TY - JOUR
T1 - Health-Related Quality of Life in Home Dialysis Patients Compared to In-Center Hemodialysis Patients
T2 - A Systematic Review and Meta-analysis
AU - Bonenkamp, Anna A.
AU - van Eck van der Sluijs, Anita
AU - Hoekstra, Tiny
AU - Verhaar, Marianne C.
AU - van Ittersum, Frans J.
AU - Abrahams, Alferso C.
AU - van Jaarsveld, Brigit C.
N1 - Funding Information:
This work is part of the research programme DOMESTICO, which is financed by the Netherlands Organisation for Health Research and Development (ZonMw, project number 843004116 ). We thank the personnel of VU Medical Library for assistance in performing the search in the databases used.
Funding Information:
Anna A. Bonenkamp, MD, Anita van Eck van der Sluijs, MD, Tiny Hoekstra, PhD, Marianne C. Verhaar, MD, PhD, Frans J. van Ittersum, MD, PhD, Alferso C. Abrahams, MD, PhD, and Brigit C. van Jaarsveld, MD, PhD. Research idea: AAB, ACA, BCvJ; literature search: AAB, AvEvdS; appraised risk of bias: AAB, AvEvdS; data extraction: AAB, AvEvdS; third opinion search regarding the literature search and appraisal for risk of bias: TH, BCvJ; statistical analysis: AAB, AvEvdS, TH; data interpretation: AAB, AvEvdS, FJvI, ACA, BCvJ; supervision/mentorship: MCV, FJvI, ACA, BCvJ. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. None. Prof van Ittersum was a nonexecutive director of Nefrovisie, the national quality agency for the treatment of kidney diseases. The remaining authors declare that they have no relevant financial interests. This work is part of the research programme DOMESTICO, which is financed by the Netherlands Organisation for Health Research and Development (ZonMw, project number 843004116). We thank the personnel of VU Medical Library for assistance in performing the search in the databases used. The results presented in this article have not been published previously, except in abstract form at the 56th ERA-EDTA Congress 2019, Budapest, Hungary, June 13 to 16, 2019. Received July 26, 2019. Evaluated by 2 external peer reviewers, with direct editorial input from an Associate Editor and the Editor-in-Chief. Accepted in revised form November 14, 2019.
Publisher Copyright:
© 2020 The Authors
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Rationale & Objective: Dialysis patients judge health-related quality of life (HRQoL) as an essential outcome. Remarkably, little is known about HRQoL differences between home dialysis and in-center hemodialysis (HD) patients worldwide. Study Design: Systematic review and meta-analysis. Setting & Study Populations: Search strategies were performed on the Cochrane Library, Pubmed, and EMBASE databases between 2007 and 2019. Home dialysis was defined as both peritoneal dialysis and home HD. Selection Criteria for Studies: Randomized controlled trials and observational studies that compared HRQoL in home dialysis patients versus in-center HD patients. Data Extraction: The data extracted by 2 authors included HRQoL scores of different questionnaires, dialysis modality, and subcontinent. Analytical Approach: Data were pooled using a random-effects model and results were expressed as standardized mean difference (SMD) with 95% CIs. Heterogeneity was explored using subgroup analyses. Results: Forty-six articles reporting on 41 study populations were identified. Most studies were cross-sectional in design (90%), conducted on peritoneal dialysis patients (95%), and used the 12-item or 36-item Short-Form Health Survey questionnaires (83%). More than half the studies showed moderate or high risk of bias. Pooled analysis of 4,158 home dialysis patients and 7,854 in-center HD patients showed marginally better physical HRQoL scores in home dialysis patients compared with in-center HD patients (SMD, 0.14; 95% CI, 0.04 to 0.24), although heterogeneity was high (I2>80%). In a subgroup analysis, Western European home dialysis patients had higher physical HRQoL scores (SMD, 0.39; 95% CI, 0.17 to 0.61), while home dialysis patients from Latin America had lower physical scores (SMD, −0.20; 95% CI, −0.28 to −0.12). Mental HRQoL showed no difference in all analyses. Limitations: No randomized controlled trials were found and high heterogeneity among studies existed. Conclusions: Although pooled data showed marginally better physical HRQoL for home dialysis patients, the quality of design of the included studies was poor. Large prospective studies with adequate adjustments for confounders are necessary to establish whether home dialysis results in better HRQoL. Trial Registration: PROSPERO 95985.
AB - Rationale & Objective: Dialysis patients judge health-related quality of life (HRQoL) as an essential outcome. Remarkably, little is known about HRQoL differences between home dialysis and in-center hemodialysis (HD) patients worldwide. Study Design: Systematic review and meta-analysis. Setting & Study Populations: Search strategies were performed on the Cochrane Library, Pubmed, and EMBASE databases between 2007 and 2019. Home dialysis was defined as both peritoneal dialysis and home HD. Selection Criteria for Studies: Randomized controlled trials and observational studies that compared HRQoL in home dialysis patients versus in-center HD patients. Data Extraction: The data extracted by 2 authors included HRQoL scores of different questionnaires, dialysis modality, and subcontinent. Analytical Approach: Data were pooled using a random-effects model and results were expressed as standardized mean difference (SMD) with 95% CIs. Heterogeneity was explored using subgroup analyses. Results: Forty-six articles reporting on 41 study populations were identified. Most studies were cross-sectional in design (90%), conducted on peritoneal dialysis patients (95%), and used the 12-item or 36-item Short-Form Health Survey questionnaires (83%). More than half the studies showed moderate or high risk of bias. Pooled analysis of 4,158 home dialysis patients and 7,854 in-center HD patients showed marginally better physical HRQoL scores in home dialysis patients compared with in-center HD patients (SMD, 0.14; 95% CI, 0.04 to 0.24), although heterogeneity was high (I2>80%). In a subgroup analysis, Western European home dialysis patients had higher physical HRQoL scores (SMD, 0.39; 95% CI, 0.17 to 0.61), while home dialysis patients from Latin America had lower physical scores (SMD, −0.20; 95% CI, −0.28 to −0.12). Mental HRQoL showed no difference in all analyses. Limitations: No randomized controlled trials were found and high heterogeneity among studies existed. Conclusions: Although pooled data showed marginally better physical HRQoL for home dialysis patients, the quality of design of the included studies was poor. Large prospective studies with adequate adjustments for confounders are necessary to establish whether home dialysis results in better HRQoL. Trial Registration: PROSPERO 95985.
KW - Home dialysis
KW - home hemodialysis
KW - in-center hemodialysis
KW - meta-analysis
KW - peritoneal dialysis
KW - quality of life
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85081698459&partnerID=8YFLogxK
U2 - 10.1016/j.xkme.2019.11.005
DO - 10.1016/j.xkme.2019.11.005
M3 - Article
C2 - 32734235
AN - SCOPUS:85081698459
VL - 2
SP - 139
EP - 154
JO - Kidney Medicine
JF - Kidney Medicine
IS - 2
ER -