Structural Equation Modeling on Quality of Life in Pre-dialysis Patients with Chronic Kidney Disease

Hye Won Kim; Smi Choi-Kwon

doi:10.4040/jkan.2012.42.5.699

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Kim and Choi-Kwon: Structural Equation Modeling on Quality of Life in Pre-dialysis Patients with Chronic Kidney Disease

Original Article

J Korean Acad Nurs 2012;42(5):699-708.

Published online: 12 October 2012

DOI: https://doi.org/10.4040/jkan.2012.42.5.699

Structural Equation Modeling on Quality of Life in Pre-dialysis Patients with Chronic Kidney Disease

Hye Won Kim¹, Smi Choi-Kwon²

¹Department of Nursing, Konyang University, Daejeon, Korea

²College of Nursing, Seoul National University·Research Institute of Nursing Science, Seoul, Korea

Address reprint requests to : Choi-Kwon, Smi College of Nursing, Seoul National University 28 Yeongeon-dong, Chongro-gu Seoul 110-799 Korea Tel: +82-2-740-8830 Fax: +82-2-765-4103 E-mail: smi@snu.ac.kr

Received 10 January 2012 Revised 14 February 2012 Accepted 24 September 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was designed to test structural equation modeling of the quality of life of pre-dialysis patients, in order to provide guidelines for the development of interventions and strategies to improve the quality of life of patients with Chronic Kidney Disease (CKD).

Methods

Participants were patients who visited the nephrology outpatient department of a tertiary hospital located in Seoul. Data on demographic factors, social support, nutritional status, physical factors and biobehavioral factors and quality of life were collected between March 4 and March 31, 2011.

Results

In the final analysis 208 patients were included. Of the patients 42% were in a malnourished state. Anxious or depressed patients accounted for 62.0%, 72.6%, respectively. Model fit indices for the hypothetical model were in good agreement with the recommended levels (GFI= .94 and CFI= .99). Quality of life in pre-dialysis patients with CKD was significantly affected by demographic factors, social support, nutritional status, physical factors and biobehavioral factors. Biobehavioral factors had the strongest and most direct influence on quality of life of patients with CKD.

Conclusion

In order to improve the quality of life in pre-dialysis patients with CKD, comprehensive interventions are necessary to assess and manage biobehavioral factors, physical factors and nutritional status.

Keywords: Chronic kidney disease, Quality of life, Nutritional status, Biobehavioral factors

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Figure 1.

Research framework.

Figure 2.

Path diagram for the hypothetical model.

Table 1.

General Characteristics of Participants (N=208)

Characteristics	Categories	n (%) or M±SD
Gender	Male	125 (60.1)
	Female	83 (39.9)
Age (year)		60.9±15.4
	≤64	106 (51.0)
	65-74	62 (29.8)
	≥75	40 (19.2)
Educational level	Elementary school	37 (17.7)
	Middle school	32 (15.4)
	High school	69 (33.2)
	≥College	70 (33.7)
Occupation	Yes	81 (38.9)
	No	127 (61.1)
Monthly expenditure	<100	56 (26.9)
(10,000 won)	100-199	136 (65.4)
	≥200	16 (7.7)

Table 2.

Descriptive Statistics of Observed Variables (N=208)

Variables	Categories	n (%) or M±SD	Range
Social support		43.0±8.8	17.0-60.0
Nutritional status	Severely malnourished	48 (23.1)
	Moderately malnourished	40 (19.2)
	Well nourished	120 (57.7)
Glomerular filtration rate		21.6±14.0	3-59
	30-59 mL/min/1.73 m²	59 (28.4)
	15-29 mL/min/1.73 m²	62 (29.8)
	<15 mL/min/1.73 m²	87 (41.8)
Karnofsky performance scale		78.6±9.7	50-100
	100-80	146 (70.2)
	79-60	57 (27.4)
	<60	5 (2.4)
Uremic symptoms		3.6±2.3	0-11.0
	None	15 (7.2)
	1-3	113 (54.3)
	4-6	50 (24.0)
	≥7	30 (14.5)
Comorbidities		1.5±0.9	0-4.0
	None	21 (10.1)
	1-2	154 (74.0)
	≥3	33 (15.9)
Anemia	Yes	162 (77.9)
	No	46 (22.1)
Anxiety		12.5±4.2	7.0-26.0
	No	18 (8.7)
	Borderline	61 (29.3)
	Yes	129 (62.0)
Depression		14.0±4.6	7.0-25.0
	No	4 (1.9)
	Borderline	53 (25.5)
	Yes	151 (72.6)
Fatigue		38.3±16.3	9.0-63.0
Sleep disorder	No	101 (48.6)
	Yes	107 (51.4)
Sleep quality		48.3±14.8	12.0-79.0
Quality of life		51.5±20.3	6.7-97.2

Table 3.

Standardized Direct, Indirect and Total Effects for the Hypothetical Model

Endogenous variables	Exogenous variables	Standardized direct effect	Standardized indirect effect	Standardized total effect	SMC
Quality of life	Demographic factors	−.23*	−.30	−.53	.537
	Social support	.15*	.15	.30
	Nutritional status	.31**	−.47	−.16
	Physical factors	.34**	.17	.51
	Biobehavioral factors	.40**		.40
Nutritional status	Demographic factors	.34**		.34	.211
	Social support	.31**		.31
Physical factors	Demographic factors	−.42**	−.16	−.58	.527
	Social support	.27**	−.15	.12
	Nutritional status	−.47**		−.47
Biobehavioral factors	Demographic factors	−.07	−.43	−.50	.807
	Social support	.15**	−.13	.02
	Nutritional status	−.58**	−.19	−.77
	Physical factors	.41**		.41

SMC=Squared multiple correlations.

*p<.05; **p<.01.

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