CHAPTER 75: Quality of Life

CENTERS FOR DISEASE CONTROL AND PREVENTION DEFINITION

• An overall sense of well-being, including aspects of happiness and satisfaction with life as a whole

BACKGROUND

• Kidney transplantation has moved from an experimental treatment to standard management for end-stage renal diseases. Prolongation in survival is accepted, but evaluation of long-term effects on patients’ quality of life (QOL) and its enhancement is the new objective.

QUALITY OF LIFE

• Comprehensive measurement of posttransplantation health-related quality of life (HRQL) are important for several reasons:

  • Patients are more concerned about QOL than longevity.

  • Kidney transplant recipients may have debilitating fatigue, bone pain, loss of self-esteem, depression, and complications of immunosuppression, which are poorly evaluated through traditional clinical outcomes.

  • Provide valuable information to the health professionals to focus their treatment and procedures towards the most affected areas of recipients’ lives.

  • Provide key components of an evaluation of both effectiveness and cost-effectiveness, which are of particular importance given the cost and scarcity of the resources involved in kidney transplantation (KT)

• Measuring of QOL helps to address the overall health status of KT recipients.

• Method for measuring QOL:

  • Generic instruments (Table 75-1)

• Pretransplant predictors of QOL (Table 75-2):

• Employment: interval without work prior to KT and pre-KT diagnosis correlated with the likelihood of employment after KT

• Sexual functioning: In most cases there isn’t a perceptible improvement, perceptions of sexual health are likely to be psychological rather than endocrine, since endocrine function typically recovers after KT

• Effect of immunosuppressant medication (Table 75-3):

  • Increased risk of infections

  • Metabolic complications such as hypertension, diabetes mellitus (DM), hyperlipidemia, obesity, and gout

    • Cardiovascular disease and renal failure are the leading nonhepatic causes of morbidity and mortality late after KT

  • De novo cancers, including posttransplant lymphoproliferative disorder

  • Psychological effects associated with steroid therapy aren’t common

• Strategies to improve QOL in post-KT patients

  • Monitoring of renal function

  • Bone mineral density screenings should be done

• Immunization

  • Annual influenza vaccination

  • Avoid live virus vaccines

  • Reimmunization is indicated for the pneumococcal vaccine (every 3–5 years)

• Behavioral intervention

  • Psychoeducational counseling

    • Frequent handwashing

    • Avoid unnecessary sun exposure

    • During periods of maximal immunosuppression, avoid crowds

    • Avoid consumption of water from lakes and rivers, unpasteurized milk products, and raw and undercooked eggs and meats

    • Avoid high-risk pets, which include rodents, reptiles, and birds

    • Reduction of travel-related risks

    • Sustained cessation of smoking

    • Preconception counseling about contraception and the risks and outcomes of pregnancy

  • Exercise and dietary counseling