The Impact of Chronic Kidney Disease and Renal Replacement Therapy on Physical and Mental Well-being in Adults with End-stage Kidney Disease

  • Joe Antoun

Student thesis: Doctoral Thesis


The physiological manifestations associated with end-stage kidney disease (ESKD), including cardiovascular and muscular abnormalities, have potential to impair an individual’s ability to be physically active, their fitness, and quality of life (QoL). However, the psychosocial and physiological differences between the different renal replacement therapies had yet to be comprehensively explored; these renal replacement therapies also had the potential to be influenced by the COVID-19 pandemic, which occurred during the production of this thesis. It was hypothesised that individuals receiving home-based dialysis (e.g. home haemodialysis or peritoneal dialysis) would be more physically active, spend less time sedentary, have better cardiac morphology, aerobic function and perceived QoL than those receiving in-centre haemodialysis, and any effects of dialysis modality would be further influenced by the COVID-19 restrictions.
Using novel data representation techniques (i.e. composite vignettes), this thesis highlighted better perceived QoL in adults dialysing at home, compared to in- centre, and the lived experiences of adult kidney transplant recipients; all groups subjectively reported low levels of physical activity (PA). These findings were confirmed through compositional analysis of the 24-hour day, demonstrating that adults receiving in-centre and home haemodialysis engaged in low levels of moderate-to-vigorous PA and short, inefficient sleep, however, individuals receiving home haemodialysis undertook significantly more light-intensity PA (131.2 ± 28.1 vs. 106.9 ± 5.4 minutes·day-1, respectively; p = 0.05; ES = 0.56) and tended to sleep more efficiently (74.5% vs. 50.0%, p = 0.07, ES = 0.51), compared to those dialysing in-centre.
Data presented within this thesis also highlighted structural (e.g. left ventricular hypertrophy) and functional (e.g. reduced ejection fraction) cardiac impairments in adults with ESKD, as well as low submaximal aerobic fitness (pulmonary oxygen uptake at the gas exchange threshold [39±8% predicted peak oxygen uptake]), which was mechanistically linked to central O2 delivery (cardiac index [r=0.61, p=0.04]). Finally, this thesis documents the deterioration in QoL and PA behaviours experienced by adults with ESKD during the COVID-19 restrictions, particular those dialysing in-centre, although widespread support for telemedicine was a positive finding during this period.
In conclusion, this thesis has explored the lived experiences of adults receiving different dialysis modalities, highlighting several benefits of home-based dialysis modalities that can mean better QoL. These reported benefits continued during the COVID-19 pandemic, and furthered our understanding of the multifactorial approach to exercise dysfunction in adults with ESKD.
Date of Award11 Aug 2023
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorZoe Saynor (Supervisor), Ant Shepherd (Supervisor) & Jo Corbett (Supervisor)

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