Determination of the relationship between adequacy of dialysis and quality of life and self-care agency

ORIGINAL ARTICLE

Determination of the relationship between adequacy of dialysis and

quality of life and self-care agency

Nurten Kalender and Nuran Tosun

Aim and objectives. To investigate the relationship between the dialysis adequacy and the quality of life and self-care

agency.

Background. Haemodialysis (HD), which is the leading treatment option for chronic renal failure (CRF), leads to significant

changes in the life of the patient. These changes affecting almost all the dimensions of life also negatively affect the quality

of life and self-care agency.

Design. Descriptive study.

Methods. The research was conducted with a total of 112 patients who had been admitted to two private dialysis centres

between May 2009 and September 2010, who met the research criteria. The Data Collection Form for the Socio-demo

graphic and Medical Characteristics, the Biochemical and Medical Parameters Form to determine the adequacy of dialysis,

the SF-36 Quality of Life Scale and the Self-Care Agency Scale were used in the research.

Results. A significant relationship was found between Kt/V, one of the parameters used for the assessment of dialysis ade-

quacy, and the emotional role scores of the SF-36 Quality of Life Scale and between the URR level and physical functioning

(r = +0�192, p = 0�045) and emotional role scores (r = +0�284, p = 0�003). No significant relationship could be found

between the self-care agency and the evaluated parameters.

Conclusions. Kt/V and URR, which have an effect on dialysis adequacy, may affect the quality of life. Our results are simi-

lar to those of previous studies, which showed that Kt/V and URR affect the quality of life.

Relevance to clinical practice. It was recommended to regularly control the parameters used for the assessment of dialysis

adequacy and to evaluate their effects on the quality of life, to determine the most affected quality of life subparameters and

to address these problems and solve them.

Key words: dialysis adequacy, haemodialysis, quality of life, self-care agency, SF-36

Accepted for publication: 27 November 2012

Introduction

Chronic renal failure (CRF) is an important problem gradu-

ally increasing worldwide and negatively affecting the quality

of life of individuals (Zhang & Rothenbacher 2008). Hae-

modialysis (HD) is the most commonly used treatment

option (Ricka et al. 2002). This method leads to significant

changes in patients’ lives (Ricka et al. 2002, Sultania et al.

2009) and impairs the quality of life of the patient (Evans

et al. 1985, Lowrie 1994). The concept ‘quality of life’ is one

of the parameters, the use of which is gradually increasing as

an indicator of health. The World Health Organization

(WHO) mentioned about how the individual perceived one-

self and individualised this concept when defining the quality

of life in 1991. Expectations from life, standards and fields

of interest are included in this concept (Bohlke et al. 2008).

There are two factors in the foreground in the treatment

for CRF. The first is to prolong the lifespan of patients, and

the second is to provide a better quality of life (Moreno et al.

1996). Prolongation of the lifespan and having a better

Authors: Nurten Kalender, RN, PhD Student, Gulhane Military

Medical Academy, School of Nursing, Ankara; Nuran Tosun, PhD,

RN, Associate Professor of Medical Nursing, Gulhane Military

Medical Academy, School of Nursing, Ankara, Turkey

Correspondence: Nurten Kalender, PhD Student, Gulhane Military

Medical Academy, School of Nursing, GATA Hems�irelik Y€uksek

Okulu, 06010 Ankara, Turkey. Telephone: +9 0312 304 39 06.

E-mail: [email protected]

© 2013 John Wiley & Sons Ltd

820 Journal of Clinical Nursing, 23, 820–828, doi: 10.1111/jocn.12208

quality of life are related to the efficacy of the dialysis. Stud-

ies have revealed that an adequate HD decreases the morbid-

ity and mortality (Owen et al. 1993, Hakim et al. 1994,

Held et al. 1996). Studies have evaluated the influence of

exercise, erythropoietin treatment and other factors on the

quality of life in patients undergoing continuous HD (Kutner

et al. 2000, Tawney et al. 2000). Assessment of the dialysis

adequacy is not easy. Many parameters such as fluid control

and electrolyte balance are being used in clinical practice.

The most commonly used parameter is Kt/V (Locatelli 2003).

In a study evaluating the relationship between Kt/V (used to

assess the dialysis adequacy) and the quality of life, the levels

of Kt/V in 6 of 8 subscales of SF-36 were found to increase

with a mean of 0�2 (Powers et al. 2000). Another parameter

used to assess the dialysis adequacy is the urea reduction rate

(URR) (Vural 2002, Assal et al. 2006). Although a significant

relationship was found between Kt/V and URR and the qual-

ity of life in some studies (Morton et al. 1996, Mingardi

et al. 1999), no significant relationship could be found in

another study (Spiegel et al. 2008).

Individuals also have difficulties in maintaining self-care

due to the side effects of the disease and the treatment

(Headley & Wall 2000, Manns et al. 2002). Self-care behav-

iours include an appropriate diet, regular drug use, restricted

fluid intake and coping with stress. Studies have revealed a

correlation between the self-care level and compliance to

therapy, health-improving behaviours and decrease in physi-

cal and psychological symptoms (Tsay 2003). Improving the

self-care agency is important for preserving, improving the

quality of life of patients maintained on HD, and prevention

of potential complications (Orem 1995).

This study was planned as a descriptive study to investigate

the relationship between the dialysis adequacy and the quality

of life and self-care agency in CRF patientsmaintained onHD.

Aim and objectives

This study was planned to investigate the relationship

between the dialysis adequacy and the quality of life and

self-care agency.

Methods

Design

Descriptive study.

Patients and study design

The research was conducted in two private dialysis centres

between September 2009 and May 2010. The study sample

consisted of 148 patients who had been admitted to these

dialysis centres. Two patients died in the course of the

study, 28 patients dropped out the current dialysis centre

and continued their treatments in another centre, and six

patients dropped out voluntarily. Consequently, 112

patients who had been admitted to the HD unit and who

had met the research criteria constituted the study sample.

Patients who had been receiving HD therapy for more than

3 months, who were above 18 years of age, had no com-

munication problems, had been informed about the study

and agreed to participation and had no severe heart failure,

active infection or malignancy were enrolled in the study.

The data were collected through face-to face interviews

after the participants had been informed about the purpose

of the study and the applications and after having obtained

informed consents from the patients. The interviews took a

mean of 15–20 minutes.

Data collection

The demographic, clinical and laboratory data of the

patients were obtained from the patients and the records by

the researcher. The demographic data comprised age, gen-

der, educational status, employment status, monthly income

and situation in family. Medical characteristics included the

diagnoses of the patients, information regarding the disease,

the drugs, whether the patient had received an education

about the disease or not, smoking/alcohol use and problems

during HD.

To assess the dialysis adequacy, the weight of the patient

was measured; the blood pressure alterations, dialysis

frequency, the type of vascular route used for the dialysis,

Kt/V, URR, potassium, sodium, creatinine, urea, albumin,

calcium, phosphorous, parathormone, haemoglobin and

haematocrit (Hct) values were recorded. Kt/V calculation

was made according to the Daugirdas formula (Daugirdas

1993). SF-36 was used for the measurement of the quality

of life, and the Self-Care Agency Scale was used for the

assessment of the self-care agency.

The SF-36 Quality of Life Scale was created by Ware in

1987 for individual assessment, clinical use and researches,

assessment of health policies and analysing the general pop-

ulation. The Turkish validation of the scale was performed

by Koc�yigit et al. (1999). The SF-36 Scale is composed of

36 items and enables the measurement of the dimensions in

health field. The scale is evaluated based on the previous

4 weeks. The assessment is Likert type (ternary, senary)

except the 4th and the 5th items, which are responded as

‘yes’ or ‘no’. The most important superiority of the scale is

its measurement of the physical functions and related


Journal of Clinical Nursing, 23, 820–828 821

Original article Dialysis efficacy and effect on quality of life

abilities. Its limitation is not including questions to evaluate

the sexual functions. While higher scores indicate a better

health status, lower scores indicate impairment of health

(Koc�yigit et al. 1999).The Self-Care Agency Scale was developed by Kearney

and Fleischer in 1979 and adapted to the Turkish popula-

tion after its reliability and validity study had been per-

formed by Nahc�ıvan in the healthy young and by Pınar in

chronically ill patients (Pınar 1993). The Self-Care Agency

Scale is used to determine the self-care ability of the indi-

vidual. The Turkish form includes 35 statements, and each

statement is scored between 0 and 4. The highest possible

score is 136. Scores below 82 are accepted as ‘low’, 82–120

as ‘moderate’ and above 120 as ‘high’. As a result of valid-

ity in chronic diseases, the test–retest reliability is 0�80 and

the internal consistency is 0�89 (Balcı 2003).

Data analysis

Descriptive statistics were shown as numbers and percent-

ages for numerical variables, and mean � standard devia-

tion for quantitative variables. The normality distribution

of quantitative variables was analysed numerically using the

Shapiro–Wilk test and graphically. The significance test

between the two mean values (t-test) was used for the inter-

group comparisons. The Spearman’s and the Pearson’s

correlation analyses were used for the assessment of the

relationship between SF-36 Quality of Life and Self-Care

Agency scores and the numerical parameters. MS-EXCEL and

SPSS for Windows Version 15.00 (SPSS Inc. Chicago, IL,

USA) package program were used for the assessment of the

data and the statistical analyses. A p level of � 0�05 was

accepted as statistically significant.

Ethical issues and approval

The ethical approval of this study was obtained from the

Ethical Committee of Gulhane Military Medical of Acad-

emy, Ankara. All patients were informed about this study,

and informed consent forms were obtained from all volun-

teers who accepted to participate in this study.

Results

Patient characteristics

The mean age of the patients was 51�5 � 14�03 years,

and 51�8% of the patients were in the 51–90 age group.

Most of the patients were females (57�1%), graduates of

elementary school (60�7%), married (81�3%), not actively

working (87�5%) and had low economic status (40�2%)

(Table 1).

The medical characteristics of the patients are demon-

strated in Table 2. Most of the patients (90�2%) had fis-

tula, 91�2% were undergoing dialysis sessions three times a

week, and 44�5% had been undergoing HD for 35–

60 months. The subscale scores of the SF-36 Quality of Life

Scale are presented in Table 3.

Basic results

Independent samples t-test results

The emotional role mean scores were higher in the group

with Kt/V� 1�2, and the difference was statistically signifi-

cant (Table 4). A statistically significant relationship was

determined between the mean scores of the emotional role

and mental health and URR level (Table 4). The mean

score of the emotional role was found to be higher in the

group in which the URR was <65%, and the mean score of

Table 1 Patients’ sociodemographic characteristics (n = 112)

n %

Age, mean � SD (51�5 � 14�035)20–50 54 48�251–90 58 51�8

Gender

Female 64 57�1Male 48 42�9

Marital status

Married 91 81�3Single 8 7�1Widowed 13 11�6

Educational status

Not literate 5 4�5Literate 6 5�4Elementary 68 60�7High school 21 18�8University 12 10�7

Employment status

Working full-/part-time 40 44�8Other (unemployed, retired, housewife) 72 55�2

Monthly income

Low 45 40�2Middle and high 67 59�8

Situation in family

Parents 92 82�1Grandparents 10 8�9Child 10 8�9

Use of cigarette

Yes/no 27/85 24�1/75�9Use of alcohol

Yes/no 11/101 9�8/90�2


822 Journal of Clinical Nursing, 23, 820–828

N Kalender and N Tosun

mental health was found to be higher in the group in which

the URR was � 65%.

The assessment of diabetic patients according to the SF-

36 Scale is presented in Table 5. According to the diabetes

diagnosis, the physical functioning, vitality (energy) and

social functioning mean scores were higher in the non-dia-

betic individuals, and a statistically significant relationship

was found.

Correlation analysis

The correlations between the evaluated parameters and the

SF-36 Quality of Life Scale are shown in Table 6. A posi-

tive and statistically significant relationship was found

between the Kt/V level and the emotional role (r = 0�277,p = 0�003) and between the URR level and physical func-

tioning (r = 0�192, p = 0�045) and emotional role scores

(r = 0�284, p = 0�003).A negative and statistically significant relationship was

found between the calcium level and physical role

(r = 0�227, p = 0�016), urea level and vitality (r = 0�280,p = 0�003) scores.A positive and statistically significant relationship was

detected between the creatinine level and physical function-

ing (r = 0�237, p = 0�012), Hct level and physical role

scores (r = 0�195, p = 0�039), and the albumin level and

bodily pain (r = 0�234, p = 0�013), general health

(r = 0�193, p = 0�041), emotional role scores (r = 0�272,p = 0�004). A negative and statistically significant relation-

ship was found between the potassium level and the mental

health scores (r = �0�243, p = 0�010).The relationships between the subgroups of the SF-36

Scale and PTH levels, the duration of dialysis and the vas-

cular route used were not statistically significant (p > 0�05).The Self-Care Agency mean score of the participants was

found to be 99�38 � 14�52 (min/max: 58–132). The differ-

ence between the Kt/V (r = �0�02, p = 0�83) and URR

(r = �0�05, p = 0�54) levels and the self-care agency was

not statistically significant (p > 0�05).The difference between calcium, phosphorous, PTH,

urea, creatinine, potassium, haemoglobin, Hct and albumin

levels and the Self-Care Agency Scores was not statistically

significant.

Discussion

One of the limitations of this study may include the lack of

investigating the effect of psychosocial factors on the

patients’ perceptions of quality of life and self-care agency.

The factors that could be effective on quality of life and

self-care agency such as the age of the patients (from

20–90 years) and the duration of dialysis (from

4–216 months) have shown a wide range of differences in

this study. So these factors can be seen as other limitations

of this study. Random and long-term studies are needed to

enhance our knowledge on the care of these patients.

The Kt/V ratio is accepted as an indicator of dialysis ade-

quacy, and the targeted minimum Kt/V ratio is 1�2[Hemodialysis Adequacy Work Group I (2001), Hemodialy-

sis Adequacy Work Group: Appendix A (2001), Khan et al.

2002]. In the study of Manns et al. (2002), a significant rela-

tionship was determined between physical functioning, gen-

eral health, emotional role, social functioning and vitality

(energy) scores in the group in which the Kt/V was � 1�3. In

Table 2 Patients’ medical characteristics (n = 112)

n %

The type of vascular route

Catheter 101 9�8Fistula 11 90�2

Cause of renal failure

Diabetes mellitus 25 22�3Cystic kidney disease 13 11�6Nephritis 11 9�8Hypertension 12 10�7Unknown 18 16�1Other* 33 29�5

Dialysis frequency

2 9 per week 6 5�43 9 per week 102 91�24 9 per week 4 3�6

Use of erythropoietin

Yes 69 61�6No 43 38�4

Treatment time (hours)

3�5 3 2�74 109 97�3

Dialysis vintage (months)

4–34 35 31�335–60 50 44�661–216 27 24�1

*Glomerulonephritis, Leukaemia, Systemic lupus erythematosus.

Table 3 SF-36 quality of life scores (n = 112)

SF-36 scales Mean � SD Minimum Maximum

Physical functioning 76�79 � 21�06 10 100

Role-physical 82�14 � 38�47 0 100

Bodily pain 66�52 � 26�29 0 90

General health 61�16 � 21�69 20 115

Vitality 62�77 � 21�37 5 100

Social functioning 72�32 � 27�94 0 100

Emotional role 77�97 � 31�49 33�3 100

Mental health 66�89 � 18�84 16 100




this study, the emotional role mean scores of the patients

whose Kt/V was � 1�2 were higher than those in whom Kt/V

was <1�2, and this difference was statistically significant.

According to correlation analysis performed between the

Kt/V ratio and the SF-36, a positive and significant relation-

ship was found between the emotional role mean scores

and the Kt/V levels. In the studies of Dwyer et al. (2002)

and Unruh et al. (2004), a positive and significant relation-

ship was found between the emotional role and the Kt/V

levels. In a systematic review carried out by Spiegel et al.

(2008), a significant relationship was found between the

Kt/V ratio and six subgroups of SF-36 Quality of Life

Score. Emotional difficulties decrease as the Kt/V ratio

increases as desired. These results are similar to ours.

URR is another parameter accepted as an indicator of dial-

ysis adequacy. URR is 65% when Kt/V is 1�2 (Merkus et al.

1997). The emotional role scores increased in the patient

group in which the URR was � 65%, and this indicates that

the patients experienced less emotional difficulty. The emo-

tional role of the patients with higher URR level being lower

is a positive outcome. However, as a different result, the

mental health scores in patients whose URR level was high

(URR � 65%) were found to be lower. The number of stud-

ies evaluating the URR level and the quality of life is few in

the literature. In the study of Assal et al. (2006), no signifi-

cant relationship could be found between the URR value and

the SF-36 Quality of Life Scores. According to the results of

this study, we can state that an increase in the URR levels

positively affected the emotional status of the patients.

There is a positive and significant relationship between

physical functioning, emotional role and URR levels. It may

be considered that patients feel better physically and emo-

tionally as the URR level increases. The perceived pain

decreased as the URR level increased as desired; however,

no statistically significant relationship could be found.

According to the 2008 data of the Turkish Association of

Nephrology (Registry of the Nephrology 2009), diabetes is

the diagnosis in 27�9% of the patients undergoing HD. Dia-

betes leads to a decrease in self-care, impairment of glycae-

mic control and an increase in the complication risk (C� ıtıl2009). In the current study, the physical, social functioning

and vitality (energy) mean scores were found to be lower in

the diabetic group. The results of Mingardi et al. (1999)

and Merkus et al. (1997) studies are similar to ours.

HD usually leads to hypocalcaemia due to the use of

phosphorous-binding agents, which comprise vitamin D

and calcium. This condition leads to fatigue and lethargy

(Morton et al. 1996, G€okdo�gan 2007). In this research, a

negative and statistically significant relationship was found

between the calcium level and the physical role score. It

may be stated that activities of the patients are restricted

together with increasing calcium levels, and a decrease

occurs in the physical role scores. Different to the current

study, a significant relationship was found between the

mental health scores and calcium levels in the study of

Tanaka et al. (2007). In the research of Bohlke et al.

(2008), no significant relationship could be found between

calcium levels and the SF-36 Quality of Life Scores.

An increase in the phosphorous level may mean that

activities of the patients are restricted due to emotional

problems by causing poor appetite, nausea, muscle

weakness, neuromuscular irritability and lethargy (Morton

Table 4 The association of dialysis adequacy with quality of life in HD patients as measured using the SF-36

Kt/V

Test<1�2 (n = 26) �1�2 (n = 86)

Role-emotional 64�10 � 33�89 82�17 � 29�68 t = �2�631, p = 0�010URR

<65% (n = 25) �65% (n = 87)

Role-emotional 65�33 � 33�99 81�60 � 29�96 t = �2�322, p = 0�022Mental health 73�76 � 18�58 64�92 � 18�54 t = 2�099, p = 0�038

Mean � SD.

p � 0�05, t = Independent samples t-test.

Table 5 SF-36 quality of life scores in diabetic/non-diabetic HD

patients

Diabetic

(n = 25)

Non-diabetic

(n = 87)

Physical

functioning

54�20 � 26�68 74�60 � 22�86 t = �3�474p = 0�001

Vitality 50�60 � 21�37 65�11 � 23�40 t = �2�928p = 0�005

Social

functioning

51�00 � 28�62 76�58 � 28�96 t = �3�928p = 0�000

Mean � SD.

p � 0�05, t = Independent samples t-test.




et al. 1996, Assal et al. 2006). In this study, a negative and

statistically significant relationship was found between the

phosphorous level, and bodily pain and emotional role

scores. In the systematic analysis of Spiegel et al. (2008)

investigating the quality of life in dialysis patients, a signifi-

cant relationship was found between the mental health

scores and the phosphorous levels. In the research of Bohlke

et al. (2008), no significant relationship was found between

the phosphorous levels and the SF-36 Quality of Life Scores.

The central nervous system is particularly affected in

end-stage renal failure patients due to increasing urea levels.

This may be seen in varying conditions from mild changes

in mental functions to convulsions and death (G€okdo�gan

2007). In this study, a negative and significant relationship

was found between the urea level, and vitality (energy) and

emotional role. These effects resulting from increased urea

levels may cause a decrease in the energy level of the

patients. In the study of Salt€urk-De�girmenci (2006), no sig-

nificant relationship could be found between the urea levels

and SF-36 Quality of Life Scores.

Creatinine is one of the biomarkers used for nutritional

and anthropometric assessment (Mingardi et al. 1999). In

this study, a positive relationship was found between the

creatinine level and physical functioning scores, and a

negative significant relationship was found between the cre-

atinine level and emotional role. Also, in the study of

Salt€urk-De�girmenci (2006), a positive and significant rela-

tionship was found between the physical functioning scores

and the creatinine level, similar to ours.

Anaemia develops due to the insufficient release of

erythropoietin in end-stage renal failure patients. This con-

dition leads to fatigue. In this study, no significant rela-

tionship was found between the Hb level and the Quality

of Life Scores, similar to the study of Mingardi et al.

(1999). On the other hand, in the study of Foley et al.

(2009), a significant relationship was found between the

energy scores and the Hb level. That study was conducted

with 554 patients. The patients were allocated to two

groups according to the Hb level and followed up for

96 weeks (a total of eight times). In particular, the energy

(vitality) scores were found to be significantly higher in

the high Hb group. The reason for not having obtained

such a result in our study may have resulted from the

short duration and the small sample in our study.

In the current study, a positive correlation was found

between the Hct level and the physical role score. In the

systematic analysis of Spiegel et al. (2008), a strong correla-

tion was found between the Hct level and the physical

functioning and energy scores. The Hct level was found to

also affect the mental health, physical role, bodily pain andTable

6Correlationanalyses:laboratory

characteristics

Kt/V

URR

Calcium

Phosphorus

Urea

Creatinine

Haem

oglobin

Haem

atocrit

Albumin

Potassium

Physicalfunctioning

r=0�01

92**

p=0�04

5

r=0�23

7*

p=0�01

2

Role-physical

r=�0

�227*

p=0�01

6

r=0�19

5*

p=0�03

9

Bodilypain

r=0�23

4**

p=0�01

3

Generalhealth

r=0�19

3**

p=0�04

1

Vitality

r=�0

�280*

p=0�00

3

Role-emotional

r=0�27

7*

p=0�00

3

r=0�28

4**

p=0�00

3

r=0�27

2**

p=0�00

4

Mentalhealth

r=�0

�243*

p=0�01

0

*Pearson’scorrelationanalyses.

**Spearm

an’scorrelationanalyses.

p�

0�05

.




the physical functioning scores in the same study. This

result is similar to ours. In the research of Moreno et al.

(2000) on 156 stable patients undergoing continuous HD,

they investigated the effect of an increase in the Hct level

on the quality of life. Haemoglobin and Hct values were

seen to increase as a result of 6 months of EPO therapy,

and this had led to an increase in the mental health and

physical scores. In our study, 69 patients were receiving

EPO therapy. However, no significant relationship could be

detected between the Hb and Hct values and the SF-36

Quality of Life Scale. This may be due to the short duration

and the small sample of the study.

The albumin level is known to be one of the important

indicators of morbidity and mortality in dialysis patients

(Kalantar-Zadeh et al. 2001, Registry of the Nephrology

2009). A significant positive relationship was found between

the albumin level and the general health status, pain and

emotional role in this study. Mingardi et al. (1999) detected

a positive relationship between the albumin level and the

SF-36 Quality of Life Scores. They observed this relation-

ship particularly in physical functioning, physical role and

general health scores. Similar to our findings, in the study of

Assal et al. (2006) and Kalantar-Zadeh et al. (2001), they

found a significant relationship between pain, physical func-

tioning, general health and physical role scores.

Hyperpotassaemia is frequent among haemodialysis

patients (8�7%). This may precipitate as paresthesia, muscle

weakness and cardiac conduction disorder. In this study, a

negative and statistically significant relationship was found

between the potassium level and the mental health scores.

In the study of Bulantekin (2008), potassium was found to

be related to the general health status.

No significant relationship could be found between the

PTH value and the SF-36 Quality of Life Score. In

the study of Tanaka et al. (2007), the relationship between

the PTH value and the mental health score was weak and

insignificant. No significant relationship was found in other

studies, either (Mingardi et al. 1999, Kalantar-Zadeh et al.

2001, Assal et al. 2006, Klersy et al. 2007).

No significant relationship could be found between the

SF-36 Quality of Life Score and duration of dialysis. No

significant relationship was found in other studies, either,

similar to ours (Mingardi et al. 1999, Kalantar-Zadeh et al.

2001, Assal et al. 2006, Kızılcık 2009).

Self-care agency and quality of life were found to interact

in some studies. The quality of life increases as the self-care

agency increases (Porter 1994, Meers et al. 1996, Akyol

Durmaz and Karadakovan 2002). The self-care agencies of

the patients were also evaluated considering that a relation-

ship could exist between the dialysis adequacy and self-care

agency. However, no significant relationship could be found

between Kt/V and URR, which we used for the assessment

of the dialysis adequacy and other parameters and self-care

agency. This result may be considered to have arisen from

the sample size and other conditions that could affect the

self-care agencies of the patients. No studies revealing the

relationship between the self-care agency and haemodialysis

adequacy could be encountered in the literature, and hence,

a comparison could not be made.

Relevance to clinical practice

In the present study, a significant relationship was deter-

mined between some subgroups of quality of life and Kt/V,

URR, calcium, phosphorous, urea, creatinine, Hct, albumin

and potassium values. A significant relationship was deter-

mined between physical functioning, vitality (energy) and

social functioning scores in diabetic patients. No significant

relationship could be found between self-care agency and

the evaluated parameters.

It is necessary to periodically evaluate the health-related

quality of life parameters of dialysis patients, to regularly

control the parameters used for the assessment of the dialy-

sis adequacy and to determine the most affected quality of

life subgroup through evaluating their effect on the quality

of life and to address these problems.

For the assessment of the effect of the dialysis adequacy

on the quality of life, it is important to consider the nutri-

tional parameters and the clinical conditions of the patients

besides Kt/V and URR, and to evaluate how the patient

feels himself/herself.

Acknowledgements

We are grateful to dialysis unit teams for the realisation of

this study.

Funding

This research received no specific grant from any funding

agency in the public, commercial or not-for-profit sectors.

Contributions

Study design: NK, NT; data collection and analysis: NK

and NT and manuscript preparation: NK, NT.

Conflict of interest

No conflict of interest has been declared by the author(s).




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Determination of the relationship between adequacy of dialysis and quality of life and self-care agency