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Saudi J Kidney Dis Transpl 2017;28(6):1293-1306

© 2017 Saudi Center for Organ Transplantation Saudi Journal
of Kidney Diseases
and Transplantation

Original Article

Impact of Pharmaceutical Care on the Health-related Quality of Life

among Hemodialysis Patients – A Multicenter Randomized Controlled
Study
Uday Venkat Mateti1,2, Anantha Naik Nagappa1, Ravindra Prabhu Attur3, Shankar Prasad Nagarapu3,
Dharshan Rangaswamy 3
1
Department of Pharmacy Management, Manipal College of Pharmaceutical Sciences, Manipal
University, Manipal, 2Department of Pharmacy Practice, Nitte Gulabi Shetty Memorial Institute
of Pharmaceutical Sciences, Nitte University, Deralakatte, Mangaluru, 3Department of Nephrology,
Kasturba Medical College, Kasturba Hospital, Manipal University, Manipal, Karnataka, India

ABSTRACT: The present study was planned to assess the impact of pharmaceutical care on the
health-related quality of life (HRQoL) among hemodialysis (HD) patients. An open-label,
randomized control study was carried out at three different HD centers of teaching, government,
and corporate hospitals in South India. The patients were randomized into two groups (Usual
Care Group [UC] and Pharmaceutical Care Group [PC]) by block design method. The PC group
received the normal care along with pharmaceutical care delivered by a qualified registered
pharmacist. The assessment of the HRQoL was carried out at baseline, 6th and 12th months for the
both groups for a total of 12-month follow-up. A total number of 200 patients were recruited from
the three HD centers. At the end of the study, 153 patients were followed. Out of 153 patients, 83
were from academic hospital (UC, n = 41; PC, n = 42), 18 from government hospital (UC, n = 09;
PC, n = 09), and 52 from corporate hospital (UC, n = 25; PC, n = 27). The HRQoL scores were
significantly improved over time in the domains noticed with regard to the “physical functioning,
general health, emotional well-being, social functioning, symptom/problem list, and effects of
kidney disease” in all the three centers of PC group compared to UC group with P <0.05. The
pharmaceutical care provided by a trained pharmacist had positive impact in HRQoL of HD
patients.

Correspondence to: Introduction

Dr. Uday Venkat Mateti, End-stage renal disease (ESRD) refers to the
Department of Pharmacy Practice, stage-5 chronic kidney disease (CKD) when
Nitte Gulabi Shetty Memorial Institute of kidneys no longer function at a level needed
Pharmaceutical Sciences, Nitte University, for survival. This stage is reached when
Mangaluru- 575 018, Karnataka, India. overall renal function, measured by glomerular
E-mail: udayvenkatmateti@gmail.com filtration rate, is <15 mL/min of normal.1 It has
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1294 Mateti UV, Nagappa AN, Attur RP, et al

been reported that globally ESRD is the 12th income. As a result, the patients invariably
highest cause of disease associated mortality depend on family income, and this has a
and annually there are 830,000 deaths.2 In negative impact on the marital status, family,
India, it is a “hidden epidemic” because there and social activities. The QoL of HD patients
is no nation-wide ESRD registry. Some epide- is found to be deteriorated compared to gene-
miological studies have revealed that millions ral population and other chronic diseases.11,13
of people suffer from CKD.3 There is a need to take stock of situation
As such, ESRD is increasing in epidemic regarding QoL and the components of social,
proportions in India and will be the third pathological, and ESRD-related morbidities.
biggest culprit of morbidity and mortality after The outcome of the inventory of above would
cancer and cardiovascular diseases. The more be able to identify the key factors and plan for
frequent complications of hemodialysis (HD) diminishing their effects on QoL of patients.
includes hypotension (20%–30%), cramps (5%– Health education is needed for patients to
20%), nausea and vomiting (5%–15%), head- assist them in self-care. In addition to self-
ache (5%), chest pain (2%–5%), back pain (2%– care, motivation plays an important role among
5%), itching (5%), and fever and chills (<1%).4 dialysis patients. Patients need updates on
The comorbidities such as cardiovascular issues of drugs, disease, and lifestyle changes
diseases, hypertension, diabetes, renal anemia, appropriate for the failed renal function.5 This
hyperphosphatemia, congestive heart failure, study was aimed to assess the impact of
peripheral vascular disease, and malnutrition Pharmaceutical Care on the HRQoL among
can cause severe consequences to the HD HD patients of teaching, government, and
patients.5,6 The review of literature suggests that corporate hospitals.
the quality of life (QoL) is compromised in
HD patients compared to general population.7 Patients and Methods
The WHO defines the health as “a state of
complete physical, mental, and social well- Study design and period
being not merely the absence of disease”. The This was an open-label, randomized control
WHO also defines QoL as “individuals” per- trial Registered under the Clinical Trial
ception of their position in life in the context Registry of India (Ref. no. CTRI/2014/
of the culture and value systems in which they 004900) was carried out for 15 months bet-
live and in relation to their goals, expectations, ween March 2014–May 2015 at three different
standards and concerns.”8 HD centers of teaching, government, and
Numerous publications have focused on corporate hospitals.
drug-related problems (DRPs) which are very
common in patients on dialysis with esti- Sample size
mation of one DRP for every 15 medicine The sample size was calculated based on the
exposures9 due to DRPs-induced morbidity primary objective and the change in QoL
and nonadherence to the medications with a scores at 0, 6, and 12 months repeated measure
high rate of 67%.10 Most of the publications at 84% power and 5% level of significance.
have revealed that there is a lack of know- The minimum sample required for the study is
ledge, attitude, and practice (KAP) regarding 76 patients per group and anticipating a
the drugs, disease, and lifestyle changes dropout rate of 20%, the required sample size
among CKD patients on HD.11,12 Poor adhe- is 76/0.8 = 95 per each group.
rence is a common problem where patient’s
myths and beliefs play an important role in Ethical approval
shaping the KAP. Health-related QoL This study was approved by the Institutional
(HRQoL) is an important measure in ESRD Ethics Committee (Ref. no. IEC/165/2013),
because long-term HD often compromises the before the initiation.
patient’s ability to earn affecting financial
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Impact of pharmaceutical care on the HRQOL in hemodialysis 1295

Study criteria view, and medication review. The nutritional

The inclusion criteria for choosing the pa- advice for HD and comorbidities, education on
tients was based on HD-continuously for foodstuffs containing potassium, phosphate,
preceding three months, two sessions of HDs protein, sodium, depending on the patients’
per week, and patients in the age group of 18– prerequisite, and fluid constraints. The PC
75 years who can speak at least English or group was provided with a validated pictogram-
Kannada language and who gave written based on patient information leaflets and
informed consent. The patients who were not advice on medication administration, labora-
willing to participate or had psychiatric illness tory monitoring and adherence to HD and
or shifted from peritoneal dialysis or kidney medication issues.
transplantation to HD were excluded from the
study. Data collection
Data were collected in predesigned forms
Randomization, sequence generation, and which had sociodemographic details such as
sampling method age, gender, educational status, economic
The patients were randomized into two groups status, HD vintage, and comorbidities. Socio-
[Usual Care Group (UC) and Pharmaceutical economic status of the patients was calculated
Care Group (PC)] by block design method using Kuppuswamy socioeconomic scale.15
with the block size of 6 at academic, 4 at the Kuppuswamy scale is a measure of patients’
government and corporate hospitals and socio-economic status, which has a blend of
concealed in opaque sealed covers. Randomi- social and economic variables. It classifies the
zation sequence was generated based on the patients into low-, middle-, and high-socio-
weekly visits of HD patients to the centers by economic status.15 Other details such as
the statistic department and concealed in the etiology, distance traveled to the HD center
opaque sealed covers. For each center, there and number of hours of HD per week were
was one UC and PC group in the study. The recorded. The detailed patients recruitment and
patients were recruited proportionally from the follow-up during the study are presented in the
each center in 1:1 ratio of UC and PC group in flowchart (Figures 1–3).
the study by the purposive sampling method.
Health-related quality of life assessment
Usual care group The QoL was assessed using validated
This group received the usual care by the KDQoL-36 instrument, which is a generic and
hospital staff such as physicians, nurses, and disease-specific instrument consisting of 12
technicians. generic questions and 24 disease-specific
questions KDQoL-36 was self-administered at
Pharmaceutical care group baseline, 6th and 12th months to assess the
The PC group received the usual care along HRQoL scores.
with pharmaceutical care delivered by a qua-
lified registered pharmacist. The customized Statistical Analysis
care plan was designed and delivered to the
patients on monthly basis based on the condi- Data were analyzed based on per-protocol
tion and need of the patient by the WHO-FIP method. Repeated measures of ANOVA ana-
Pharmaceutical care model.14 The plan was lysis was performed for the analysis of change
updated based on monthly observations of in the HRQoL scores in the two groups. The P
patients in the area of diet, drugs, and lifestyle. <0.05 was considered as statistically significant.
The PC emphasized motivation and patient
education with validated protocols regarding Results
knowledge about disease, medication, lifestyle
changes, nutritional information, personal inter- A total number of 200 patients were recruited
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1296 Mateti UV, Nagappa AN, Attur RP, et al

Figure 1. Consort flowchart for academic hospital hemodialysis patients.

Figure 2. Consort flowchart for government hospital hemodialysis patients.

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Impact of pharmaceutical care on the HRQOL in hemodialysis 1297

Figure 3. Consort flowchart for corporate hospital hemodialysis patients.

from the three HD centers. Out of 200 of the HD patients were from the lower middle
patients, 104 from academic hospital (UC, n = class, rural background who were not doing
52; PC, n = 52), 26 government hospital (UC, any job. The median vintage of HD was (UC
n = 13; PC, n = 13), and 70 corporate hospital group is 50; PC group is 53), (UC group is 26;
(UC, n = 35; PC, n = 35). At the end of the PC group is 24), and (UC group is 32; PC
study, 153 patients were followed. Out of 153 group is 36) months in academic, government,
patients, 83 were from academic hospital (UC, and corporate hospital patients, respectively.
n = 41; PC, n = 42), 18 from government The baseline demographics such as age, gender,
hospital (UC, n = 09; PC, n = 09), and 52 from education, marital status, working status, domi-
corporate hospital (UC, n = 25; PC, n = 27). ciliary status, socioeconomic status, income
There were 47 dropouts in total, out of which per month, health-care schemes, distance tra-
25 were in UC group and 22 in PC group. veled to the HD centers, HD vintage, number
of hours of HD per week, risk factors, and
Baseline characteristics of hemodialysis patients comorbidities were not significantly different
The mean age of HD patients from the aca- in the UC group vs. PC group in all the three
demic hospital (UC group is 49.40 years; PC HD centers. The detailed baseline characte-
group is 52.78 years), government hospital (UC ristics of HD patients are presented in Table 1.
group is 48 years; PC group is 49.15 years), The baseline HRQoL score of KDQoL-36
and corporate hospital (UC group is 53.77 domains such as short form-12 (SF-12) com-
years; PC group is 52.97 years); gender-wise ponents and ESRD-targeted areas were not
distribution of men from the academic hospital significantly different in the UC group vs. PC
(UC group is 76.9%; PC group is 82.7%), group in all the three HD centers. The detailed
government hospital (UC group is 76.9%; PC baseline HRQoL scores of the HD patients are
group is 84.6%), and corporate hospital (UC presented in Table 2.
group is 74.3%; PC group is 68.6%), majority
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Table 1. Baseline demographic details of HD patients from academic, government and corporate hospitals.
Academic hospital Government hospital Corporate hospital
Demographics UC PC UC PC UC PC
P P P
(n=52) (n=52) (n=13) (n=13) (n=35) (n=35)
Age, Mean±SD 49.40±12.47 52.78±10.45 0.137 48±17 49.15±12.57 0.846 53.77±11.87 52.97±15.12 0.806
Gender, n (%)
Male 40 (76.9) 43 (82.7) 0.464 10 (76.9) 11 (84.6) 1.000 26 (74.3) 24 (68.6) 0.597
Female 12 (23.1) 9 (17.3) 3 (23.1) 2 (15.4) 9 (25.7) 11 (31.4)
Education status, No.
(%)
Illiterate 10 (19.2) 9 (17.3) 0.313 3 (23.1) 3 (15.4) 0.719 2 (5.7) 7 (20) 0.059
Primary school 3 (5.8) 2 (3.8) 3 (23.1) 5 (38.5) 5 (14.2) 1 (2.9)
Middle school 6 (11.5) 6 (11.5) 1 (7.7) - 7 (20) 5 (14.3)
High school 17 (32.7) 11 (21.1) 4 (30.8) 4 (30.8) 7 (20) 9 (25.7)
Intermediate 8 (15.4) 9 (17.3) 2 (15.4) 2 (15.4) 8 (22.9) 5 (14.3)
Graduate 8 (15.4) 14 (26.9) - - 6 (17.1) 8 (22.9)
Marital status, No. (%)
Married 44 (84.6) 49 (94.2) 10 (76.9) 12 (92.3) 32 (91.4) 3 (88.6)
Unmarried 8 (15.4) 3 (5.8) 0.105 3 (23.1) 1 (7.7) 0.593 3 (8.6) 4 (11.4) 1.000
Employment status, No.
(%)
Not working 43 (82.7) 43 (82.7) 11 (84.6) 12 (92.3) 34 (97.1) 29 (82.9)
Working 9 (17.3) 9 (17.3) 1.00 2 (15.4) 1 (7.7) 1.000 1 (2.9) 6 (17.1) 0.106

Mateti UV, Nagappa AN, Attur RP, et al

Domiciliary status, No.
(%)
Rural 47 (90.4) 39 (75.0) 12 (92.3) 13 (100) 15 (42.9) 16 (45.7)
Urban 5 (9.6) 13 (25.0) 0.068 1 (7.7) - 1.000 20 (57.1) 19 (54.3) 1.000
Socioeconomic status,
No. (%)
Upper 3 (5.8) 2 (3.8) - - 2 (5.7) 1 (2.9)
Upper middle 10 (19.2) 16 (30.8) 0.193 1 (7.7) - 0.057 13 (37.1) 13 (37.1) 0.269
Lower middle 25 (48.1) 18 (34.6) 5 (38.5) 3 (23.1) 16 (45.7) 11 (31.4)
Upper lower 4 (23.1) 16 (30.8) 7 (53.8) 6 (46.2) 4 (11.4) 10 (28.6)
Lower 2 (3.8) - - 4 (30.8) - -
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Impact of pharmaceutical care on the HRQOL in hemodialysis

Continuation of table 1
Distance traveled to HD
center (km), Median (Q3, 30 (40, 15) 26.50 (35, 10) 0.078 23 (32, 11) 26 (40, 15) 0.143 40 (60, 20) 35 (56, 16) 0.121
Q1)
Length of time spent on
HD (Months), Median 50 (68, 14) 53 (79, 24) 0.084 26 (45, 9.5) 24 (39, 10) 0.718 32 (48, 12) 36 (64, 10) 0.397
(Q3, Q1)
No. of hours of HD per
10.19±0.97 10.38±1.34 0.405 9.46±2.92 9.15±2.19 0.730 9.94±2.02 10.40±1.98 0.344
week, Mean±SD
Etiology for CKD, n (%)
Diabetic nephropathy 18 (34.6) 15 (28.8) 4 (30.7) 5 (38.5) 12 (34.4) 10 (28.6)
CTIN 12 (23.0) 14 (26.9) 2 (15.3) 4 (30.7) 7 (20) 7 (20)
CGN 9 (17.3) 7 (13.4) 0.541 2 (15.3) 1 (7.7) 0.245 5 (14.2) 4 (11.4) 0.561
Hereditary nephritis 1 (1.9) 3 (5.7) 1 (7.7) - 2 (5.7) 1 (2.8)
PKD 3 (5.7) 4 (7.6) - 1 (7.7) 2 (5.7) 3 (8.6)
Hypertension 4 (7.6) 5 (9.6) 3 (23.0) 2 (15.3) 4 (11.4) 5 (14.2)
Obstructive uropathy 4 (7.6) 4 (7.6) 1 (7.7) - 2 (5.7) 3 (8.6)
Renovascular disease 1 (1.9) - - - 1 (2.8) 2 (5.7)
Comorbidity, n (%)
Diabetes 18 (34.6) 15 (28.8) 4 (30.7) 5 (38.5) 12 (34.4) 10 (28.6)
Hypertension 52 (100) 52 (100) 13 (100) 13 (100) 35 (100) 35 (100)
Ischemic heart disease 36 (69.2) 34 (65.3) 0.283 7 (53.8) 9 (69.2) 0.791 19 (54.2) 24 (68.5) 0.926
Obstructive airway disease 7 (13.4) 5 (9.6) 1 (7.7) 3 (23.0) 3 (8.6) 5 (14.2)
Hypothyroidism 2 (3.8) 3 (5.7) - 1 (7.7) 5 (14.2) 2 (5.7)
Connective tissue disease 3 (5.7) 2 (3.8) 1 (7.7) 2 (15.3) 2 (5.7) 4 (11.4)
Cerebrovascular accident 6 (11.5) 8 (15.3) 3 (23.0) 1 (7.7) 5 (14.2) 3 (8.6)
HD: Hemodialysis, UC: Usual care group, PC: Pharmaceutical care group, SD: Standard deviation, CTIN: Chronic tubular interstitial nephritis; CGN:
Chronic Glomerulonephritis, PKD: Polycystic kidney disease.

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1300 Mateti UV, Nagappa AN, Attur RP, et al

Humanistic outcomes back to the health-care professionals as early

The PC group had significantly improved its as possible with an aim to avoid and mitigate
HRQoL scores comparatively to HRQoL scores any serious complications arising due to
of UC group at different time intervals when unmanaged morbid conditions.
analyzed by repeated measures of ANOVA. In the present study, the intervention of phar-
The increase in HRQoL score domains noticed maceutical care showed significant improve-
with regard to the “physical functioning, gene- ment in HRQoL scores over time in the do-
ral health, emotional well-being, social func- mains of “physical functioning, general health,
tioning, symptom/problem list, and effects of emotional well-being, social functioning,
kidney disease” in PC group compared to UC symptom/problem list, and effects of kidney
group with a statistically significance of P disease” in all the three centers of PC group
<0.05. The changes in HRQoL domains scores compared to UC group. These results were
across the study period of the HD patients are comparable with the studies conducted in the
presented in the Tables 3–5 for academic intervention of patient counseling, patient
hospital, government hospital, and corporate education, and pharmaceutical care in the
hospital. HRQoL of HD patients.9,11,16-20,23,24 The study
carried out by Abraham et al, assessed the
Discussion impact of patient counseling in HRQoL of HD
patients at 6 and 12 months in India. The
In the present study, HRQoL was assessed by increase in HRQoL scores was observed in
utilizing the generic and disease-specific vali- “physical, psychological, environmental, and
dated KDQoL-36 instrument in contrast to the social domains” in the test group compared to
previously conducted studies in the HRQoL of control group.16-18 The study carried out by
HD patients was measured using the generic- Thomas et al assessed the impact of patient
specific HRQoL instruments such as SF-36, counseling in HRQoL of HD patients at 6
Karnofsky Performance Status, EQ-5D, and months in India. The increase in HRQoL
WHO-Bref.16-20 The study carried out by scores by 2% in the test group were observed
Apostolou et al, results suggest that the as compared to control group.16
disease-specific HRQoL instruments were The study carried out by Baraz et al, assessed
better compared with the generic instruments the post-interventional educational program in
in identifying specific items that affected the HRQoL of HD patients in Iran. The increase in
overall QoL in dialysis patients.21 The pre- HRQoL domains scores was observed in “phy-
viously conducted HRQoL studies on HD pa- sical functioning, role physical, social func-
tients revealed that the HRQoL is compro- tioning, and mental health” after the educa-
mised in HD patients.7,20,22 tional intervention.24 The study carried out by
The pharmaceutical care is a comprehensive Dashti-Khavidaki et al, assessed the impact of
patient education system serving in the areas pharmaceutical care in HRQoL of HD patients
of drug, disease, nutritional, and lifestyle at six months in Iran. The increase in HRQoL
information with an objective to empower the domains scores was observed in “role-
patient with self-management of his or her emotional, mental health, social functioning,
condition. Pharmaceutical care also focuses on and general health dimensions” in case group
motivating the patients to take the ownership as compared to control group.25 In a study
of their disease management with a limitation carried out in the USA on the intervention of
for day-to-day management. However, they pharmaceutical care in HRQoL of HD patients.
have sought a professional guidance whenever The increase in HRQoL domains scores was
the self-management fails to deliver satisfac- observed in “eating/drinking, physical acti-
tory QoL. The patients were specifically trained vities, leisure time, psychosocial activities, and
to identify many early symptoms of the prog- impact of treatment” over time in PC com-
nosis of morbidity and are instructed to revert pared to standard care group.23
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Impact of pharmaceutical care on the HRQOL in hemodialysis

Table 2. HRQOL baseline scores of HD patients from academic, government, and corporate hospitals.
Academic hospital patients HRQoL Government hospital patients Corporate hospital patients HRQoL
scores# HRQoL scores# scores#
KDQoL-36 Domains
UC PC UC PC UC PC
P P P
(n=52) (n=52) (n=13) (n=13) (n=35) (n=35)
12 item health survey
(SF-12)
Physical functioning 47.19 ±21.15 45.67±23.59 0.342 42.15±22.46 44.23±14.97 0.280 40±21.02 43.57±21.30 0.459
Role-Physical 42.30±16.22 41.34±16.84 0.576 38.46±16.25 34.61±11.52 0.665 42.85±18.74 44.28±17.79 0.432
Pain 48.55±20.65 49.51±18.84 0.253 48.07±23.85 46.15±22.67 0.739 45.71±21.42 45±18.98 0.503
General health 37.50±17.50 34.61±13.24 0.345 36.53±16.50 26.92±16.01 0.359 31.42±17.51 30.71±12.25 0.844
Emotional well-being 42.50±15.32 39.23±17.35 0.364 36.15±12.60 33.84±10.43 0.514 43.42±17.51 43.14±15.48 0.556
Role-emotional 50±17.04 49.03±14.40 0.142 38.46±16.25 34.61±11.52 0.665 44.28±19.33 48.57±21.09 0.373
Social functioning 56.73±21.07 51.92±23.66 0.957 50±24.12 42.30±20.37 0.779 68.57±17.51 62.14±19.52 0.389
Energy/Fatigue 45.76±20.70 43.46±13.55 0.503 43.07±13.77 40±16.32 0.610 40.26±15.29 42.02±16.76 0.981
ESRD targeted areas
Symptom/Problem list 81.31±8.23 80.32±8.60 0.709 75.96±8.74 75.44±7.35 0.662 83.63±6.27 82.26±7.31 0.158
Effects of kidney disease 64.60±11.72 65.68±10.60 0.330 68.75±8.46 70.43±7.17 0.777 74.64±10.49 70.35±9.29 0.688
Burden of kidney disease 45.07±20.94 44.01±21.51 1.000 51.92±16.80 47.59±12.37 0.548 48.39±17.50 45.35±17.50 0.702
HRQoL: Health-related quality of life, HD: Hemodialysis, UC: Usual care group, PC: Pharmaceutical care group, #: Mean ± SD, SD: Standard
deviation, ESRD: End-stage renal disease.

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Table 3. HRQOL scores for UC and PC groups of academic hospital HD patients.
Baseline HRQoL Scores# 6 Months HRQoL Scores# 12 Months HRQoL Scores#
Greenhouse-Geisser
KDQoL-36 Domains UC PC UC PC UC PC
and P
(n=41) (n=42) (n=41) (n=42) (n=41) (n=42)
12 item health survey
(SF-12)
F (1.572, 127.324) =
Physical functioning 48.17±19.67 44.64±16.02 45.12±18.72 53.57±19.57 43.29±21.32 51.19±20.19
3.944, P = 0.031*
F (1.813, 146.886) =
Role-physical 43.90±120.69 44.04±19.68 43.90±17.82 48.80±18.12 39.02±19.16 46.42±20.87
0.447, P = 0. 621
F (1.518, 122.991) =
Pain 50±18.54 52.97±17.63 43.90±16.56 48.21±13.96 40.85±16.54 47.61±19.76
0.473, P = 0. 572
F (1.815, 147.055) =
General health 37.19±14.91 34.52±13.47 35.97±12.56 42.26±17.88 34.75±15.69 41.07±18.16
3.656, P = 0. 032*
F (1.416, 114.688) =
Emotional well-being 42.92±14.92 39.76±12.32 39.26±112.32 48.33±16.66 40.24±16.04 47.14±22.22
7.882, P = 0. 002**
F (1.797, 145.533) =
Role-emotional 47.56±19.20 52.38±24.57 43.90±19.98 59.52±29.71 46.34±23.42 61.90±30.86
1.331, P = 0.226
F (1.634, 132.344) =
Social functioning 56.09±22.20 55.35±23.12 54.26±17.59 67.85±17.70 52.43±21.50 66.66±25.10
5.569, P = 0.008**
F (1.395, 113.027) =

Mateti UV, Nagappa AN, Attur RP, et al

Energy/Fatigue 44.87±18.85 45.23±13.29 41.46±12.95 44.76±13.83 43.41±19.44 45.71±21.57
0.299, P = 0.662
ESRD-targeted areas
F (1.436, 116.327) =
Symptom/Problem list 82.78±6.66 81.15±8.76 78.81±5.68 78.17±8.37 77.03±6.96 78.32±8.42
4.815, P = 0.018**
F (1.642, 133.025) =
Effects of kidney disease 65.70±110.49 65.69±10.76 62.04±9.96 69.41±10.59 61.12±9.90 70.23±10
49.386, P <0.001**
F (1.386, 108.296) =
Burden of kidney disease 42.37±20.56 45.27±21.78 42.22±14.90 45.42±19.68 41.28±14.15 46.27±18.10
0.358, P = 0.621
HRQoL: Health-related quality of life, UC: Usual care group, PC: Pharmaceutical care group, HD: Hemodialysis, *:P is significant at the 0.05 level,
**:P is significant at the 0.01 level, #: Mean ± SD, SD: Standard deviation, ESRD: End-stage renal disease.
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Impact of pharmaceutical care on the HRQOL in hemodialysis

Table 4. HRQOL scores for UC and PC groups of Government Hospital HD patients.
Baseline HRQoL scores# 6 Months HRQoL scores# 12 Months HRQoL scores#
Greenhouse-Geisser
KDQoL-36 Domains UC PC UC PC UC PC
and P
(n=9) (n=9) (n=9) (n=9) (n=9) (n=9)
12 item health survey
(SF-12)
F (1.913, 30.616) =
Physical functioning 50±25 41.66±17.67 44.44±20.83 44.44±20.83 38.88±18.16 44.44±16.66
3.707, P = 0.038*
F (1.435, 22.953) =
Role-physical 22.22±10.83 44.44±19.84 27.77±16.25 38.88±16.25 27.77±16.25 33.33±15.78
0.949, P = 0.373
F (1.706, 27.300) =
Pain 55.55±20.83 44.44±21.32 47.22±15.02 38.88±18.16 41.66±12.50 36.11±15.34
0.176, P = 0.805
F (1.891, 30.253) =
General health 33.33±12.50 27.77±8.33 30.55±11.02 36.11±13.17 27.77±8.33 38.88±13.17
3.446, P = 0.047
F (1.182, 18.910) =
Emotional well-being 38.88±11.66 31.11±10.54 33.33±10 37.77±12.01 34.44±13.33 44.44±15.09
4.288, P = 0.047*
F (1.916, 30.661) =
Role-emotional 33.33±15.57 44.44±16.66 44.44±16.66 50±25 33.33±15.35 44.44±16.66
0.119, P = 0.880
F (1.992, 31.867) =
Social functioning 55.55±16.66 47.22±23.66 50±12.50 52.77±8.33 44.44±11.02 58.33±121.65
4.129, P = 0.026
F (1.442, 23.071) =
Energy/Fatigue 46.66±14.14 37.77±15.63 40±10 35.55±8.81 35.55±16.66 37.77±12.01
1.070, P = 0.338
ESRD targeted areas
F (1.755, 28.083) =
Symptom/problem list 80.55±2.94 75.18±6.91 65.97±5.70 67.08±5.70 65.04±4.39 65±7.93
4.042, P = 0.033*
F (1.446, 23.131) =
Effects of kidney disease 69.09±10.05 71.52±10.60 62.15±8.90 74.65±4.80 60.76±7.67 73.95±6.98
18.060, P <0.001***
F (1.422, 22.755) =
Burden of kidney disease 50.69±18.34 46.52±14.01 42.36±10.25 41.66±12.88 40.27±10.41 45.83±12.10
1.539, P = 0.235
HRQoL: Health-related quality of life, UC: Usual care group, PC: Pharmaceutical care group, HD: Hemodialysis, *:P is significant at the 0.05 level,
***:P is significant at the 0.001 level, #: Mean ± SD, SD: Standard deviation, ESRD: End-stage renal disease.

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Table 5. HRQOL Scores for UC and PC groups of Corporate Hospital HD patients.
Baseline HRQoL Scores# 6 Months HRQoL Scores# 12 Months HRQoL Scores#
Greenhouse-Geisser
KDQoL-36 Domains UC PC UC PC UC PC
and P
(n = 25) (n = 27) (n = 25) (n = 27) (n = 25) (n = 27)
12 item health survey
(SF-12)
F (1.797, 89.865) =
Physical functioning 42±21.31 44.44±16.01 36±14.57 51.85±15.38 37±19.25 48.14±22.91
3.606, P = 0.036*
F (1.744, 87.189) =
Role-physical 46±13.10 40.74±14.68 44±14.06 44.44±14.89 40±14.83 38.88±11.87
0.159, P = 0.824
F (1.498, 74.885) =
Pain 43±21.26 42.59±18.10 39±17.79 38.88±14.43 38±16.32 39.81±17.34
0.106, P = 0.842
F (1.857, 92.850) =
General health 33±17.26 31.48±11.16 30±12.50 38.88±18.77 31±16.58 42.59±20.59
3.349, P = 0.043*
F (1.290, 64.519) =
Emotional well-being 42.80±14.29 39.25±14.65 38±11.54 46.66±14.93 39.20±18.96 48.14±22.19
4.606, P = 0.027*
F (1.977, 98.874) =
Role-emotional 48±22.73 46.29±23.03 42±18.70 61.11±28.86 44±21.98 57.40±26.68
2.926, P = 0.059
F (1.547, 77.367) =
Social functioning 67±17.26 61.11±20.01 59±21.50 69.44±18.77 61±22.91 64.81±24.27
3.992, P = 0.032*
F (1.430, 71.497) =
Energy/Fatigue 38.40±15.18 42.22±17.83 36.80±14.92 41.48±14.59 37.60±16.54 44.44±18.54

Mateti UV, Nagappa AN, Attur RP, et al

0.234, P = 0.716
ESRD targeted areas
F (1.595, 79.739) =
Symptom/ problem list 82.66±6.63 81.55±7.11 74.75±6.73 78.16±5.93 73.83±8.31 78.62±7.81
10.224, P <0.001***
Effects of kidney F (1.512, 75.621) =
71.25±10.08 69.62±8.80 66.62±8.73 74.65±7.86 65.62±8.46 75.69±8.59
disease 38.079, P <0.001***
Burden of kidney F (1.548, 77.389) =
48.50±17.70 44.44±18.20 42±14.49 42.36±13.12 44.25±18.30 46.52±12.05
disease 1.729, P = 0.190
HRQoL: Health-related quality of life, UC: Usual care group, PC: Pharmaceutical care group, HD: Hemodialysis, *:P is significant at the 0.05 level,
**:P is significant at the 0.01 level, #: Mean ± SD, SD: Standard deviation, ESRD: End-stage renal disease.
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Impact of pharmaceutical care on the HRQOL in hemodialysis 1305

The study carried out by Aghakhani et al Manipal University for providing us with the
assessed the intervention of nutritional edu- research facilities.
cation in HRQoL of HD patients in Iran. The
increase in HRQoL domains scores was Conflict of interest: None declared.
observed in diet-counseled group compared to
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