Differences in quality of life across renal replacement therapies: A meta-analytic comparison

A meta analysis compared emotional distress and psychological well-being ac ross renal replacement therapies (RRTs) and examined whether differences co uld be explained by: (1) treatment modalities, (2) case mix, or (3) methodo logic rigor, Standard meta-analytic procedures were used to evaluate publis hed comparative studies, Successful renal transplantation was associated wi th: (1) lower distress (effect size, d = -0.43 SD) and greater well-being ( d = 0.62 SD) than incenter hemodialysis (CHD) and (2) lower distress (d = - 0.29 SD) and greater well-being (d = 0.53 SD) than continuous ambulatory pe ritoneal dialysis (CAPD), CAPD was characterized by greater well-being (d = 0.18 SD) than CHD and CHD was associated with greater distress (d = 0.16 S D) than home hemodialysis, Although methodologic rigor and case-mix differe nces did not correlate with the magnitude of psychosocial differences acros s RRTs, 10 of the 12 comparisons (83%) were threatened by publication bias tie, that nonsignificant comparisons may have been underrepresented in the published literature, Thus, although significant quality-of-life difference s were evident across treatment groups, the types of patients representativ e of the various RRTs also differed significantly in terms of case-mix vari ables relevant to psychosocial well-being and emotional distress. Published findings indicating differential quality of life across RRTs may thus be a ttributable to: (I) valid differences in effective renal replacement, reduc ed medical complications, and lifestyles afforded by these treatment modali ties; (2) case-mix differences in the patient samples selected to represent them in research comparisons; or (3) both of these alternative explanation s, (C) 2000 by the National Kidney Foundation, Inc.