Quality of life in patients receiving standard and extended hours haemodialysis versus quality of life of their caregivers: a secondary analysis of the Co-ACTIVE sub-study of the ACTIVE dialysis trial

Dr Melissa Nataatmadja1,2, Assoc Prof Rathika Krishnasamy1,2,3, Dr Li Zuo4, Dr Daqing Hong5, Dr Brendan Smyth6,7,8, Dr Min Jun6, Dr Janak de Zoysa9,10, Prof Kirsten Howard7, Dr  Jing Wang11, Dr Chunlai Lu12, Dr Zhangsuo Liu13, Prof Chris Chan14, Prof Alan Cass15, Prof Vlado Perkovic6, Assoc Prof Meg Jardine6,16, Assoc Prof Nicholas Gray1,2

1Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Australia, 2Faculty of Medicine, University of Queensland, Herston, Australia, 3Australasian Kidney Trials Network, Woolloongabba, Australia, 4Peking University People’s Hospital, Beijing, China, 5Sichuan Provincial People’s Hospital, Chengdu, China, 6The George Institute for Global Health, Sydney, Australia, 7Sydney School of Public Health, University of Sydney, Sydney, Australia, 8Department of Renal Medicine, St George Hospital, Sydney, Australia, 9Renal Service, Waitemata District Health Board, Auckland, New Zealand, 10Department of Medicine, University of Auckland, Auckland, New Zealand, 11Department of Nephrology, First Affiliated Hospital of Dalain Medical Univeristy, Dalain, China, 12Department of Nephrology, Shanghai 85th Hospital, Shanghai, China, 13Department of Nephrology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, 14Division of Nephrology, University Health Network, Toronto General Hospital, Toronto, Canada, 15Menzies School of Health Research, Charles Darwin University, Darwin, Australia, 16Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, Australia

Clinicians may advocate for extended hours dialysis due to perceived benefits for the patient, however little is known about its effects on caregivers.

Participants were randomised to receive extended (median 24 hours/week) or standard (12 hours/week) haemodialysis for 12 months in the ACTIVE Dialysis trial. In this sub-study, participants  nominated a carer who was invited to participate in an assessment of QOL and carer impact. Patients and their caregivers completed the EuroQOL-5 Dimension-3 Level (EQ5D-3L), Short Form-36 (SF-36) physical component summary (PCS), mental component summary (MCS) and SF-6D and differences between patients and carers were evaluated using Wilcoxon rank-sum test.

A total of 40 patient-caregiver pairs participated in the Co-ACTIVE sub-study, including 34 from China. There was no significant difference in change in EQ5D from baseline to follow-up between patients and caregivers in either the standard hours (0.005±0.27 vs -0.02±0.16, p=0.97) or extended hours groups (-0.04±0.16 vs -0.18±0.30, p=0.06 ). Similarly, there were no differences between the patients and caregivers respectively in mean change in scores, in those randomised to either standard hours [SF-36 PCS (0.21±6.5 vs -5.34±8.77, p=0.16); MCS (0.5±9.35 vs -2.21±8.68, p=0.62), SF-6D (0.0003±0.12 vs -0.037±0.096, p=0.63)] or extended hours [SF-36 PCS (-0.66±8.41 vs -1.06±9.28, p=0.6); MCS (-0.5±8.25 vs -4.11±11.63, p=0.34), SF-6D (-0.02±0.12 vs -0.03±0.12, p=0.8)].

There were no significant differences between patients and caregivers in change in QOL or health utility over time, in either standard or extended hours dialysis. Further work is needed to examine the impact of extended hours haemodialysis on caregivers.


Melissa completed her medical training at the University of Queensland and trained in nephrology at the Gold Coast University Hospital and Princess Alexandra Hospital before moving to Vancouver, Canada to complete her training and undertake a home dialysis fellowship. She is now working as a nephrologist at the Sunshine Coast University Hospital, and is a PhD candidate studying quality of life and clinical outcomes in patients on home dialysis.


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