Quality of life (QoL) is defined by the World Health Organization (WHO) as an individual’s perception of their place in existence, in the context of the culture and value systems in which they live, in relation to their goals, expectations, standards, and concerns [1]. It is a very broad concept, influenced in complex ways by the individual’s physical health, psychological state, level of independence, social relationships, and relationship to the essential elements of their environment [2].

As chronic kidney disease is a major issue in medical and economic decision-making, assessing quality of life allows both the medical community and health authorities to evaluate how patients perceive their state of health. Measuring quality of life helps to reduce the asymmetry of information between patients and the medical profession [3]-[5]. Unlike the criteria generally used to measure health status, QOL incorporates the individual’s perception, making it possible to explore not only the impact of the disease but also its repercussions on daily life [6]. Improving QOL in patients with renal failure is therefore an important goal of therapeutic management, which should enable them to live a life that is as close to normal as possible, both in terms of duration and quality [7].

For this reason, tools for measuring quality of life are made available to medical staff, in particular the SF36 questionnaire, whose questions can be grouped into several dimensions. The SF36 is the most frequently used generic questionnaire in the context of end-stage chronic kidney disease [5]. One of the main advantages of the SF36 is that it incorporates both behavioral and physical data from the patient.

Chronic kidney disease (CKD) is a long-term, progressive disease that is often associated with disability and the threat of serious complications [3]. The end-stage of the disease has a considerable impact on daily life, making it difficult to perform the activities necessary for personal well-being and requiring replacement therapy such as hemodialysis [1][8].

In Guinea, several initial studies have been conducted on chronic kidney disease, including a few on the QOL of patients in the end-stage of chronic kidney disease without access to dialysis or in dialysis patients [4][9]. To our knowledge, no studies have been conducted to assess the QoL of patients with moderate to severe chronic kidney disease who are not on dialysis.

We therefore chose this topic, with the following objectives:

Our objective was to assess the quality of life of patients with chronic kidney disease who are not on dialysis, as well as the factors influencing it in the nephrology department.

This was a descriptive and analytical cross-sectional study covering a period of seven months, from September 1, 2020, to March 31, 2021.

Our main findings relating to socio-demographic and clinical data are presented in Tables 1-5 and Figure 1.

Table 1 describes the socio-demographic characteristics of patients with chronic kidney disease. Women were the most affected, and almost all older people were affected, especially the elderly.

Table 1. Distribution of 74 patients with CRF in the nephrology department according to sociodemographic characteristics.

Figure 1 concerns pain intensity in patients with CRF. More than 20% of patients experienced very severe pain.

Figure 1. Distribution of non-dialysis CRF patients according to pain intensity and discomfort in the nephrology department of Donka University Hospital from September 1, 2020, to March 31, 2021.

Tables 2-4 concern the assessment of patients’ quality of life according to the SF36 components. Finally, Table 5 concerns the factors associated according to the univariate analysis.

Table 2. Distribution of non-dialysis CRF patients according to general health status in the nephrology department of Donka University Hospital from September 1, 2020, to March 31, 2021.

Table 3. Distribution of non-dialysis CKD patients according to vitality and mental health in the nephrology department of Donka University Hospital from September 1, 2020, to March 31, 2021 (N = 74).

Table 4. Distribution of non-dialysis CKD patients according to social functioning at the nephrology department of Donka University Hospital from September 1, 2020, to March 31, 2021 (N = 74).

Table 5. Correlation between factors and QOL in non-dialysis CKD patients in the nephrology department of Donka University Hospital from September 1, 2020, to March 31, 2021.

The complexity involved in adapting the SF36 questionnaire into our local languages was our main difficulty.

The modest size of our sample and the single-center nature of our study were our limitations.

However, during the study period, we identified 105 patients, 74 of whom were included, representing 70.47% of cases (Table 1). Our result is higher than that of Bah AO et al. in Guinea [2], who reported a frequency of 55.2%. This difference can be explained by our larger sample size compared to theirs, as we took into account all three stages of CRF, unlike them, who only included patients in the terminal stage of CRF.

The average age in our study is lower than that of Eyeni SDT et al. in Congo Brazzaville [10], who found an average age of 51.8 ± 15.2 years. This difference could be due to the fact that African patients with chronic renal failure are young adults who are socially active and easily exposed to certain environmental factors. However, we noted a predominance of females, a finding that corroborates the study by Ndiaye A et al. in Senegal [11], contrary to many authors who have reported a predominance of males [1][4][7][12].

Furthermore, we noted a close relationship between pain intensity and discomfort. In most cases, the more intense the pain, the greater the discomfort (Figure 1). In our study, 82.43% of patients were non-autonomous, compared to 17.57% who were autonomous (Table 2). Our results differ from those of Bah AO et al. in Guinea [2], who reported 57.30% of patients as dependent. This is consistent with the fact that 52.70% of patients had poor overall health. Regarding limitations due to mental health, 78.4% of our patients claimed to have had difficulty doing their work or any activity, while 91.9% of them had limitations due to physical health. On the other hand, 59.5% of patients had a normal social and relational life. Our results differ from those of Bah AO et al. in Guinea [2], who also reported significant limitations due to physical pain, with 63.7% of patients in poor general health and limitations due to mental health in 28.9% of cases in their study. However, they found that 52.1% were completely unable to work due to physical health. With regard to social and relational life, our results were also consistent with those observed in the study by Bah AO [2] (Table 3 and Table 4).

In addition, we noted a close relationship between pain intensity and discomfort. In most cases, the more intense the pain, the greater the discomfort.

In bivariate analysis, dyspnea was significantly associated with poor quality of life (p = 0.03), while other factors (age, gender, hypertension, diabetes, hemoglobin levels) were not significant (Table 5). In the study by Ranivoharisoa E et al. [13], the factors significantly associated with impaired quality of life were: advanced age, length of time on dialysis, irregular sessions, lack of support for care, and alcohol consumption. This result differs from that of Lobna Z et al. [14], who found a correlation between the occurrence of impaired QOL and the following nine variables: age > 60 years (p < 0.001), marital status of widowed or divorced (p = 0.005), rural living environment (p = 0.001), educational level not exceeding primary school (p = 0.002), low economic status (p = 0.005), lack of independence (p < 0.001), dialysis three times a week (p < 0.001), comorbidities such as diabetes (p = 0.006), and anemia (p = 0.017). According to some authors [15]-[17],the association between low educational or socioeconomic levels and impaired QoL has been found by several authors [12][15][18],who emphasized that a high level of education and socioeconomic status would protect against deterioration in the QOL of hemodialysis patients.

The patients, mainly young adults, were mostly dependent, with a predominance of women. Hypertension and diabetes were the most common conditions. Only dyspnea had a significant impact on QOL. Assessing quality of life should therefore be an important objective for nephrologists in the therapeutic management of patients with chronic renal failure.