Quality of life of caregivers for dialysis recipients poorer than general population

Gilbertson EL, et al. Am J Kidney Dis. 2018;doi:10.1053/j.ajkd.2018.09.006.

The burden of helping a family member or partner through treatment for kidney disease can leave a caregiver with a poorer quality of life compared with the general population, a new meta-analysis shows, and dialysis providers should develop ways to help alleviate the hardship.

“Quality of life of caregivers of dialysis recipients is ... comparable to that of caregivers of individuals with other chronic diseases,” Elise L. Gilbertson, MBBS(Hons), from the department of nephrology at The University of Queensland Australia, and colleagues wrote. “Further research is needed to optimally inform dialysis programs how to educate and support caregivers.”

The researchers conducted a systematic review of 61 quantitative studies that included 5,367 caregivers from 21 countries. Descriptive reports of demographics, measurement scales and outcomes were analyzed; 70 different scales were used to assess quality of life and caregiver burden. Overall, according to the researchers, finding measures used consistently to assess quality of life among caregivers was a challenge, and the design of most of the available studies was “generally poor.”

Female spouses were the largest group of caregivers identified in the studies, with the mean age of caregivers ranging from 31.5 to 67.9 years. Education level, reported in 26 studies, ranged from 11.1% to 63.1% reaching tertiary-level education and 1.4% to 50.8% illiterate. Employment status was reported in 23 studies; there was a range of 9.8% to 88.3% who were employed in an occupation outside of their caregiving role. “Only 7 studies (13.9% of total participants) reported the mean hours of caregiving, which ranged from 26 to 69 hours per week,” the researchers wrote.

One of the studies looked at the results of the NIH-funded Frequent Hemodialysis Network study, conducted between 2006 and March 2010. Patients were randomly assigned to conventional three weekly dialysis treatments or six treatments a week. That review “showed no difference for caregivers of frequent in-center [home hemodialysis] patients, but a nominally increased burden for caregivers of home nocturnal [home hemodialysis] when compared with caregivers of standard facility [home hemodialysis] patients, although this difference was not statistically significant,” the researchers wrote.

Seven studies compared quality of life of dialysis caregivers with that of other caregivers. Of this group, four studies showed poorer outcomes for dialysis caregivers compared with caregivers of renal transplant recipients. Some studies showed no difference in rates of depression in dialysis caregivers compared with caregivers of the frail elderly, but increased burden compared with caregivers of oncology patients, according to the researchers.