Lew and Piraino identified several factors that should be monitored in a patient undergoing peritoneal dialysis, including quality of life and psychological status. These can help to identify a patient who may be at increased risk for clinical deterioration. The authors are from George Washington University in Washington, D.C.
Common factors associated with a decline in the quality of life:
(1) hopelessness and depression
(2) anxiety
(3) economic worries
(4) impairment in physical function
(5) burden on family
(6) loss of independence
Measures to monitor in peritoneal dialysis patients:
(1) overall quality of life
(2) comorbid conditions
(3) depression and anxiety
(4) nutritional status
(5) anemia
(6) residual renal function
(7) functional status and impairments
Patients with severe depression have higher rates of:
(1) peritonitis
(2) hospital admission
The authors noticed that once peritoneal dialysis started the percentage of patients with major depression stopped. Although this might be explained by psychological adjustment, it was also hypothesized as reflecting the higher mortality seen with severely depressed patients.
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