Running Head: BIOSTATISTICS IN NURSING: FINAL PAPER

Biostatistics in Nursing: Final Paper Richard Hoinacki Nova Southeastern University NUR 3200 Marcia Derby RN, MSN, Asst Prof. October 15, 2008

Many people develop renal disease and once they become diagnosed with End Stage Renal Disease many have only a few choices when it comes to renal replacement modalities. According to Chapman, M., Fink, N., Finkelstein, F., Marsh, J., Meyer, K., Powe, N., Wu, A. (2004), every year in the United States, nearly 90,000 patients with chronic kidney disease progress to ESRD and begin renal replacement therapy. Most patients optimally would prefer a kidney transplant, but many may not have the ability to find a donor and must get on a transplant list. So while they wait for a suitable kidney donor their only option is dialysis. End Stage Renal Disease patients have two choices of dialysis, either hemodialysis or peritoneal dialysis. Chronic dialysis can impose a considerable burden on patients and their families, with regards to health care and their quality of life. Many statistical studies have been done to compare the qualities of life with ESRD patients who are on hemodialysis and peritoneal dialysis. According to Lausevic, M., Nesic, V., Stojanovic, M., Stefanovic, V. (2006), health-related quality of life is a multidimensional concept that includes physical functioning, social functioning, mental health, and general health perceptions. This paper will discuss certain nursing issues, with regard to ESRD patients and their choice of renal replacement modalities, and review the literature from which this information was collected, and the statistical methods used and how the data was analyzed.
Nursing Issues The choice of renal replacement modalities is usually a personal choice of the patient if they are given the proper information on both hemodialysis and peritoneal dialysis. With regards to health related quality of life, there are advantages and disadvantages with each type of therapy. Each patient must base their decision on factors such as how they can incorporate either modality into their particular lifestyle, how involved they want to become with regards to self-care, and/or if they want to get stuck with a needle every few days, and even there abilities and attitudes must be taken into consideration when choosing between modalities. These are just a few of the factors that an ESRD patient must make a decision from, which will then eventually affect their quality of life. So the problem in question here is which renal replacement therapy provides a better quality of life and which modality of renal replacement therapy do ESRD patients prefer? With statistical analysis of the variability’s between these two groups of patients a null hypothesis that can be produced would be, there is no difference between the qualities of life of ESRD patients on hemodialysis and peritoneal dialysis.
Review of the Literature The articles selected to help identify and clarify the research into this question came from a few different journals that specialize in the aspects of nephrology, such as the Journal of the American Society of Nephrology, The Institute of Nephrology and Hemodialysis: Artificial Organs, and the Journal of Nephrology, Dialysis, and Transplantation. Each article was chosen because they contained research information specifically about ESRD patients and the quality of their lives, with regards to the type of renal replacement therapy that they chose. Each journal article was broken down into background information for research, methods used for obtaining research data, the results of the analyzed data. Two articles had at least five dimensions of analysis specific domains and one article had eight. Much of data that was collected included variables that consisted of sociodemographic information, such as age, race, gender, employment, duration of dialysis treatment, limitations on usual activities, bodily pain, laboratory values, and general health perceptions, to name a few. These articles were chosen primarily because they contain statistical factual information and are peer reviewed.
Method
The population of interest for this study included End Stage Renal Disease patients, and the two groups that were chosen and compared were on either hemodialysis or peritoneal dialysis. This population was chosen based on the history and knowledge acquired from the specific care given to these types of patients on the units that I worked. The samples of the population that were assessed in these studies were given questionnaires to fill out so that pertinent data could be collected. One study used the EQ-5D, which was developed by the international EuroQol group as a standardized generic measure for description of health status according to Wasserfallen, J., Halabi, G., Saudan, P., Perneger, T., Feldman, H. Martin, P., Wauters, J. (2004). The other studies used the Short Form Health Survey Questionnaire and the Choice Health Experience Questionnaire to collect data from the sample groups. In each study the questionnaire was self-administered and as was discussed prior, each questionnaire contained five to eight domains that covered different aspects of quality of life in ESRD patients.
Data Analysis According to Salkind, N. (2007), descriptive statistics are used to organize and describe the characteristics of a collection of data. In these particular studies descriptive statistics was used to collect data from ESRD patients that were on either hemodialysis or peritoneal dialysis. One such descriptive statistic that was used was the mean which measured the quality of life values; however the predicted mean and the measured values were similar in both dialysis groups according to Wasserfallen, J., et al (2004). Once the data was collected, inferential statistics was used to make deductions about each separate group, one being patients on hemodialysis and the other on peritoneal dialysis. This is usually the next step according to Salkind, N. (2007). These smaller groups are called samples that were derived from the population of ESRD patients. The data set collected from each sample contained variables such as age, race, gender, employment, duration of dialysis treatment, limitations on usual activities, bodily pain, laboratory values, comorbid conditions, and general health perceptions. After the data was collected from each group the variables had to be tested and compared in order to be able to reject the null hypothesis, so a t test for independent samples was used because there were two separate groups and they were only tested once. After the analysis of the variables was computed, a measured quality of life value was derived from each case study.
Conclusion
According to Wasserfallen, J. et al. (2004), PD is often presented as the easier and less cumbersome dialysis modality, but it is used with only a small portion of ESRD patients. Each study had one major limitation that stood out, and that was the quality of life prior to the commencement of renal therapy had not studied and taken into account. One of the other studies admitted to having a limited power to detect some differences in sub-domains of health-related quality of life (Chapman, M. et al., 2004). Also, each study stated that there was really no consensus on the measurement of comorbid illnesses with patients on renal replacement therapy and that it was difficult to suggest which modality provided a better quality of life. But, according to Chapman, M. et al. (2004), their study had important implications for practice and there was good news for ESRD patients on either modality, which was that general health and well-being should improve during the first year of dialysis.

References
Chapman, M., Fink, N., Finkelstein, F., Marsh, J., Meyer, K., Powe, N., Wu, A. (2004).
Changes in the quality of life during hemodialysis and peritoneal dialysis treatment: generic and disease specific measures. Journal of the American Society of Nephrology,
15, 743-753. Retrieved October 10, 2008, from Pubmed database.
Lausevic, M., Nesic, V., Stojanovic, M., Stefanovic, V. (2006). Health-related quality of life in patients on peritoneal dialysis in serbia: comparison with hemodialysis. Institute of Nephrology and Dialysis: Artificial Organs, 31(12), 901-909. Retrieved October 10, 2008, from Pubmed database.
Salkind, N. (2007). Statistics for people who (think they) hate statistics (3rd ed.). Thousand Oaks: CA. Sage Publications, Inc.
Wasserfallen, J., Halabi, G., Saudan, P., Perneger, T., Feldman, H. Martin, P., Wauters, J. (2004). Quality of life on chronic dialysis: comparison between haemodialysis and peritoneal dialysis, 19(6), 1594-1599. The Journal of Nephrology, Dialysis, and Transplantation. Retrieved October, 10, 2008, from Pubmed database.