Background
Methods
Data collection and measures
Analysis
Results
Demographic and clinical characteristics of study participants
Health related quality of life
Variable | Category | Sample n = 89 | % |
---|---|---|---|
Sex
| Female | 30 | 33.7 |
Male | 59 | 66.3 | |
Age
| < 45 years | 29 | 32.6 |
45–60 years | 33 | 37.1 | |
> 60 years | 27 | 30.3 | |
Education
| Post-secondary | 36 | 40.4 |
Secondary school | 26 | 29.2 | |
Primary or less | 27 | 30.3 | |
Marital status
| Married/ living together | 48 | 53.9 |
Never married | 23 | 25.8 | |
Separated or widowed | 18 | 20.2 | |
Ubudehe category
| 1 | 7 | 8.0 |
2 | 18 | 20.5 | |
3 | 63 | 71.6 | |
4 | 0 | 0 | |
Insurance coverage
| < 100% coverage | 29 | 32.6 |
100% coverage | 60 | 67.4 | |
Hemodialysis centers
| CHUK-CHUB | 14 | 15.7 |
King Faisal Hospital | 43 | 48.3 | |
Rwanda Military Hospital | 32 | 36.0 | |
Employment status
| Employed | 27 | 30.3 |
Retired | 12 | 13.5 | |
Unemployed | 50 | 56.2 | |
Number of comorbidities
| 0 | 8 | 9.0 |
1 | 44 | 49.4 | |
2 | 28 | 31.5 | |
3 or more | 9 | 10.1 | |
Number of medications
| < 3 drugs | 18 | 20.2 |
3–4 drugs | 38 | 42.7 | |
> 4 drugs | 33 | 37.1 | |
Hospitalized in the last 6 months (n = 87)
| No | 40 | 46.0 |
Yes | 47 | 54.0 | |
Albumin g/l
| < 35 | 21 | 23.6 |
35–40 | 40 | 44.9 | |
> 40 | 28 | 31.5 | |
Hemoglobin g/dl
| < 10 | 38 | 42.7 |
10–11 | 24 | 27.0 | |
> 11 | 27 | 30.3 | |
Prescribed number of HD sessions per week | 2 | 17 | 19.1 |
3 | 72 | 80.9 | |
Number of HD in past 30 days
| ≤ 10 sessions | 28 | 31.5 |
> 10 sessions | 61 | 68.5 | |
Hemodialysis access
| Fistula/ graft | 30 | 33.7 |
Semi-permanent dialysis catheter | 34 | 38.2 | |
Temporary dialysis catheter | 25 | 28.1 | |
Dialysis vintage
| < 12 months | 36 | 40.4 |
13–24 months | 22 | 24.7 | |
> 24 months | 31 | 34.8 |
Discussion
Study limitations:
Conclusion
Independent variables (reference group) | Overall KDQOL | Physical.Composite Summary | Mental.Composite Summary | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Crude ß coefficient (95% CI)
|
P value
|
Adjusted ß coefficient (95% CI)
|
P value
|
Crude ß coefficient (95% CI)
|
P value
|
Adjusted ß coefficient (95% CI)
|
P value
|
Crude ß coefficient (95% CI)
|
P value
|
Adjusted ß coefficient (95% CI)
|
P value
| |||
Sex (Female)
| ||||||||||||||
Male
| 6.57 (0.02, 13.04) | 0.04 | 8.54 (2.77, 14.26) | 0.008 | 6.84 (3.24, 10.41) | < 0.001 | 4.62 (1.02, 8.21) | 0.01 | -0.45 (-4.39, 3.42) | 0.81 | 0.61 (-2.86, 4.12) | 0.74 | ||
Age (< 45 years)
| ||||||||||||||
45–60 years
| 3.35 (-4.32, 11.49) | 0.40 | 6.23 (-0.37, 13.14) | 0.09 | -2.76 (-7.19, 1.91) | 0.23 | -1.32 (-5.40, 2.96) | 0.55 | 4.04 (-0.37, 8.85) | 0.08 | 3.83 (-0.17, 8.39) | 0.08 | ||
> 60 years
| 5.37 (-2.43, 13.47) | 0.18 | 6.68 (-1.67, 15.17) | 0.15 | -3.92 (-8.42, 0.74) | 0.09 | -4.19 (-9.50, 1.20) | 0.14 | 4.56 (0.05, 9.31) | 0.05 | 1.09 (-3.86, 6.36) | 0.68 | ||
Education (Primary school and less)
| ||||||||||||||
Secondary school
| 2.38 (-6.06, 10.56) | 0.56 | 0.75 (-4.16, 5.52) | 0.75 | 2.58 (-2.24, 7.45) | 0.24 | ||||||||
Post-secondary
| 2.17 (-5.33, 9.57) | 0.57 | 0.62 (-3.76, 4.93) | 0.77 | 2.70 (-1.81, 6.89) | 0.27 | ||||||||
Marital status (Never married)
| ||||||||||||||
Married/living together
| 3.59 (-3.63, 10.89) | 0.33 | -1.09 (-5.17, 3.01) | 0.60 | 1.37 (-2.94, 5.75) | 0.53 | ||||||||
Separated/widowed
| -4.77 (-13.75, 4.31) | 0.30 | -7.61 (-12.67, -2.49) | 0.004 | -1.48 (-6.84, 3.96) | 0.59 | ||||||||
Employment (Unemployed)
| ||||||||||||||
Employed
| 5.99 (-0.85, 12.89) | 0.09 | 8.16 (2.18, 14.29) | 0.01 | 4.85 (0.92, 8.80) | 0.01 | 3.88 (0.39, 7.39) | 0.04 | 2.32 (-1.66, 6.34) | 0.25 | 5.76 (2.09, 9.53) | 0.005 | ||
Retired
| 6.93 (-2.32, 16.37) | 0.14 | 4.23 (-5.01, 13.70) | 0.41 | 4.18 (-1.12, 9.58) | 0.12 | 5.68 (0.05, 11.40) | 0.06 | 6.45 (1.07, 11.96) | 0.02 | 8.18 (2.66, 13.86) | 0.007 | ||
Ubudehe category (1)
| ||||||||||||||
2
| 1.78 (-10.99, 14.66) | 0.78 | -0.75 (-7.75, 6.30) | 0.83 | -2.87 (-10.46, 4.80) | 0.46 | ||||||||
3
| 6.84 (-4.62, 18.56) | 0.25 | 4.41 (-1.87, 10.83) | 0.17 | -1.04 (-7.84, 5.96) | 0.76 | ||||||||
Health insurance coverage (< 100% coverage)
| ||||||||||||||
100% coverage | 4.77 (-1.84, 11.28) | 0.15 | 0.34 (-3.55, 4.17) | 0.86 | 1.08 (-2.86, 4.93) | 0.58 | ||||||||
Prescribed number of HD sessions per week (Twice)
| ||||||||||||||
Thrice
| -1.47 (-9.67, 6.46) | 0.71 | -0.48 (-5.26, 4.13) | 0.83 | -0.30 (-5.15, 4.35) | 0.89 | ||||||||
Number of HD in the past 30 days (≤ 10)
| ||||||||||||||
> 10
| -2.53 (-9.19, 4.09) | 0.45 | -0.39 (-4.27, 3.47) | 0.84 | -0.15 (-4.08, 3.74) | 0.93 | ||||||||
Hospitalized in the last 6 months (No)
| ||||||||||||||
Yes
| -3.61 (-9.88, 2.63) | 0.25 | -4.68 (-8.22, -1.15) | 0.01 | -1.97 (-5.66, 1.68) | 0.29 | ||||||||
Number of medications taking (< 3 drugs)
| ||||||||||||||
3–4 drugs
| -2.32 (-10.76, 6.01) | 0.58 | -4.22 (-9.06, 0.54) | 0.08 | -2.75 (-7.67, 2.08) | 0.27 | ||||||||
> 4 drugs
| -2.74 (-11.48, 5.80) | 0.53 | -3.72 (-8.74, 1.16) | 0.14 | -0.12 (-5.23, 4.83) | 0.96 | ||||||||
Albumin (< 35 g/l)
| ||||||||||||||
35–40 g/l
| 8.36 (0.65, 16.27) | 0.03 | 6.29 (-0.39, 13.17) | 0.09 | 3.07 (-1.47, 7.76) | 0.19 | 1.97 (-2.65, 6.77) | 0.41 | ||||||
> 40 g/l
| 8.86 (0.66, 17.27) | 0.03 | 2.47 (-4.92, 10.01) | 0.54 | 3.76 (-1.07, 8.75) | 0.13 | 2.36 (-2.55, 7.46) | 0.35 | ||||||
Hemoglobin (< 10 g/dl)
| ||||||||||||||
10–11 g/dl
| 9.44 (2.03, 16.82) | 0.01 | 7.27 (0.70, 13.72) | 0.04 | 1.84 (-2.59, 6.26) | 0.41 | 5.05 (0.66, 9.40) | 0.02 | ||||||
> 11 g/dl
| 2.39 (-4.75, 9.59) | 0.51 | 2.09 (-3.94, 8.13) | 0.53 | -0.59 (-4.89, 3.71) | 0.78 | 2.65 (-1.58, 6.91) | 0.22 | ||||||
Vintage (≤ 12 months)
| ||||||||||||||
13–24 months
| 8.65 (0.83, 16.80) | 0.03 | 10.47 (3.57, 17.58) | 0.008 | -0.44 (-5.09, 4.40) | 0.85 | 7.48 (3.04, 12.19) | 0.001 | 9.10 (5.03, 13.46) | < 0.001 | ||||
> 24 months
| 5.70 (-1.36, 13.03) | 0.12 | 9.71 (3.33, 16.30) | 0.007 | 1.52 (-2.68, 5.87) | 0.48 | 3.40 (-0.6, 7.63) | 0.107 | 6.30 (2.54, 10.30) | 0.003 | ||||
HD access (Fistula/graft)
| ||||||||||||||
Semi-permanent dialysis catheter
| -8.44 (-16.35, -0.89) | 0.03 | -6.20 (-10.69, -1.90) | 0.006 | -6.11 (-10.38, -1.94) | 0.008 | -3.88 (-8.62, 0.57) | 0.09 | ||||||
Temporary dialysis catheter
| -6.75 (-14.71, 1.01) | 0.09 | -5.59 (-10.12, -1.17) | 0.01 | -5.30 (-9.51, -1.16) | 0.02 | -3.00 (-7.75, 1.59) | 0.21 | ||||||
Number of comorbidities (0)
$
| ||||||||||||||
1
| -11.40 (-22.62, -0.52) | 0.04 | -15.31 (-25.17, -5.76) | 0.005 | -0.12 (-6.52, 6.08) | 0.96 | -3.28 (-9.11, 2.40) | 0.29 | -10.04 (-16.60, -3.74) | 0.003 | -9.55 (15.58, -3.82) | 0.003 | ||
2
| -11.14 (-22.79, 0.13) | 0.06 | -13.20 (-23.30, -3.46) | 0.01 | -4.55 (-11.20, 1.88) | 0.17 | -3.36 (-9.64, 2.72) | 0.31 | -6.51 (-13.33, 0.021) | 0.059 | -6.51 (-12.96, -0.57) | 0.04 | ||
3 or more
| -21.49 (35.22, -8.03) | 0.002 | -29.97 (-41.47, -18.32) | < 0.001 | -9.49 (-17.33, -1.81) | 0.01 | -9.06 (-16.42, -1.84) | 0.02 | -10.81 (-18.84, -3.012) | 0.009 | -12.55 (-19.97, -5.60) | 0.001 |
IndepenIndependent variables (reference) group) | Burden of kidney disease | Effects of kidney disease | Symptom problem of kidney disease | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Crude ß coefficient (95% CI)
|
P value
|
Adjusted ß coefficient (95% CI)
|
P value
|
Crude ß coefficient (95% CI)
|
P value
|
Adjusted ß coefficient (95% CI)
|
P value
|
Crude ß coefficient (95% CI)
|
P value
|
Adjusted ß coefficient (95% CI)
|
P value
| |
Sex (Female)
| ||||||||||||
Male
| 7.17 (-0.11, 14.32) | 0.05 | 2.95 (-4.49, 10.29) | 0.46 | 6.51 (-1.27, 13.78) | 0.09 | 6.84 (-0.35, 14.03) | 0.07 | 5.51 (-4.75, 15.66) | 0.29 | 11.98 (2.82, 21.18) | 0.01 |
Age (< 45 years)
| ||||||||||||
45–60 years
| -0.71 (-9.23, 8.55) | 0.87 | 1.16 (-7.12, 10.49) | 0.80 | 2.25 (-6.31, 10.82) | 0.61 | 7.24 (-0.98, 15.47) | 0.10 | 7.30 (-4.46, 19.91) | 0.23 | 11.49 (0.50, 23.35) | 0.05 |
> 60 years
| 0.99 (-7.68, 10.15) | 0.82 | -1.70 (-12.81, 9.70) | 0.78 | 3.02 (-5.98, 12.02) | 0.51 | 9.09 (-0.42, 18.61) | 0.07 | 9.87 (-2.10, 22.39) | 0.11 | 13.611 (1.42, 26.29) | 0.04 |
Education (Primary school and less)
| ||||||||||||
Secondary school
| 0.11 (-9.22, 9.02) | 0.98 | 0.51 (-8.69, 9.44) | 0.91 | 3.75 (-9.30, 16.34) | 0.87 | ||||||
Post-secondary
| 5.68 (-2.58, 13.77) | 0.17 | 7.51 (-0.93, 15.87) | 0.08 | -0.94 (-12.55, 10.45) | 0.56 | ||||||
Marital status (Never married)
| ||||||||||||
Married/living together
| 0.17 (-7.86, 8.32) | 0.96 | 0.04 (-8.49, 8.62) | 0.99 | 5.81 (-5.53, 17.27) | 0.32 | ||||||
Separated/widowed
| -8.12 (-18.10, 2.02) | 0.11 | 1.52 (-9.05, 12.18) | 0.78 | -0.87 (-14.96, 13.41) | 0.90 | ||||||
Employment (Unemployed)
| ||||||||||||
Employed
| 9.78 (2.34, 17.31) | 0.01 | 10.29 (3.20, 17.49) | 0.009 | 12.35 (4.72, 19.98) | 0.002 | -0.12 (10.91, 10.76) | 0.98 | ||||
Retired
8.12 (-1.92, 18.43)
| 0.12 | 10.57 (-0.96, 22.57) | 0.10 | 6.33 (-3.93, 16.60) | 0.23 | 4.01 (-10.56, 18.91) | 0.59 | |||||
Ubudehe category (1)
| ||||||||||||
2
| 8.34 (-5.78, 22.63) | 0.25 | 3.51 (-11.22, 18.52) | 0.64 | 8.71 (-11.00, 28.62) | 0.39 | ||||||
3
| 7.09 (-5.54, 20.15) | 0.28 | 3.06 (-9.93, 16.67) | 0.65 | 6.89 (-10.77, 25.05) | 0.45 | ||||||
Health insurance coverage (< 100% coverage)
| ||||||||||||
100% coverage
| 1.60 (-5.85, 8.88) | 0.66 | -2.18 (-9.81, 5.42) | 0.57 | 13.03 (3.06, 22.81) | 0.01 | 9.57 (0.01, 18.74) | 0.05 | ||||
Prescribed number of HD sessions per week (twice)
| ||||||||||||
Thrice
| -0.56 (-9.74, 8.20) | 0.90 | -11.83 (-20.59, -3.07) | 0.009 | 2.21 (-10.46, 14.46) | 0.72 | ||||||
Number of HD in the past 30 days (≤ 10)
| ||||||||||||
> 10
| -1.34 (-8.75, 6.02) | 0.72 | -9.08 (-16.56, -1.62) | 0.01 | -7.70 (-14.81, -0.59) | 0.04 | -1.91 (-12.22, 8.34) | 0.71 | ||||
Hospitalized in the last 6 months (No)
| ||||||||||||
Yes
| -3.73 (-10.62, 3.11) | 0.28 | -8.30 (-15.42, -1.15) | 0.025 | 0.75 (-9.08, 10.53) | 0.87 | ||||||
Number of medications taking (< 3 drugs)
| ||||||||||||
3–4 drugs
| -5.10 (-14.33, 3.96) | 0.27 | -5.69 (-15.26, 3.87) | 0.25 | -7.48 (-20.31, 5.16) | 0.25 | ||||||
> 4 drugs
| 1.64 (-7.95, 10.92) | 0.73 | -6.07 (-15.87, 3.72) | 0.23 | -12.43 (-25.73, 0.52) | 0.06 | ||||||
Albumin (< 35 g/l)
| ||||||||||||
35–40 g/l
| 7.24 (-1.29, 16.14) | 0.10 | 2.19 (-6.89,11.27) | 0.64 | -1.02 (-13.24, 11.61) | 0.87 | ||||||
> 40 g/l
| 9.62 (0.51, 19.08) | 0.04 | 2.71 (-7.01, 12.44) | 0.58 | 0.36 (-12.65, 13.77) | 0.95 | ||||||
Hemoglobin (< 10 g/dl)
| ||||||||||||
10–11 g/dl
| 9.03 (0.74, 17.25) | 0.03 | 4.80 (-3.93, 13.54) | 0.28 | 11.12 (-0.50, 22.68) | 0.06 | ||||||
> 11 g/dl
| 1.17 (-6.81, 9.21) | 0.77 | 2.84 (-5.58, 11.29) | 0.51 | 6.05 (-5.16, 17.34) | 0.29 | ||||||
Vintage (≤ 12 months)
| ||||||||||||
13–24 months
| 5.10 (-3.66, 14.44) | 0.26 | 4.82 (-4.16, 13.88) | 0.30 | 18.70 (6.97, 31.03) | 0.002 | 16.28 (5.20, 27.82) | 0.008 | ||||
> 24 months
| -0.01 (-7.95, 8.35) | 0.99 | -2.76 (-10.89, 5.44) | 0.51 | 11.61 (1.001, 22.68) | 0.03 | 9.74 (-0.35, 20.31) | 0.07 | ||||
HD access (Fistula/graft)
| ||||||||||||
Semipermanent dialysis catheter
| -8.59 (-17.38, -0.37) | 0.04 | -8.01 (-16.95, 0.51) | 0.09 | -2.87 (-11.30, 5.64) | 0.50 | -8.89 (-21.34, 2.92) | 0.15 | ||||
Temporary dialysis catheter
| -10.78 (-19.59, -2.28) | 0.01 | -10.71 (-19.48, -2.32) | 0.02 | -1.14 (-10.26, 7.97) | 0.80 | -4.32 (-16.83, 7.84) | 0.49 | ||||
Number of comorbidities (0)$
| ||||||||||||
1
| -9.66 (-22.58, 2.62) | 0.13 | -17.32 (-29.95, -5.63) | 0.009 | -6.32 (-18.76, 6.12) | 0.32 | -5.89 (-18.13, 6.34) | 0.36 | -22.96 (-40.51, -6.03) | 0.01 | -19.93 (-36.47, -4.05) | 0.02 |
2
| -13.45 (-26.87, -0.69) | 0.04 | -14.96 (-28.29, -2.676) | 0.03 | -13.17 (-26.14, -0.18) | 0.05 | -15.53 (-27.99, -3.06) | 0.02 | -19.00 (-37.23, -1.43) | 0.04 | -19.16 (-36.56, -2.71) | 0.03 |
3 or more
| -14.78 (-30.54, 0.46) | 0.06 | -17.62 (-33.01, -2.97) | 0.03 | -17.36 (-33.09 -1.62) | 0.03 | -19.66 (-34.92, -4.41) | 0.01 | -26.47 (-47.96, -5.51) | 0.01 | -33.27 (-53.11, -14.20) | 0.001 |
Country | |||||
---|---|---|---|---|---|
Rwanda
#
| Kenya(28) | Saudi Arabia(30) | USA(31) | USA(32) | |
PCS | 37.33 | 39.09 | 37.4 | 38 | 36.6 |
MCS | 44.74 | 41.87 | 43.5 | 51.8 | 49.0 |
BKD | 20.01 | 16.15 | 31.5 | 53.2 | 51.3 |
EKD | 53.48 | 67.63 | 56.5 | 76.6 | 78.1 |
SPKD | 58.22 | 73.46 | 74 | 80.7 | 73.0 |