duration, VPT, and laboratory variables
RQLP A	<0.0005	<0.0005	0.0005	0.74
RQLP B	0.001	0.069	0.12	0.77
RQLP C	<0.0005	<0.0005	<0.0005	0.083
RQLP D	0.024	0.18	0.17	0.83
RQLP E	0.35	NA	NA	NA
SF-36 physical activity	0.017	0.091	0.057	0.50
SF-36 role limitation (physical)	0.001	0.002	<0.0005	0.48
SF-36 role limitation (mental)	0.007	0.026	0.069	0.89
SF-36 social functiononig	0.001	0.005	0.001	0.89
SF-36 mental health	0.45	NA	NA	NA
SF-36 energy/vitality	0.003	0.020	0.001	0.18
SF-36 bodily pain	0.40	NA	NA	NA
SF-36 health perceptions	0.20	NA	NA	NA
SF-36 health change	0.97	NA	NA	NA

Abbreviation: NA = Non-applicable because p value (adjusted) was NS. From the above table, it is seen that adjustment for age, sex, comorbidity, duration of dialysis, and neuropathy (VPT) showed differences between groups for RQLP B and D, and physiacl activity and role limitation (mental) disappear. Moreover, additional adjustment for laboratory variables made all statistical differences disappear.

RQLP A,B,C,D,E are refering to RQLP domains (see text).