Determinants of Health-related Quality of Life Post Kidney Transplantation at Kenyatta National Hospital

Abstract

Background: Prevalence of chronic kidney disease has been rising globally causing a substantial burden on healthcare resources across the globe. ESRD is coupled with reduced functional capacity and quality of life. Kidney transplantation is the recommended treatment; however, it necessitates lifelong use of immunosuppressive agents that are associated with side effects. Objective: Study aim was to determine the HRQoL in kidney transplant recipients and its determinants. Methods: Descriptive cross-sectional study conducted at KNH transplant outpatient clinic. Questionnaires collected data on social, economic and demographics. Clinical and laboratory characteristics derived from medical records. HRQoL determined using the WHOQoL–BREF and KDQoL36 questionnaire. Variables summarised using, mean and standard deviation for continuous variables while percentages and proportions for categorical variables. HRQoL Scores vis-a-vis continuous variables analysed using Pearson correlation. HRQoL scores versus categorical variables analysed using the student T test /ANOVA. A 0.05 level of significance was adopted. Outcomes: Seventy-three participants were recruited,75% were males with a mean age 46.6 (SD14.4), 65% resided in an urban setup and 42% had tertiary level education. Majority (63%) were very satisfied with their overall HRQoL. Male participants had higher physical health scores (65.9±7.1 vs 58.9±10.3 p0.002) while residing in an urban setup was associated with high environmental scores (79.5±14.2 vs 71.8±12.0 p0.025). Participants with well controlled blood pressure had high scores in social and environmental (89.7±12.9 vs 80.5±14.6 p0.016) (80.0±12.2 vs 66.5±14.6 p<0.001) respectively. Participants with HB>12g/dl had high physical and psychological scores (59.4±12.2 vs 65.9±6.1 p0.004) (69.7±10.8 vs 77.4 ±7.3 p0.001) respectively. High scores in physical, psychological, and environmental for participants with eGFR>45ml/min (65.9±6.4 vs 58±11.9 p0.001) (77.3±7.4 vs 68.4±10.7 p<0.001) (79.1±13 vs 68.8±14.5 p0.007) respectively. KDQoL and WHOQoL-BREF questionnaires correlated poorly in physical (0.295 p0.011), psychological (0.415 p <0.001) and social domains (0.298 p0.011). Conclusions: Transplant recipients on follow-up at KNH transplant clinic are satisfied with their HRQoL. Factors associated are male gender, residing in urban setup, eGFR>45ml/min, HB>12g/dl and BP<130/80. The KDQoL and WHOQoL- BREF questionnaires correlate poorly and should be used separately. Recommendations: Better HRQoL in KTR thus transplantation should be recommended for eligible patients with ESRD. Further longitudinal studies are required to test for these associations