Children on hemodialysis show greater improvements in quality of life post-transplant than those on PD

DALLAS — Following kidney transplant, children with ESRD who were on hemodialysis showed greater improvements in quality of life scores than did those who were on PD, according to findings presented at the Annual Dialysis Conference.

“There has been a dramatic decrease in the mortality risk of children with ESRD in recent decades,” Cortney Taylor Zimmerman, PhD, of the department of pediatrics, renal section, at Baylor College of Medicine and Texas Children’s Hospital in Houston, and colleagues wrote. “With increasing life expectancy, there is a need for further research into patient quality of life (QoL) to address the question of whether patients are ‘living well.’ This study is one of the first to longitudinally follow pediatric QoL over time for the same patient and caregiver proxy from chronic dialysis to kidney transplant.”

To examine the change in QoL for pediatric patients from dialysis to transplant, researchers considered responses to the pediatric quality of life inventory 4.0 generic core scales from 19 caregiver/patient dyads (31% were men; aged 2 to 17 years). The questions addressed a variety of measures including physical, emotional and school functioning.

Researchers found patients reported higher overall QoL than did caregivers for both dialysis and transplant and that there were no significant improvements in any of the caregiver response categories. Researchers also found that, although patient self-report scores did not significantly improve after transplant for those who had been on PD (74.8 while on PD vs. 74.9 post-transplant), patients who had been on hemodialysis had increases in total QoL score (75.8 vs. 85.2) and in the health and activity score (75 vs. 87.5). Researchers hypothesized that this may be related to the fact that children on hemodialysis have restricted activity as they are required to go to the hospital three times a week for treatments.

As QoL scores increased for patients who had been on hemodialysis but not for patients who had been on PD, researchers concluded that this study emphasizes “the convenience of home therapies.”

“Further research is needed to examine these findings within a larger population, change in scores over time on transplant, as well as to attempt to better understand potential contributing factors and differences in treatment modalities,” the researchers wrote. “This could lead to the identification of potentially modifiable factors with the goal of improving quality of life and medical outcomes.” – by Melissa J. Webb

Reference:

Zimmerman CT, et al. The Quality of life journey from dialysis to transplant in pediatric end-stage renal disease patients. Presented at the Annual Dialysis Conference; March 16-19, 2019; Dallas.

Disclosure: Healio/Nephrology was unable to confirm relevant financial disclosures prior to publication.