Factors associated with quality of life in older patients undergoing peritoneal dialysis: a single-center cross- sectional study

Factors associated with quality of life in older patients undergoing peritoneal dialysis: a single-center cross- sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors associated with quality of life in older patients undergoing peritoneal dialysis: a single-center cross- sectional study Hiroki Yabe, Daiki Natsume, Yuto Imoto, Akiho Masuda, Haruka Nakano, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7071150/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The increasing number of elderly patients with chronic kidney disease (CKD) undergoing peritoneal dialysis (PD) has highlighted the need to improve their quality of life (QOL). While PD has been shown to benefit QOL compared to hemodialysis, the factors influencing QOL in older patients are not fully understood. This study aimed to identify factors associated with QOL in elderly patients undergoing PD, focusing on physical function and activities of daily living (ADLs). Methods This cross-sectional study included 30 ambulatory patients aged > 65 years, who had been undergoing PD for at least three months. QOL was assessed using the EuroQol 5 dimensions 5-level (EQ5D) scale. Functional Independence Measure (FIM) and physical performance metrics, including the 6-minute walk distance (6MWD), handgrip strength, and short physical performance battery (SPPB), were used to assess functional capacity. Spearman’s coefficient and multiple regression models were used to identify factors associated with QOL. Results The mean age of participants was 75.6 ± 7.5 years, and the median PD duration was 48 months. The mean EQ5D score was 0.89 ± 0.15. Pain/discomfort (33.3%) and mobility issues (26.7%) were the most frequently reported problems. Significant correlations were found between EQ5D scores and 6MWD (r = 0.46), SPPB score (r = 0.50), and FIM motor scores (r = 0.52). Multiple regression showed that FIM motor scores were independently associated with QOL (p < 0.01), even after adjusting for confounders. Conclusions QOL in elderly PD patients is closely related to physical function and ADLs, rather than renal function or nutritional status. Interventions that improve physical function may enhance QOL in this population. Trial registration This study was prospectively registered at inception in the UMIN Clinical Trials Registry under identification number UMIN000038405. quality of life peritoneal dialysis cross-sectional study Figures Figure 1 Introduction With the increase in the number of elderly patients with chronic kidney disease (CKD), healthcare providers must provide therapeutic care to enhance the quality of life (QOL) of those undergoing peritoneal dialysis (PD). PD is a suitable treatment for patients aged > 65 years with CKD [ 1 ], and it offers benefits such as ease of procedure and stable hemodynamics [ 2 ]. Furthermore, studies have demonstrated that PD can enhance QOL in older patients compared with hemodialysis [ 3 ]. The Standardized Outcomes in Nephrology-Peritoneal Dialysis initiative, which aims to establish a core outcome set for trials in patients on peritoneal dialysis on the basis of the shared priorities of all stakeholders, has demonstrated the importance of caring for QOL in patients with PD in addition to traditional medical outcomes [ 4 ]. QOL [ 5 ] and symptom burden, as measured by patient-reported outcomes [ 6 ], can affect prognosis. Thus, clinicians must provide care to enhance the QOL of older adults undergoing PD through a multidisciplinary approach that includes geriatric assessment and traditional medical treatment. To enhance the QOL of older patients undergoing PD, it is essential to identify the factors associated with QOL and provide appropriate care for these factors. Several factors have been associated with the QOL in older patients with CKD. For instance, a study of 440 participants aged 31–70 years revealed that age, education, CKD stage, hemodialysis, and transfer to a hospital were associated with QOL in the physical component [ 7 ]. Lower functional status was associated with lower physical component summary and mental component summary scores on the Kidney Disease Quality of Life (KDQOL) [ 8 ]. In another study involving patients with PD, sex, age, nationality, living status, satisfaction, place of dialysis, and causes of end-stage renal disease were independent predictors of QOL [ 9 ]. The spiritual well-being scores in patients with PD were significantly lower in patients with older age and unemployed status, and they were significantly correlated with QOL, the burden of kidney disease, functional status scores, and depression [ 10 ]. However, factors associated with QOL in older patients undergoing PD have not been thoroughly investigated. Thus, several factors may affect the QOL of older patients undergoing PD. Physical function and activities of daily living (ADLs) may be factors associated with QOL in older patients undergoing PD. Before dialysis, physical function tends to decline with age and CKD progression [ 11 ]. Moreover, physical function in patients with PD was lower than the reference values for age and sex in the general population and was at levels indicative of impairment [ 12 ]. A previous study demonstrated that poor physical function in older patients undergoing PD was a significant prognostic factor [ 13 ]. Another study revealed that Timed Up and Go test, which reflects complex physical functions, e.g., balance, walking, and chair stand ability, were associated with physical health, malnutrition, and education level[ 14 ]. Similarly, another study showed that the physical function of predialysis patients with CKD is an important factor influencing QOL [ 15 ]. Physical function and ADLs in older patients undergoing PD may be important factors affecting QOL; however, limited evidence is available on this subject. Therefore, this study aimed to examine the factors associated with QOL in older patients undergoing PD with respect to physical function and ADLs. Materials and methods Study design and participants This cross-sectional study was conducted at Nagoya Kyoritsu Hospital (Aichi Nagoya, Japan) between December 1, 2014, and December 31, 2016, to examine the factors associated with QOL in older patients undergoing PD. Thirty stable, ambulatory patients aged > 65 years who had been undergoing PD for at least 3 months were screened for this study. Patients with certain conditions such as peritonitis, severe infections, trauma, recent surgery or hospitalization, physical disabilities, or impaired cognitive function were excluded. All willing patients at the facility were included because this was a single-center study with a fixed number of participants. The Seirei Christopher University Ethics Committee approved the study (approval number: 20010), and informed consent was obtained from all patients. Data collection and patient evaluation QOL was measured using the EuroQol 5 dimensions 5-level (EQ5D), which consists of five items (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Each dimension is evaluated on a scale from 1–5. Level 1 indicates “no problems” in the dimension; level 2, “slight problems;” level 3, “moderate problems;” level 4, “severe problems;” and level 5, “extreme problems” or an inability to perform activities related to the dimension. Responses to the five items of the EQ5D-5L define the individual’s health status, and an index score is created to indicate the general value of the person’s health status [ 16 ]. This scale allows for a consistent assessment of impairments across different health dimensions. The EQ-5D-5L index value ranges from − 0.025–1.000; the closer the value is to 1.000, the better is the individual’s health condition. The Functional Independence Measure (FIM) evaluates the functional independence of patients undergoing rehabilitation, and it comprises 18 items, each scored from 1 (total assistance) to 7 (complete independence) across the motor and cognitive categories. The motor section, consisting of 13 items, covers self-care, sphincter control, mobility, locomotion, and transfers, with a maximum score of 91. The cognitive section includes five items related to communication and social cognition, with a total possible score of 35. The overall scores range from 18–126, indicating complete dependence and full independence, respectively. The occupational therapist in charge performed the FIM measurements. To assess physical function, a dedicated physical therapist measured the patients’ 6-minute walk distance (6MWD), 10-meter walk speed, handgrip strength, lower extremity muscle strength (LES), and short physical performance battery (SPPB). The 6MWD was defined as the total distance walked by the patients in 6 minutes along a marked indoor corridor. The 10-meter walk speed recorded was the fastest of the two trials, handgrip strength was the highest value for each side, and LES was standardized by dividing the measured values by the patient's body weight. LES was measured in kilogram force (kgf), with the participants' most recent dry weight used to calculate the body weight ratio (%). The maximum values on the left and right sides were used to determine the grip strength and IKES. The SPPB is a measure of overall physical function that evaluates balance, 4-metre walking speed, and repeated chair stands, with a total possible score of 12 points. Patient demographics included age, sex, height, weight, body mass index, PD vintage, automated or continuous ambulatory PD, comorbidities, underlying causes of end-stage renal disease, and laboratory findings. Laboratory data were collected from patient’s medical records and included total protein, albumin (Alb), blood urea nitrogen, creatinine, estimated glomerular filtration rate (eGFR), sodium, potassium, chloride, calcium, phosphorus, and hemoglobin (Hb). The Geriatric Nutritional Risk Index (GNRI) was calculated using a formula that considers Alb levels and body weight/ideal body weight and was set to 1 if the patient's body weight exceeded the ideal body weight. The eGFR as residual renal function and Alb and the GNRI as the nutritional index were included as outcomes in addition to laboratory data. PD adequacy was determined by weekly Kt/V and creatinine clearance using the 24-hour urine and drainage and peritoneal equilibration test results from the most recent evaluation. Statistical analysis The missing components of the variables were complemented using multiple assignment methods based on the missing-at-random assumption to minimize missing bias (SPSS Missing Values 28; IBM Corp.). The normality of all data was confirmed by the Shapiro–Wilk test, with normally distributed data expressed as mean ± standard deviation and non-normally distributed data presented as median (interquartile range). The Spearman coefficient was used to examine the relationship between the EQ5D score and each variable. Multiple regression analysis was conducted using the EQ5D score as the dependent variable and variables with a significant relationship as a single correlation analysis as independent variables. In multiple regression analysis, models were set up to adjust for confounding factors. Model 1 was not adjusted and only the independent variable with a significant association in the single correlation analysis was entered. Models 2 and 3 were adjusted for confounding factors such as age and PD vintage or Hb level and GNRI, respectively. Collinearity was confirmed using the variance inflation factor to exclude confounding factors. A variable with a variance inflation factor of ≤10 reflected a lack of collinearity and was selected as the explanatory variable. Statistical analyses were performed using SPSS Statistics 28 (IBM Corp.), and the significance level was set at a risk rate of 5%. Results Participants’ basic characteristics are presented in Table 1 . The mean age of the patients was 75.6 ± 7.5 years, and the median PD vintage was 48 (10–73.5) months. The most common primary disease was diabetic nephrology (18 patients, 60%) followed by immunoglobulin A nephropathy (four patients, 13.3%). The total EQ-5D-5L score for all the participants was 0.89 ± 0.15. The percentages for each item in the EQ-5D-5L are shown in Fig. 1 . Ten respondents (33.3%) selected the second or higher level corresponding to “have a problem” for the pain/discomfort section, accounting for more than half of the respondents. Eight (26.7%), five (16.7%), and two (6.7%) patients selected their degree of mobility, usual activities, and anxiety/depression as second or higher levels, respectively. Table 1 Patients characteristics N = 30 Age (years) 75.6 ± 7.5 Sex, n (male/female) 20/10 Height (cm) 155.8 ± 8.4 Weight (kg) 60.3 ± 10.1 BMI (kg/m2) 23.3 ± 2.9 PD vintage (months) 48(10-73.5) APD/CAPD, n 9/21 Comorbidities, n (%) Diabetes 28(93.3) Hypertension 22(73.3) Cardiovascular disease 24(80) Cause of renal failure, n (%) Diabetic nephropathy 18(60) IgA nephropathy 4(13.3) Renal Sclerosis 3(10) Chronic pyelonephritis 1(3.3) Polycystic kidney disease 1(3.3) Unknown cause 3(10) Laboratory data Total Protein (g/dl) 6.8 ± 0.9 Albumin (g/dl) 3.4 ± 0.4 BUN (mg/dl) 57.2 ± 11.7 Creatinine (mg/dl) 9.2 ± 3.3 Natrium (mmol/l) 135.1 ± 3.6 Potassium (mmol/l) 4.3 ± 0.6 Chloride (mmol/l) 129.1 ± 157.5 Calcium (mg/dl) 36.2 ± 146.8 Phosphorus (mg/dl) 6.8 ± 7.5 Hemoglobin (g/dl) 18.9 ± 27 Table 2 Results of single correlation coefficient between EQ-5D Mean ± SD r p Age (year) 75.6 ± 7.5 -0.26 0.2 PD Vintage (month) 48(10-73.5) -0.19 0.33 6MWD (m) 369.8 ± 97.5 0.46 0.01 Hand grip strength (kg) 23.6 ± 7.3 0.31 0.1 LES (%) 37.4 ± 13.6 0.27 0.15 SPPB (points) 11(8.75-12) 0.36 0.05 FIM mortar (points) 90(89–90) 0.52 0.00 FIM overall (points) 124(123–125) 0.35 0.07 Alb (g/dL) 3.4 ± 0.4 0.12 0.53 GNRI 94.6 ± 8.1 0.28 0.14 eGFR 5.3 ± 2.4 -0.01 0.97 Kt/V 2 ± 0.8 -0.01 0.95 CCr 90.1 ± 43.1 0.08 0.69 Hb (g/dL) 18.9 ± 27 -0.1 0.6 Table 3 Multiple regression analysis between EQ-5D Multiple regression Model Multiple regression Model 2 Multiple regression Model 2 β 95% CI P β 95% CI P β 95% CI P FIM motor 0.61 0.01–0.03 <0.01 0.59 0.01–0.03 <0.01 0.56 0.01–0.03 <0.01 6MD 0.19 0.00-0.01 0.22 0.17 0–0 0.29 0.18 0–0 0.26 SPPB 0.09 -0.01-0.02 0.53 0.11 -0.01-0.02 0.51 0.14 -0.01-0.03 0.39 Age -0.04 -0.01-0.01 0.77 PD vintage -0.07 0–0 0.63 GNRI 0.1 -0.01-0.01 0.51 Hb -0.11 0.00–0.00 0.42 The EQ-5D score was significantly associated with the 6MWD (r = 0.46), SPPB score (r = 0.05), and FIM motor items (r = 0.52) in a single correlation coefficient analysis (p < 0.05). No correlations were detected with the other indices (Table 1 ). Multiple regression analysis revealed that only the FIM motor items were significantly associated in model 1 (R = 0.76, R 2 = 0.53), and the results remained the same in model 2 (R = 0.67, R 22 0.50) and model 3 (R = 0.78, R 2 = 0.51, p < 0.01) after adjusting for confounding factors such as age, PD vintage, GNRI, and Alb level, respectively (all, p < 0.01). Discussion To our best knowledge, this is the first study to investigate the characteristics of QOL and factors affecting QOL in elderly patients with PD. The QOL of elderly patients with PD was low and was related to their ability to perform ADLs and physical function rather than renal function or nutritional status. This study’s results will contribute to the accumulation of evidence regarding the importance of caring for QOL in elderly patients with PD. This study observed a mild decline in the QOL of patients with older age and PD. In a previous study, the EQ5D score in patients with PD was 0.90 ± 0.16, and that in healthy individuals was 0.931 ± 0.131 [ 17 ], indicating that elderly patients with PD had a lower QOL than healthy individuals. In the present study, the EQ-5D-5L score was 0.89 ± 0.15, which was considered reasonable compared with that in previous studies. Among the sub-items of the EQ-5D-5L, 10 respondents (33.3%) selected “problematic” for the pain/discomfort item, a higher percentage than that for the other items. In a study examining pain in patients with PD, 33.1% of patients with PD reported having pain symptoms, and pain was reported to be an independent risk factor for older age and higher parathyroid hormone levels [ 18 ]. High parathyroid hormone levels are an independent factor for bone pain in patients with hemodialysis [ 19 ], and patients with chronic renal failure may have increased secretion of the parathyroid hormone with elevated phosphorus levels, resulting in brittle bones and pain similar to bone pain [ 19 ]. Although the detailed mechanism is not known, it is possible that one of the reasons for the high percentage of patients who selected “problematic” in the pain/discomfort category is related to the aforementioned mechanism; however, further research is needed. In a study of QOL in patients undergoing PD, a systematic review showed that there was no unanimous conclusion on the QOL between the hemodialysis and peritoneal dialysis groups [ 20 ]. QOL outcomes in frail elderly patients undergoing automated PD were equivalent to those in patients receiving in-center hemodialysis [ 21 ]. Another study showed that patients with PD had better generic health-related QOL than patients with hemodialysis [ 3 ]. Although patients with PD have some factors that reduce QOL, e.g., pain, PD is still an effective treatment to maintain QOL compared with hemodialysis. Nevertheless, further study of treatments to improve QOL in elderly patients with PD is necessary. Limitation in ADLs may strongly influence the QOL in elderly patients undergoing PD. A recent study showed that dialysis patients with higher scores on physical role, a sub-item of the KDQOL 36-Item Short Form Survey, were associated with a lower burden of kidney disease (r = 0.845), less pain (r = 0.931), higher health status (r = 0.888), and social function (r = 0.965); therefore, limitation in ADLs may reduce QOL [ 20 ]. Another study showed that many patients on hemodialysis had difficulty performing ADLs, although their ADLs were independent [ 22 ]. Functional status and frailty were associated with worse QOL measures, irrespective of the CKD modality [ 23 ]. Routine assessment of functional status may provide valuable insights for patients and providers in anticipating outcomes and supporting the needs of patients receiving either PD or hemodialysis [ 24 ]. In contrast, the present study’s results showed a high FIM score of 124 (range, 123–125), suggesting that small ADL impairments may have an impact on reduced QOL. Difficulties with ADLs and small ADL impairments in elderly patients with PD may be an important issue directly related to their QOL. Residual renal function, anemia, and malnutrition are important factors in patients undergoing PD, and their association with QOL should be considered in the future. Previous studies have reported that QOL is associated with residual renal function [ 25 ], anemia [ 26 ], and nutritional management [ 27 ]; however, this was not the case in the current study. Residual renal function contributes to QOL through the removal of fluid and urinary toxins, reduction in the degree of anemia, and good calcium and phosphorus control [ 28 ]; for every 1 mL/min/1.73 m 2 increase in the eGFR, mortality is reduced by 12% [ 29 ]. Anemia is present in 90% of patients on dialysis, and it is associated with decreased exercise tolerance, sleep disturbances, increased cardiovascular events, and hospitalizations [ 30 ]. Anemia control in patients is considered ≥11 g/dL [ 31 ]. Malnutrition occurs in 30–50% of patients with PD [ 32 ], and mortality associations have been reported, including decreased performance capacity [ 33 ] and a 16% decrease in mortality for every 1 increase in the protein nutrition index [ 34 ]. Anemia also contributes to weight loss associated with malnutrition, decreased immunity, mucosal damage, and increased risk of developing infections, and low Alb levels increase the risk of developing peritonitis [ 35 ]. The incidences of peritonitis in PD patients with Alb levels 2.9 g/dL are 1.5 times/year and 0.6 times/year, respectively [ 36 ]. The Alb and Hb level of patients with PD in the present study were 3.4 ± 0.4 g/dL and 18.9 ± 2.7 g/dL, respectively, suggesting that they were at a low risk of developing peritonitis and that their nutritional and anemia statuses were well managed. Although residual renal function, anemia, and nutritional management are important factors affecting the QOL of patients with PD, it is possible that the patients’ residual renal function, anemia, and nutritional management were well controlled and not associated with the QOL because the criteria were exceeded. Exercise therapy has been shown to enhance QOL. The ISPD guidelines recommend exercise to maintain physical function and QOL in patients, and report on points of practice and precautions for exercise [ 37 ]. The effects of exercise therapy on patients with PD have been reported to improve physical function, appetite [ 38 ], and nutritional status [ 39 ]. A previous study showed that in a 20-week home training program for patients with continuous ambulatory PD, in addition to improvements in exercise tolerance, here were improvements in the KDQOL kidney disease burden, sleep, pain, vitality, social interaction, daily role activities, and physical function [ 40 ]. Other studies have reported that 12 weeks of exercise therapy for patients resulted in significant improvements in exercise tolerance and QOL in the summary of daily functioning (physical), daily functioning (mental), and social functioning (RCS) of the KDQOL (39). Additionally, in a study of patients on hemodialysis, exercise therapy improved the motor items of ADLs measured using the FIM [ 41 ]. Exercise therapy for patients with PD may contribute to improved QOL through improved physical function and ADLs, and thus may be an important treatment option in this patient population. Further investigations into the effectiveness of exercise therapy are required. The current study has certain limitations. As the number of patients in this study was small and it was not possible to examine the FIM sub-items affecting QOL, future studies should examine the details of ADL activities that strongly influence QOL decline in this population. Conclusion This study identified that the quality of life (QOL) in elderly patients undergoing peritoneal dialysis (PD) is significantly influenced by their physical function and ability to perform activities of daily living (ADLs). Our findings suggest that limitations in physical function, rather than factors such as renal function or nutritional status, play a critical role in determining QOL in this population. These results highlight the importance of incorporating physical rehabilitation strategies into the care of elderly PD patients to improve their functional independence and overall QOL. Further research is warranted to explore the impact of specific interventions, such as exercise therapy, on improving physical function and QOL in this patient group. Additionally, routine assessments of physical performance and ADL capabilities should be considered in the management of elderly patients on PD to optimize outcomes and enhance their quality of life. Abbreviations CKD chronic kidney disease QOL quality of life PD peritoneal dialysis KDQOL Kidney Disease Quality of Life ADLs activities of daily living EQ5D EuroQol 5 dimensions 5-level FIM Functional Independence Measure 6MWD 6-minute walk distance LES lower extremity muscle strength SPPB short physical performance battery Alb albumin eGFR estimated glomerular filtration rate Hb hemoglobin GNRI Geriatric Nutritional Risk Index Declarations Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Seirei Christopher University Ethics Committee approved the study (approval number: 20010), and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent for publication: Informed consent was obtained from all individual participants included in the study. Availability of data and materials: Please contact author for data requests Competing interests: The authors declare that they have no competing interests Funding; There is no funding in this study Authors' contributions; HY conceived the study, and participated in its design and coordination and wrote the first draft of the manuscript. DN, YI, AM, and HN measured data of this study. YM integrated research data measurements as the measurement manager. HK and KO treated patients and measured clinical data as the principal doctor. All authors read and approved the final manuscript. Acknowledgements: Not applicable References Portolés J, Vega A, Lacoba E, López-Sánchez P, Botella M, Yuste C, Martín Cleary C, Sanz Ballesteros S, González Sanchidrian S, Sánchez García L, Carreño A, Bajo MA, Janeiro D; Peritoneal Dialysis Center Group (GCDP). Is peritoneal dialysis a suitable technique for CKD patients over 65 years? A prospective multicenter study. 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Termorshuizen F, Korevaar JC, Dekker FW, van Manen JG, Boeschoten EW, Krediet RT; NECOSAD Study Group. The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2. Am J Kidney Dis. 2003 Jun;41(6):1293-302. Pergola PE, Pecoits-Filho R, Winkelmayer WC, Spinowitz B, Rochette S, Thompson-Leduc P, et al. Economic burden and health-related quality of life associated with current treatments for anaemia in patients with CKD not on dialysis: a systematic review. Pharmacoecon Open. 2019 Dec;3(4):463-78. Tsubakihara Y, Nishi S, Akiba T, Hirakata H, Iseki K, Kubota M, Kuriyama S, Komatsu Y, Suzuki M, Nakai S, Hattori M, Babazono T, Hiramatsu M, Yamamoto H, Bessho M, Akizawa T. 2008 Japanese Society for Dialysis Therapy: guidelines for renal anemia in chronic kidney disease. Ther Apher Dial. 2010 Jun;14(3):240-75. Satirapoj B, Limwannata P, Kleebchaiyaphum C, Prapakorn J, Yatinan U, Chotsriluecha S, Supasyndh O. Nutritional status among peritoneal dialysis patients after oral supplement with ONCE dialyze formula. Int J Nephrol Renovasc Dis. 2017 Jun 13;10:145-151. Cupisti A, D'Alessandro C, Finato V, Del Corso C, Catania B, Caselli GM, Egidi MF. Assessment of physical activity, capacity and nutritional status in elderly peritoneal dialysis patients. BMC Nephrol. 2017 May 30;18(1):180. Chen K-H, Wu C-H, Hsu C-W, Chen Y-M, Weng S-M, Yang C-W, Hung C-C. Protein nutrition index as a function of patient survival rate in peritoneal dialysis. Kidney Blood Press Res. 2010;33(3):174-80. Ozturk S, Soyluk O, Karakaya D, Yazici H, Caliskan YK, Yildiz A, Bozfakioglu S. Is decline in serum albumin an ominous sign for subsequent peritonitis in peritoneal dialysis patients? Adv Perit Dial. 2009:25:172-7. Wang Q, Bernardini J, Piraino B, Fried L. Albumin at the start of peritoneal dialysis predicts the development of peritonitis. Am J Kidney Dis. 2003 Mar;41(3):664-9. Bennett PN, Bohm C, Harasemiw O, Brown L, Gabrys I, Jegatheesan D, Johnson DW, Lambert K, Lightfoot CJ, MacRae J, Meade A, Parker K, Scholes-Robertson N, Stewart K, Tarca B, Verdin N, Wang AYM, Warren M, West M, Zimmerman D, Li PK-T, Thompson S. Physical activity and exercise in peritoneal dialysis: International Society for Peritoneal Dialysis and the Global Renal Exercise Network practice recommendations. Perit Dial Int. 2022 Jan;42(1):8-24. Bennett PN, Hussein WF, Matthews K, West M, Smith E, Reiterman M, Alagadan G, Shragge B, Patel J, Schiller BM. An exercise program for peritoneal dialysis patients in the United States: a feasibility study. Kidney Med. 2020 Mar 17;2(3):267-275. Uchiyama K, Washida N, Morimoto K, Muraoka K, Kasai T, Yamaki K, Miyashita K, Wakino S, Itoh H. Home-based aerobic exercise and resistance training in peritoneal dialysis patients: a randomized controlled trial. Sci Rep. 2019 Feb 22;9(1):2632. Palanova P, Mrkvicova V, Nedbalkova M, Sosikova M, Konecny P, Jarkovsky J, Marques E, Novakova M, Pohanka M, Soucek M, Dobsak P. Home-based training using neuromuscular electrical stimulation in patients on continuous ambulatory peritoneal dialysis: a pilot study. Artif Organs. 2019 Aug;43(8):796-805. Matsufuji S, Shoji T, Yano Y, Tsujimoto Y, Kishimoto H, Tabata T, Emoto M, Inaba M. Effect of chair stand exercise on activity of daily living: a randomized controlled trial in hemodialysis patients. J Ren Nutr. 2015 Jan;25(1):17-24. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7071150","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":501861367,"identity":"ef933286-e253-44d3-b360-e76742860081","order_by":0,"name":"Hiroki Yabe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIie2QsQrCMBRFbynoUnGNg/oLKRnUSfwTuzg5CC4OIimCLkLXfoYgODcE6lLo2tHiD+guaooKTjWjYM70XuDAeQEMhh+E2oDFKVBXSwSQ56uW0uDaCgqlGCLdsE61lufhBN4ulULOZl3U1xGmkxKlt6wyd0vh7bPRUCQJAUmGYGFZmKxUGkd6V4pDhb9St2QAc74rKixIz8K/EbS1lCJsizGEzwmohmK7IVX12YgKHhPHTTxefksaW/nmimYQyNOFzxet1kHGrOzH3gz4a1BJ1oppGOh/LvZJRzEYDIa/4QEnvUpNasOulwAAAABJRU5ErkJggg==","orcid":"","institution":"Seirei Christopher University","correspondingAuthor":true,"prefix":"","firstName":"Hiroki","middleName":"","lastName":"Yabe","suffix":""},{"id":501861372,"identity":"279fcf04-b6cf-4c35-b6aa-c87caa54a723","order_by":1,"name":"Daiki Natsume","email":"","orcid":"","institution":"Nagoya Kyoritsu Hospital","correspondingAuthor":false,"prefix":"","firstName":"Daiki","middleName":"","lastName":"Natsume","suffix":""},{"id":501861373,"identity":"4de658dc-a14a-4cb6-b267-b6f4cb26488b","order_by":2,"name":"Yuto Imoto","email":"","orcid":"","institution":"Nagoya Kyoritsu Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuto","middleName":"","lastName":"Imoto","suffix":""},{"id":501861374,"identity":"e8282a18-a73e-4666-a11c-53752ea2a1e7","order_by":3,"name":"Akiho Masuda","email":"","orcid":"","institution":"Nagoya Kyoritsu Hospital","correspondingAuthor":false,"prefix":"","firstName":"Akiho","middleName":"","lastName":"Masuda","suffix":""},{"id":501861375,"identity":"b08ba47d-fbcd-4e0e-ae63-e0666ca30b72","order_by":4,"name":"Haruka Nakano","email":"","orcid":"","institution":"Nagoya Kyoritsu Hospital","correspondingAuthor":false,"prefix":"","firstName":"Haruka","middleName":"","lastName":"Nakano","suffix":""},{"id":501861376,"identity":"62c33427-3d69-427a-a446-118fa9609e51","order_by":5,"name":"Yoshifumi Moriyama","email":"","orcid":"","institution":"Nagoya Kyoritsu Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yoshifumi","middleName":"","lastName":"Moriyama","suffix":""},{"id":501861377,"identity":"d333e9a0-bb23-4bb4-a7ad-761c2829d540","order_by":6,"name":"Keiko Okada","email":"","orcid":"","institution":"Kaikoukai Central Clinic","correspondingAuthor":false,"prefix":"","firstName":"Keiko","middleName":"","lastName":"Okada","suffix":""},{"id":501861378,"identity":"0176f926-4f2e-4b34-b36e-cc3a2898ebf1","order_by":7,"name":"Hirotake Kasuga","email":"","orcid":"","institution":"Nagoya Kyoritsu Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hirotake","middleName":"","lastName":"Kasuga","suffix":""}],"badges":[],"createdAt":"2025-07-08 06:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7071150/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7071150/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89464289,"identity":"ad63789b-4c11-47e7-a2b6-f016802803ea","added_by":"auto","created_at":"2025-08-20 08:21:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28259,"visible":true,"origin":"","legend":"\u003cp\u003eBreakdown of EQ5D 5L results\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7071150/v1/12e8dddd445c58c845e7788a.png"},{"id":89743637,"identity":"533ea006-6c16-4aea-918f-c100aeae5338","added_by":"auto","created_at":"2025-08-23 23:46:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":606415,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7071150/v1/e0ecdbbd-7ba7-4ba2-8be1-c47fc42224a9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors associated with quality of life in older patients undergoing peritoneal dialysis: a single-center cross- sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the increase in the number of elderly patients with chronic kidney disease (CKD), healthcare providers must provide therapeutic care to enhance the quality of life (QOL) of those undergoing peritoneal dialysis (PD). PD is a suitable treatment for patients aged\u0026thinsp;\u0026gt;\u0026thinsp;65 years with CKD [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and it offers benefits such as ease of procedure and stable hemodynamics [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Furthermore, studies have demonstrated that PD can enhance QOL in older patients compared with hemodialysis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The Standardized Outcomes in Nephrology-Peritoneal Dialysis initiative, which aims to establish a core outcome set for trials in patients on peritoneal dialysis on the basis of the shared priorities of all stakeholders, has demonstrated the importance of caring for QOL in patients with PD in addition to traditional medical outcomes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. QOL [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and symptom burden, as measured by patient-reported outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], can affect prognosis. Thus, clinicians must provide care to enhance the QOL of older adults undergoing PD through a multidisciplinary approach that includes geriatric assessment and traditional medical treatment.\u003c/p\u003e\u003cp\u003eTo enhance the QOL of older patients undergoing PD, it is essential to identify the factors associated with QOL and provide appropriate care for these factors. Several factors have been associated with the QOL in older patients with CKD. For instance, a study of 440 participants aged 31\u0026ndash;70 years revealed that age, education, CKD stage, hemodialysis, and transfer to a hospital were associated with QOL in the physical component [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Lower functional status was associated with lower physical component summary and mental component summary scores on the Kidney Disease Quality of Life (KDQOL) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In another study involving patients with PD, sex, age, nationality, living status, satisfaction, place of dialysis, and causes of end-stage renal disease were independent predictors of QOL [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The spiritual well-being scores in patients with PD were significantly lower in patients with older age and unemployed status, and they were significantly correlated with QOL, the burden of kidney disease, functional status scores, and depression [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, factors associated with QOL in older patients undergoing PD have not been thoroughly investigated. Thus, several factors may affect the QOL of older patients undergoing PD.\u003c/p\u003e\u003cp\u003ePhysical function and activities of daily living (ADLs) may be factors associated with QOL in older patients undergoing PD. Before dialysis, physical function tends to decline with age and CKD progression [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Moreover, physical function in patients with PD was lower than the reference values for age and sex in the general population and was at levels indicative of impairment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A previous study demonstrated that poor physical function in older patients undergoing PD was a significant prognostic factor [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Another study revealed that Timed Up and Go test, which reflects complex physical functions, e.g., balance, walking, and chair stand ability, were associated with physical health, malnutrition, and education level[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, another study showed that the physical function of predialysis patients with CKD is an important factor influencing QOL [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePhysical function and ADLs in older patients undergoing PD may be important factors affecting QOL; however, limited evidence is available on this subject. Therefore, this study aimed to examine the factors associated with QOL in older patients undergoing PD with respect to physical function and ADLs.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eStudy design and participants\u003c/p\u003e\u003cp\u003eThis cross-sectional study was conducted at Nagoya Kyoritsu Hospital (Aichi Nagoya, Japan) between December 1, 2014, and December 31, 2016, to examine the factors associated with QOL in older patients undergoing PD. Thirty stable, ambulatory patients aged\u0026thinsp;\u0026gt;\u0026thinsp;65 years who had been undergoing PD for at least 3 months were screened for this study. Patients with certain conditions such as peritonitis, severe infections, trauma, recent surgery or hospitalization, physical disabilities, or impaired cognitive function were excluded. All willing patients at the facility were included because this was a single-center study with a fixed number of participants. The Seirei Christopher University Ethics Committee approved the study (approval number: 20010), and informed consent was obtained from all patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection and patient evaluation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eQOL was measured using the EuroQol 5 dimensions 5-level (EQ5D), which consists of five items (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Each dimension is evaluated on a scale from 1\u0026ndash;5. Level 1 indicates \u0026ldquo;no problems\u0026rdquo; in the dimension; level 2, \u0026ldquo;slight problems;\u0026rdquo; level 3, \u0026ldquo;moderate problems;\u0026rdquo; level 4, \u0026ldquo;severe problems;\u0026rdquo; and level 5, \u0026ldquo;extreme problems\u0026rdquo; or an inability to perform activities related to the dimension. Responses to the five items of the EQ5D-5L define the individual\u0026rsquo;s health status, and an index score is created to indicate the general value of the person\u0026rsquo;s health status [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This scale allows for a consistent assessment of impairments across different health dimensions. The EQ-5D-5L index value ranges from \u0026minus;\u0026thinsp;0.025\u0026ndash;1.000; the closer the value is to 1.000, the better is the individual\u0026rsquo;s health condition.\u003c/p\u003e\u003cp\u003eThe Functional Independence Measure (FIM) evaluates the functional independence of patients undergoing rehabilitation, and it comprises 18 items, each scored from 1 (total assistance) to 7 (complete independence) across the motor and cognitive categories. The motor section, consisting of 13 items, covers self-care, sphincter control, mobility, locomotion, and transfers, with a maximum score of 91. The cognitive section includes five items related to communication and social cognition, with a total possible score of 35. The overall scores range from 18\u0026ndash;126, indicating complete dependence and full independence, respectively. The occupational therapist in charge performed the FIM measurements.\u003c/p\u003e\u003cp\u003eTo assess physical function, a dedicated physical therapist measured the patients\u0026rsquo; 6-minute walk distance (6MWD), 10-meter walk speed, handgrip strength, lower extremity muscle strength (LES), and short physical performance battery (SPPB). The 6MWD was defined as the total distance walked by the patients in 6 minutes along a marked indoor corridor. The 10-meter walk speed recorded was the fastest of the two trials, handgrip strength was the highest value for each side, and LES was standardized by dividing the measured values by the patient's body weight. LES was measured in kilogram force (kgf), with the participants' most recent dry weight used to calculate the body weight ratio (%). The maximum values on the left and right sides were used to determine the grip strength and IKES. The SPPB is a measure of overall physical function that evaluates balance, 4-metre walking speed, and repeated chair stands, with a total possible score of 12 points.\u003c/p\u003e\u003cp\u003ePatient demographics included age, sex, height, weight, body mass index, PD vintage, automated or continuous ambulatory PD, comorbidities, underlying causes of end-stage renal disease, and laboratory findings. Laboratory data were collected from patient\u0026rsquo;s medical records and included total protein, albumin (Alb), blood urea nitrogen, creatinine, estimated glomerular filtration rate (eGFR), sodium, potassium, chloride, calcium, phosphorus, and hemoglobin (Hb). The Geriatric Nutritional Risk Index (GNRI) was calculated using a formula that considers Alb levels and body weight/ideal body weight and was set to 1 if the patient's body weight exceeded the ideal body weight. The eGFR as residual renal function and Alb and the GNRI as the nutritional index were included as outcomes in addition to laboratory data. PD adequacy was determined by weekly Kt/V and creatinine clearance using the 24-hour urine and drainage and peritoneal equilibration test results from the most recent evaluation.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe missing components of the variables were complemented using multiple assignment methods based on the missing-at-random assumption to minimize missing bias (SPSS Missing Values 28; IBM Corp.). The normality of all data was confirmed by the Shapiro\u0026ndash;Wilk test, with normally distributed data expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and non-normally distributed data presented as median (interquartile range). The Spearman coefficient was used to examine the relationship between the EQ5D score and each variable. Multiple regression analysis was conducted using the EQ5D score as the dependent variable and variables with a significant relationship as a single correlation analysis as independent variables. In multiple regression analysis, models were set up to adjust for confounding factors. Model 1 was not adjusted and only the independent variable with a significant association in the single correlation analysis was entered. Models 2 and 3 were adjusted for confounding factors such as age and PD vintage or Hb level and GNRI, respectively. Collinearity was confirmed using the variance inflation factor to exclude confounding factors. A variable with a variance inflation factor of \u0026le;10 reflected a lack of collinearity and was selected as the explanatory variable. Statistical analyses were performed using SPSS Statistics 28 (IBM Corp.), and the significance level was set at a risk rate of 5%.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eParticipants\u0026rsquo; basic characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of the patients was 75.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5 years, and the median PD vintage was 48 (10\u0026ndash;73.5) months. The most common primary disease was diabetic nephrology (18 patients, 60%) followed by immunoglobulin A nephropathy (four patients, 13.3%). The total EQ-5D-5L score for all the participants was 0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15. The percentages for each item in the EQ-5D-5L are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Ten respondents (33.3%) selected the second or higher level corresponding to \u0026ldquo;have a problem\u0026rdquo; for the pain/discomfort section, accounting for more than half of the respondents. Eight (26.7%), five (16.7%), and two (6.7%) patients selected their degree of mobility, usual activities, and anxiety/depression as second or higher levels, respectively.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatients characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex, n (male/female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20/10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e155.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePD vintage (months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48(10-73.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAPD/CAPD, n\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9/21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbidities, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28(93.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(73.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCardiovascular disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24(80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCause of renal failure, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetic nephropathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18(60)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIgA nephropathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(13.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRenal Sclerosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic pyelonephritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(3.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolycystic kidney disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(3.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown cause\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaboratory data\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Protein (g/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlbumin (g/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBUN (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNatrium (mmol/l)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e135.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePotassium (mmol/l)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChloride (mmol/l)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e129.1\u0026thinsp;\u0026plusmn;\u0026thinsp;157.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCalcium (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.2\u0026thinsp;\u0026plusmn;\u0026thinsp;146.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhosphorus (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin (g/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.9\u0026thinsp;\u0026plusmn;\u0026thinsp;27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults of single correlation coefficient between EQ-5D\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePD Vintage (month)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48(10-73.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6MWD (m)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e369.8\u0026thinsp;\u0026plusmn;\u0026thinsp;97.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHand grip strength (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLES (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.4\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSPPB (points)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11(8.75-12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFIM mortar (points)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90(89\u0026ndash;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFIM overall (points)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124(123\u0026ndash;125)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlb (g/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGNRI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eeGFR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKt/V\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCr\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90.1\u0026thinsp;\u0026plusmn;\u0026thinsp;43.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHb (g/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.9\u0026thinsp;\u0026plusmn;\u0026thinsp;27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple regression analysis between EQ-5D\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eMultiple regression Model\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eMultiple regression Model 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e\u003cp\u003eMultiple regression Model 2\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFIM motor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.01\u0026ndash;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.01\u0026ndash;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.01\u0026ndash;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6MD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.00-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u0026ndash;0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u0026ndash;0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSPPB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.01-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.01-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.01-0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.01-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePD vintage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u0026ndash;0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGNRI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.01-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.00\u0026ndash;0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe EQ-5D score was significantly associated with the 6MWD (r\u0026thinsp;=\u0026thinsp;0.46), SPPB score (r\u0026thinsp;=\u0026thinsp;0.05), and FIM motor items (r\u0026thinsp;=\u0026thinsp;0.52) in a single correlation coefficient analysis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No correlations were detected with the other indices (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Multiple regression analysis revealed that only the FIM motor items were significantly associated in model 1 (R\u0026thinsp;=\u0026thinsp;0.76, R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.53), and the results remained the same in model 2 (R\u0026thinsp;=\u0026thinsp;0.67, R\u003csup\u003e22\u003c/sup\u003e0.50) and model 3 (R\u0026thinsp;=\u0026thinsp;0.78, R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.51, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) after adjusting for confounding factors such as age, PD vintage, GNRI, and Alb level, respectively (all, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our best knowledge, this is the first study to investigate the characteristics of QOL and factors affecting QOL in elderly patients with PD. The QOL of elderly patients with PD was low and was related to their ability to perform ADLs and physical function rather than renal function or nutritional status. This study\u0026rsquo;s results will contribute to the accumulation of evidence regarding the importance of caring for QOL in elderly patients with PD.\u003c/p\u003e\u003cp\u003eThis study observed a mild decline in the QOL of patients with older age and PD. In a previous study, the EQ5D score in patients with PD was 0.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16, and that in healthy individuals was 0.931\u0026thinsp;\u0026plusmn;\u0026thinsp;0.131 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], indicating that elderly patients with PD had a lower QOL than healthy individuals. In the present study, the EQ-5D-5L score was 0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15, which was considered reasonable compared with that in previous studies. Among the sub-items of the EQ-5D-5L, 10 respondents (33.3%) selected \u0026ldquo;problematic\u0026rdquo; for the pain/discomfort item, a higher percentage than that for the other items. In a study examining pain in patients with PD, 33.1% of patients with PD reported having pain symptoms, and pain was reported to be an independent risk factor for older age and higher parathyroid hormone levels [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. High parathyroid hormone levels are an independent factor for bone pain in patients with hemodialysis [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and patients with chronic renal failure may have increased secretion of the parathyroid hormone with elevated phosphorus levels, resulting in brittle bones and pain similar to bone pain [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Although the detailed mechanism is not known, it is possible that one of the reasons for the high percentage of patients who selected \u0026ldquo;problematic\u0026rdquo; in the pain/discomfort category is related to the aforementioned mechanism; however, further research is needed. In a study of QOL in patients undergoing PD, a systematic review showed that there was no unanimous conclusion on the QOL between the hemodialysis and peritoneal dialysis groups [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. QOL outcomes in frail elderly patients undergoing automated PD were equivalent to those in patients receiving in-center hemodialysis [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Another study showed that patients with PD had better generic health-related QOL than patients with hemodialysis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although patients with PD have some factors that reduce QOL, e.g., pain, PD is still an effective treatment to maintain QOL compared with hemodialysis. Nevertheless, further study of treatments to improve QOL in elderly patients with PD is necessary.\u003c/p\u003e\u003cp\u003eLimitation in ADLs may strongly influence the QOL in elderly patients undergoing PD. A recent study showed that dialysis patients with higher scores on physical role, a sub-item of the KDQOL 36-Item Short Form Survey, were associated with a lower burden of kidney disease (r\u0026thinsp;=\u0026thinsp;0.845), less pain (r\u0026thinsp;=\u0026thinsp;0.931), higher health status (r\u0026thinsp;=\u0026thinsp;0.888), and social function (r\u0026thinsp;=\u0026thinsp;0.965); therefore, limitation in ADLs may reduce QOL [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Another study showed that many patients on hemodialysis had difficulty performing ADLs, although their ADLs were independent [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Functional status and frailty were associated with worse QOL measures, irrespective of the CKD modality [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Routine assessment of functional status may provide valuable insights for patients and providers in anticipating outcomes and supporting the needs of patients receiving either PD or hemodialysis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In contrast, the present study\u0026rsquo;s results showed a high FIM score of 124 (range, 123\u0026ndash;125), suggesting that small ADL impairments may have an impact on reduced QOL. Difficulties with ADLs and small ADL impairments in elderly patients with PD may be an important issue directly related to their QOL.\u003c/p\u003e\u003cp\u003eResidual renal function, anemia, and malnutrition are important factors in patients undergoing PD, and their association with QOL should be considered in the future. Previous studies have reported that QOL is associated with residual renal function [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], anemia [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and nutritional management [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]; however, this was not the case in the current study. Residual renal function contributes to QOL through the removal of fluid and urinary toxins, reduction in the degree of anemia, and good calcium and phosphorus control [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]; for every 1 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e increase in the eGFR, mortality is reduced by 12% [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Anemia is present in 90% of patients on dialysis, and it is associated with decreased exercise tolerance, sleep disturbances, increased cardiovascular events, and hospitalizations [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Anemia control in patients is considered \u0026ge;11 g/dL [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Malnutrition occurs in 30\u0026ndash;50% of patients with PD [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], and mortality associations have been reported, including decreased performance capacity [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and a 16% decrease in mortality for every 1 increase in the protein nutrition index [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Anemia also contributes to weight loss associated with malnutrition, decreased immunity, mucosal damage, and increased risk of developing infections, and low Alb levels increase the risk of developing peritonitis [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The incidences of peritonitis in PD patients with Alb levels\u0026thinsp;\u0026lt;\u0026thinsp;2.9 g/dL and \u0026gt;\u0026thinsp;2.9 g/dL are 1.5 times/year and 0.6 times/year, respectively [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The Alb and Hb level of patients with PD in the present study were 3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 g/dL and 18.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7 g/dL, respectively, suggesting that they were at a low risk of developing peritonitis and that their nutritional and anemia statuses were well managed. Although residual renal function, anemia, and nutritional management are important factors affecting the QOL of patients with PD, it is possible that the patients\u0026rsquo; residual renal function, anemia, and nutritional management were well controlled and not associated with the QOL because the criteria were exceeded.\u003c/p\u003e\u003cp\u003eExercise therapy has been shown to enhance QOL. The ISPD guidelines recommend exercise to maintain physical function and QOL in patients, and report on points of practice and precautions for exercise [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The effects of exercise therapy on patients with PD have been reported to improve physical function, appetite [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], and nutritional status [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. A previous study showed that in a 20-week home training program for patients with continuous ambulatory PD, in addition to improvements in exercise tolerance, here were improvements in the KDQOL kidney disease burden, sleep, pain, vitality, social interaction, daily role activities, and physical function [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Other studies have reported that 12 weeks of exercise therapy for patients resulted in significant improvements in exercise tolerance and QOL in the summary of daily functioning (physical), daily functioning (mental), and social functioning (RCS) of the KDQOL (39). Additionally, in a study of patients on hemodialysis, exercise therapy improved the motor items of ADLs measured using the FIM [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Exercise therapy for patients with PD may contribute to improved QOL through improved physical function and ADLs, and thus may be an important treatment option in this patient population. Further investigations into the effectiveness of exercise therapy are required.\u003c/p\u003e\u003cp\u003eThe current study has certain limitations. As the number of patients in this study was small and it was not possible to examine the FIM sub-items affecting QOL, future studies should examine the details of ADL activities that strongly influence QOL decline in this population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identified that the quality of life (QOL) in elderly patients undergoing peritoneal dialysis (PD) is significantly influenced by their physical function and ability to perform activities of daily living (ADLs). Our findings suggest that limitations in physical function, rather than factors such as renal function or nutritional status, play a critical role in determining QOL in this population. These results highlight the importance of incorporating physical rehabilitation strategies into the care of elderly PD patients to improve their functional independence and overall QOL. Further research is warranted to explore the impact of specific interventions, such as exercise therapy, on improving physical function and QOL in this patient group. Additionally, routine assessments of physical performance and ADL capabilities should be considered in the management of elderly patients on PD to optimize outcomes and enhance their quality of life.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003echronic kidney disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eQOL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003equality of life\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eperitoneal dialysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKDQOL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKidney Disease Quality of Life\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eADLs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eactivities of daily living\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEQ5D\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEuroQol 5 dimensions 5-level\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFIM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFunctional Independence Measure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e6MWD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e6-minute walk distance\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLES\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003elower extremity muscle strength\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSPPB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eshort physical performance battery\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAlb\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ealbumin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eeGFR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eestimated glomerular filtration rate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHb\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehemoglobin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGNRI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGeriatric Nutritional Risk Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u0026nbsp;All procedures performed in studies involving human participants were in accordance with the ethical standards of the\u0026nbsp;Seirei Christopher University Ethics Committee approved the study (approval number: 20010),\u0026nbsp;and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: Please contact author for data requests\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding;\u0026nbsp;There is no funding in this study\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions;\u0026nbsp;HY conceived the study, and participated in its design and coordination and wrote the first draft of the manuscript. DN, YI, AM, and HN measured data of this study. YM integrated research data measurements as the measurement manager. HK and KO treated patients and measured clinical data as the principal doctor. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePortol\u0026eacute;s J, Vega A, Lacoba E, L\u0026oacute;pez-S\u0026aacute;nchez P, Botella M, Yuste C, Mart\u0026iacute;n Cleary C, Sanz Ballesteros S, Gonz\u0026aacute;lez Sanchidrian S, S\u0026aacute;nchez Garc\u0026iacute;a L, Carre\u0026ntilde;o A, Bajo MA, Janeiro D; Peritoneal Dialysis Center Group (GCDP). Is peritoneal dialysis a suitable technique for CKD patients over 65 years? A prospective multicenter study. Nefrologia (Engl Ed). 2021 Sep-Oct;41(5):529-38.\u003c/li\u003e\n\u003cli\u003eJiang C, Zheng Q. Outcomes of peritoneal dialysis in elderly vs non-elderly patients: A systematic review and meta-analysis. PLoS One. 2022 Feb 8;17(2):e0263534.\u003c/li\u003e\n\u003cli\u003eChuasuwan A, Pooripussarakul S, Thakkinstian A, Ingsathit A, Pattanaprateep O. Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis: a systematic review and meta-analysis. Health Qual Life Outcomes. 2020 Jun 18;18(1):191.\u003c/li\u003e\n\u003cli\u003eManera KE, Johnson DW, Craig JC, Shen JI, Gutman T, Cho Y, et al. Establishing a core outcome set for peritoneal dialysis: report of the SONG-PD (Standardized Outcomes in Nephrology-Peritoneal Dialysis) consensus workshop. Am J Kidney Dis. 2020 Mar;75(3):404-12.\u003c/li\u003e\n\u003cli\u003eManera KE, Johnson DW, Craig JC, Shen JI, Gutman T, Cho Y, et al. Establishing a core outcome set for peritoneal dialysis: report of the SONG-PD (Standardized Outcomes in Nephrology-Peritoneal Dialysis) consensus workshop. Am J Kidney Dis. 2020 Mar;75(3):404-12.\u003c/li\u003e\n\u003cli\u003ede Oliveira MP, Kusumota L, Haas VJ, Ribeiro Rde C, Marques S, Oller GA. Health-related quality of life as a predictor of mortality in patients on peritoneal dialysis. Rev Lat Am Enfermagem. 2016;24.\u003c/li\u003e\n\u003cli\u003eIto M, Nawano T, Masakane I, Yamaguchi I, Kudo K, Nagasawa J, Yabuki K. Clinical impact of patient-centered care for hemodialysis patients using routine assessment of symptom burden. Ther Apher Dial. 2022 Apr;26(2):417-24.\u003c/li\u003e\n\u003cli\u003eMahato SKS, Apidechkul T, Sriwongpan P, Hada R, Sharma GN, Nayak SK, Mahato RK. Factors associated with quality of life among chronic kidney disease patients in Nepal: a cross-sectional study. Health Qual Life Outcomes. 2020 Jun 29;18(1):207.\u003c/li\u003e\n\u003cli\u003eBrown EA, Zhao J, McCullough K, Fuller DS, Figueiredo AE, Bieber B, et al. 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Ren Fail. 2013;35(5):667-72.\u003c/li\u003e\n\u003cli\u003eZazzeroni L, Pasquinelli G, Nanni E, Cremonini V, Rubbi I. Comparison of quality of life in patients undergoing hemodialysis and peritoneal dialysis: a systematic review and meta-analysis. Kidney Blood Press Res. 2017;42(4):717-727.\u003c/li\u003e\n\u003cli\u003eIyasere O, Brown E, Gordon F, Collinson H, Fielding R, Fluck R, Johansson L, Morgan N, Stoves J, Vardhan A, Woodrow G, Davenport A. Longitudinal trends in quality of life and physical function in frail older dialysis patients: a comparison of assisted peritoneal dialysis and in-center hemodialysis. Perit Dial Int. 2019 Mar-Apr;39(2):112-118.\u003c/li\u003e\n\u003cli\u003eWatanabe T, Kutsuna T, Suzuki Y, Harada M, Shimoda T, Yamamoto S, Isobe Y, Imamura K, Matsunaga Y, Matsuzawa R, Kamiya K, Takeuchi Y, Yoshida A, Matsunaga A. Perceived difficulty in activities of daily living and survival in patients receiving maintenance hemodialysis. Int Urol Nephrol. 2021 Jan;53(1):177-184.\u003c/li\u003e\n\u003cli\u003eIyasere O, Brown EA, Johansson L, Davenport A, Farrington K, Maxwell AP, Collinson H, Fan S, Habib AM, Stoves J, Woodrow G. Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis. Clin Kidney J. 2018 Jul 20;12(2):262-26.\u003c/li\u003e\n\u003cli\u003eBrown EA, Zhao J, McCullough K, Fuller DS, Figueiredo AE, Bieber B, Finkelstein FO, Shen J, Kanjanabuch T, Kawanishi H, Pisoni RL, Perl J; PDOPPS Patient Support Working Group. Burden of kidney disease, health-related quality of life, and employment among patients receiving peritoneal dialysis and in-center hemodialysis: findings from the DOPPS program. Am J Kidney Dis. 2021 Oct;78(4):489-500.e1.\u003c/li\u003e\n\u003cli\u003eLi T, Wilcox CS, Lipkowitz MS, Gordon-Cappitelli J, Dragoi S. Rationale and strategies for preserving residual kidney function in dialysis patients. Am J Nephrol. 2019;50(6):411-421.\u003c/li\u003e\n\u003cli\u003eLew SQ, Piraino B. Quality of life and psychological issues in peritoneal dialysis patients. Semin Dial. 2005 Mar-Apr;18(2):119-23.\u003c/li\u003e\n\u003cli\u003eAli I, Haddad D, Soliman MA, Al-Sabi A, Jebreen K, Abuzahra D, Shrara B, Ghanayem D, Natour N, Hassan M, Alsedfy MY, Shellah D, Nawajah I. Quality of life and nutritional status in peritoneal dialysis patients: a cross-sectional study from Palestine. BMC Nephrol. 2024 Jan 12;25(1):20.\u003c/li\u003e\n\u003cli\u003eCoronel F, P\u0026eacute;rez Flores I. [Factors related to loss of residual renal function in peritoneal dialysis]. Nefrologia. 2008:28 Suppl 6:39-44.\u003c/li\u003e\n\u003cli\u003eTermorshuizen F, Korevaar JC, Dekker FW, van Manen JG, Boeschoten EW, Krediet RT; NECOSAD Study Group. The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2. Am J Kidney Dis. 2003 Jun;41(6):1293-302.\u003c/li\u003e\n\u003cli\u003ePergola PE, Pecoits-Filho R, Winkelmayer WC, Spinowitz B, Rochette S, Thompson-Leduc P, et al. Economic burden and health-related quality of life associated with current treatments for anaemia in patients with CKD not on dialysis: a systematic review. Pharmacoecon Open. 2019 Dec;3(4):463-78.\u003c/li\u003e\n\u003cli\u003eTsubakihara Y, Nishi S, Akiba T, Hirakata H, Iseki K, Kubota M, Kuriyama S, Komatsu Y, Suzuki M, Nakai S, Hattori M, Babazono T, Hiramatsu M, Yamamoto H, Bessho M, Akizawa T. 2008 Japanese Society for Dialysis Therapy: guidelines for renal anemia in chronic kidney disease. Ther Apher Dial. 2010 Jun;14(3):240-75.\u003c/li\u003e\n\u003cli\u003eSatirapoj B, Limwannata P, Kleebchaiyaphum C, Prapakorn J, Yatinan U, Chotsriluecha S, Supasyndh O. Nutritional status among peritoneal dialysis patients after oral supplement with ONCE dialyze formula. Int J Nephrol Renovasc Dis. 2017 Jun 13;10:145-151.\u003c/li\u003e\n\u003cli\u003eCupisti A, D\u0026apos;Alessandro C, Finato V, Del Corso C, Catania B, Caselli GM, Egidi MF. Assessment of physical activity, capacity and nutritional status in elderly peritoneal dialysis patients. BMC Nephrol. 2017 May 30;18(1):180.\u003c/li\u003e\n\u003cli\u003eChen K-H, Wu C-H, Hsu C-W, Chen Y-M, Weng S-M, Yang C-W, Hung C-C. Protein nutrition index as a function of patient survival rate in peritoneal dialysis. Kidney Blood Press Res. 2010;33(3):174-80. \u003c/li\u003e\n\u003cli\u003eOzturk S, Soyluk O, Karakaya D, Yazici H, Caliskan YK, Yildiz A, Bozfakioglu S. Is decline in serum albumin an ominous sign for subsequent peritonitis in peritoneal dialysis patients? Adv Perit Dial. 2009:25:172-7.\u003c/li\u003e\n\u003cli\u003eWang Q, Bernardini J, Piraino B, Fried L. Albumin at the start of peritoneal dialysis predicts the development of peritonitis. Am J Kidney Dis. 2003 Mar;41(3):664-9.\u003c/li\u003e\n\u003cli\u003eBennett PN, Bohm C, Harasemiw O, Brown L, Gabrys I, Jegatheesan D, Johnson DW, Lambert K, Lightfoot CJ, MacRae J, Meade A, Parker K, Scholes-Robertson N, Stewart K, Tarca B, Verdin N, Wang AYM, Warren M, West M, Zimmerman D, Li PK-T, Thompson S. Physical activity and exercise in peritoneal dialysis: International Society for Peritoneal Dialysis and the Global Renal Exercise Network practice recommendations. Perit Dial Int. 2022 Jan;42(1):8-24.\u003c/li\u003e\n\u003cli\u003eBennett PN, Hussein WF, Matthews K, West M, Smith E, Reiterman M, Alagadan G, Shragge B, Patel J, Schiller BM. An exercise program for peritoneal dialysis patients in the United States: a feasibility study. Kidney Med. 2020 Mar 17;2(3):267-275.\u003c/li\u003e\n\u003cli\u003eUchiyama K, Washida N, Morimoto K, Muraoka K, Kasai T, Yamaki K, Miyashita K, Wakino S, Itoh H. Home-based aerobic exercise and resistance training in peritoneal dialysis patients: a randomized controlled trial. Sci Rep. 2019 Feb 22;9(1):2632.\u003c/li\u003e\n\u003cli\u003ePalanova P, Mrkvicova V, Nedbalkova M, Sosikova M, Konecny P, Jarkovsky J, Marques E, Novakova M, Pohanka M, Soucek M, Dobsak P. Home-based training using neuromuscular electrical stimulation in patients on continuous ambulatory peritoneal dialysis: a pilot study. Artif Organs. 2019 Aug;43(8):796-805.\u003c/li\u003e\n\u003cli\u003eMatsufuji S, Shoji T, Yano Y, Tsujimoto Y, Kishimoto H, Tabata T, Emoto M, Inaba M. Effect of chair stand exercise on activity of daily living: a randomized controlled trial in hemodialysis patients. J Ren Nutr. 2015 Jan;25(1):17-24.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"quality of life, peritoneal dialysis, cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-7071150/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7071150/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe increasing number of elderly patients with chronic kidney disease (CKD) undergoing peritoneal dialysis (PD) has highlighted the need to improve their quality of life (QOL). While PD has been shown to benefit QOL compared to hemodialysis, the factors influencing QOL in older patients are not fully understood. This study aimed to identify factors associated with QOL in elderly patients undergoing PD, focusing on physical function and activities of daily living (ADLs).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional study included 30 ambulatory patients aged\u0026thinsp;\u0026gt;\u0026thinsp;65 years, who had been undergoing PD for at least three months. QOL was assessed using the EuroQol 5 dimensions 5-level (EQ5D) scale. Functional Independence Measure (FIM) and physical performance metrics, including the 6-minute walk distance (6MWD), handgrip strength, and short physical performance battery (SPPB), were used to assess functional capacity. Spearman\u0026rsquo;s coefficient and multiple regression models were used to identify factors associated with QOL.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean age of participants was 75.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5 years, and the median PD duration was 48 months. The mean EQ5D score was 0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15. Pain/discomfort (33.3%) and mobility issues (26.7%) were the most frequently reported problems. Significant correlations were found between EQ5D scores and 6MWD (r\u0026thinsp;=\u0026thinsp;0.46), SPPB score (r\u0026thinsp;=\u0026thinsp;0.50), and FIM motor scores (r\u0026thinsp;=\u0026thinsp;0.52). Multiple regression showed that FIM motor scores were independently associated with QOL (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), even after adjusting for confounders.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eQOL in elderly PD patients is closely related to physical function and ADLs, rather than renal function or nutritional status. Interventions that improve physical function may enhance QOL in this population.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003eThis study was prospectively registered at inception in the UMIN Clinical Trials Registry under identification number UMIN000038405.\u003c/p\u003e","manuscriptTitle":"Factors associated with quality of life in older patients undergoing peritoneal dialysis: a single-center cross- sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-20 08:13:34","doi":"10.21203/rs.3.rs-7071150/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"25c6feb7-75b2-4583-b506-9caab1edba5b","owner":[],"postedDate":"August 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-23T23:38:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-20 08:13:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7071150","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7071150","identity":"rs-7071150","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}