Biomedical subjects
P Rebollo
Publications and source records attributed to P Rebollo.
[Changes in health-related quality of life in the first year of kidney transplantation].
OBJECTIVE: To study the changes in the health related quality of life (HRQOL) during the first year following renal transplant (RT), comparing azathioprine vs mycophenolate mofetil (MMF) in triple immunosuppressant therapy with prednisone and cyclosporine. METHODS: Prospective, open and random study with 26 patients who received a primary cadaveric renal transplant consecutively. Analysis of clinical variables: delayed graft function (DGF), acute rejection (AR), infections and comorbidity; analytical: haemogram, albumin and serum creatinine, hepatic function, cyclosporin levels; instruments for assessing the HRQOL: Psychological General Well-being Index (PGWBI) and Euroqol-5d (EQ-5d) health questionnaire, which includes a self-assessment scale of the state of health, Visual Analogical Scale (VAS). Controlled collection of data upon discharge following renal transplant, and subsequently 1, 3, 6, and 12 months following the first questionnaire. RESULTS: There were no differences between patients on azathioprine or MMF, except that AR occurred less frequently with MMF (7% vs 42%, p = 0.065). Global AR: 23%, cytomegalovirus infection/illness: 81%/8%, readmissions: 42%. There was an improvement in HRQOL measured by the progressive increase in the scores on the PGWBI, EQ-5d and VAS during the first three months following RT. By the sixth month, in comparison to the third, a decrease in the score was observed (PGWBI, p = 0.011). Later the HRQOL improved, but without reaching the maximum scores achieved. CONCLUSIONS: Patients on MMF showed less frequent incidence of AR. The HRQOL decreases during the third and the sixth month, but with less intensity in patients on MMF, probably related to the lower rate of AR, and excluding the over 60s.
Is the loss of health-related quality of life during renal replacement therapy lower in elderly patients than in younger patients?
BACKGROUND: Previous studies have reported that elderly (aged 65 years or over) end-stage renal disease (ESRD) patients have poorer health-related quality of life (HRQOL) than both younger patients and healthy subjects of the same age. The aim of present study was to evaluate the effect of ESRD and its treatment on the HRQOL, and to determine the effects of age and gender. METHODS: A cross-sectional multicentric study was carried out with 485 haemodialysis and renal-transplant patients, using the SF-36 Health Survey to evaluate their HRQOL. SF-36 scores were standardized by age and gender using Spanish normative data. Karnofsky scale score (KS), socio-demographic, and clinical data were also collected. RESULTS: In renal-replacement therapy (RRT), chronic haemodialysis, and renal-transplant patients, SF-36 standardized scores of elderly patients were higher than in younger patients. Therefore the reduction in HRQOL of elderly patients, in relationship with that of the general population of the same age and gender, was lower than in younger patients. In the case of renal-transplant patients, standardized scores in elderly patients were higher than in the general population for all parameters. CONCLUSIONS: Using standardized scores, elderly patients on renal replacement therapy (haemodialysis and kidney transplant) had relatively better HRQOL than younger patients, and in the case of transplant patients, they had even better HRQOL than in the general population of the same age and gender.
Health related quality of life (HRQOL) of kidney transplanted patients: variables that influence it.
UNLABELLED: The incidence and prevalence of patients on renal replacement therapy (RRT) who receive a renal transplant are continuously increasing in Spain. At the moment, they are the main group of end-stage renal disease (ESRD) patients in our region (60% of total RRT patients). The aim of the present study was to assess the health related quality of life (HRQOL) of kidney transplanted patients of our region, and to identify socio-demographic and clinical variables that influence it. The intention was also to compare the HRQOL of these patients with that of chronic haemodialysis (HD) patients and of the general population. METHODS: Two hundred and ten kidney transplanted patients and 170 HD patients were evaluated using the Karnofsky performance scale (KPS), sickness impact profile (SIP), and SF-36 Health Survey (SF-36). Socio-demographic and clinical data, including a comorbidity index (CI), were also collected. To compare our patients with the general population we used SF-36 mean scores from an aleatory sample taken from our region. RESULTS: Transplant patients had lower mean scores on SIP dimensions and higher scores on SF-36 dimensions than chronic HD patients. In transplant patients, we found significant differences on SIP and SF-36 scores in gender, educational level, haematocrite and haemoglobin, CI, time since transplantation, and KPS. CONCLUSIONS: The HRQOL of transplant patients is clearly better than that of chronic HD patients and similar to that of the general population. Differences in the HRQOL within transplant patients did not appear to be as a result of patient's age, but rather it would appear to be a consequence of gender, analytic figures, CI, KPS score, time with transplant, and educational level.
[Introduction to the 6th International Symposium of the "Reina Sofía" Institute of Nephrologic Research].
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Health-related quality of life (HRQOL) in end stage renal disease (ESRD) patients over 65 years.
OBJECTIVES: The aim of the study was to assess Health Related Quality of Life (HRQOL) of elderly patients on renal replacement therapy (RRT) of our region, and to identify socio-demographic and clinical variables which influence it. We also attempted to compare HRQOL of transplant patients, with that of chronic hemodialysis patients. DESIGN: Cross-sectional study. SETTING: Institutional Hospital Nephrology Unit. PATIENTS: All patients from 9 of the 10 hemodialysis centres in our region, aged 65 years or more, who had been on RRT (chronic hemodialysis and kidney transplantation) for at least three months, showing no cognitive problems, were included. The sample included 124 patients. INTERVENTIONS: These patients participated in a structured interview using two generic HRQOL questionnaires: Sickness Impact Profile and SF-36 Health Survey. Karnofsky Scale, Comorbidity Index, socio-demographic and clinical data, were also collected. RESULTS: The median age was 71 years (range 65-75); 55.6% of the patients were male; 19.8% of the sample were transplant patients and 80.2%, hemodialysis patients (only 2% on renal transplant waiting list); 69.2% had a low-intermediate socio-economic level, 52.9% had elementary studies, and 10.6% lived alone. Transplant patients had higher HRQOL than hemodialysis patients. Women had lower HRQOL than men. A higher economic level, higher educational level, higher Karnofsky Performance Scale, and lower Comorbidity Index score, were associated with higher HRQOL. CONCLUSIONS: The good HRQOL of elderly transplant patients, in comparison with hemodialysis patients, is an important reason for advising kidney transplants in elderly patients. Economic and educational levels, functional status and comorbidity are variables which influence the HRQOL of these patients.
[Factors associated with health related quality of life in patients undergoing renal replacement therapy].
The aim of this study was to investigate the sociodemographic and clinical variables which influence health-relate quality of life (HRQOL) of patients on renal replacement therapy (RRT). A cross-sectional study was carried out with a sample including all patients on hemodialysis (n = 170) and transplant patients (n = 210) of our region. The HRQOL assessment instruments used in this study were: the Spanish versions of the sickness impact profile (SIP) and the SF-36 health survey (SF-36). Sociodemographic and clinical data (including age at start of RRT, age at the interview, gender, hospital, socioeconomic level, educational level, living conditions, inclusion in transplant waiting list, renal disease diagnosis, time in any RRT, hemoglobin, hematocrit, serum urea, creatinine, proteins and albumin, hospital admissions and length of hospital stay during last year), a comorbidity index and the Karnofsky performance scale score step. To investigate which studied variables had independent influence over the HRQOL measures, logistic regression method was employed in the case of the SF-36, and multiple regression, in the case of the SIP. A model was adjusted step by step in each RRT method (hemodialysis and transplantation) for each dimension of the PCE (physical dimension, psychosocial dimension and total score), and for each component summary score of the SF-36 (physical and mental component summary). In patients on hemodialysis, variables associated with better HRQOL were: higher age, female gender, higher educational level, and better functional status; and variables associated with worse HRQOL were: higher number of hospital admissions, and higher comorbidity index. In transplant patients, variables associated with better HRQOL were: higher age and higher functional status; and variables associated with worse HRQOL were: longer time on dialysis before transplant, longer time with functioning transplant, and higher comorbidity index. Despite the independent influence on the HRQOL demonstrated for some of the studied variables, it seems that HRQOL assessment instruments scores may mainly depend on other non-studied variables, and it may be that these instruments evaluate other aspects of the patients which have not been taken into account until now.
[Interpretation of health-related quality of life of patients on replacement therapy in end-stage renal disease].
UNLABELLED: STATEMENT: Older age is associated with a worse Health-Related Quality of Life (HRQOL) in patients with End-Stage Renal Disease (ESRD). The aim of this study is to demonstrate that differences on HRQOL between two groups of patients, defined according to age (< 65 years and > or = 65 years or elderly), change according to the form in which the results are analysed. METHODS: We evaluated the HRQOL of 170 patients undergoing hemodialysis and 210 transplant patients from Asturias (Spain), using the SF-36 Health Survey. Sociodemographic and clinical data, Karnofsky Scale and a Comorbidity Index were also collected. The raw scores of the SF-36 and the standardised scores according to age and gender were employed. RESULTS: The majority of elderly patients on hemodialysis lived alone, constituted a smaller percentage on the transplant waiting list, had a lower serum albumin and lower score of the Karnofsky Scale, than patients under 65 years. No differences were found in transplant patients. The raw scores on the SF-36 were less for the elderly patients on hemodialysis and transplant. The raw scores for elderly undergoing hemodialysis were less than those obtained by the general population, and raw scores for elderly transplant patients were similar or slightly greater. The standardized scores of the SF-36 were greater for the elderly in both treatment groups. CONCLUSIONS: Important differences exist in the evaluation of HRQOL differences between the two groups of age according to the method of analysing the results. The HRQOL of elderly patients is better than that of patients under 65 years of age.
[Physical symptoms and emotional disorders in patient on a periodic hemodialysis program].
OBJECTIVES: To establish the frequency and severity of somatic symptoms and emotional distress (anxiety and/or depression) among our chronic hemodialysis (CHD) patients and to study the relationship between them as well as their influence on the perceived health status. PATIENTS AND METHODS: All patients who had been on CHD for a minimum of three months were eligible for the study. Eight of them were excluded: six because they were unable to answer the questionnaires and two because they refused to participate. The 58 remaining patients were the subject of our study (median age 68.5 years; median duration of HD 29.5 months). Diverse sociodemographic and clinical data were recorded. The patients answered the following questionnaires: 1) The "physical symptoms" dimension of the Kidney Disease Questionnaire; 2) A measure of anxiety (STAI); 3) A measure of depression (Beck Depression Inventory and Cognitive Depression Index); and 4) The Nottingham Health Profile (NHP). RESULTS: The most frequent and severe symptoms were tiredness, itching, thirst, bone and joint pain and sleep disturbance. The severity of the symptoms was positively associated with female sex, and the presence of clinically relevant degrees of anxiety and/or depression. A quarter of the patients were anxious and almost half of them suffered from depression. Emotional disturbances were associated with the severity of somatic symptoms and comorbidity. Only anxiety and depression were significantly associated with the global NHP score; they explained 47% of its variance. A score of 50 or more in the "Emotional Reactions" dimensions with the NHP detected 69% of the patients with anxiety and 81% of those with depression. CONCLUSIONS: Somatic symptoms are common among patients on CHD and they appear to be associated with emotional distress (anxiety and depression) that influences significantly the perceived health status. Measuring the perceived health status by means of generic and specific questionnaires, may help to establish the diagnosis of these problems.
[Controversies in nephrology: dialysis in the elderly].
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