Elsevier

Seminars in Nephrology

Volume 26, Issue 1, January 2006, Pages 68-79
Seminars in Nephrology

Quality of Life in Patients With Chronic Kidney Disease: Focus on End-Stage Renal Disease Treated With Hemodialysis

https://doi.org/10.1016/j.semnephrol.2005.06.015Get rights and content

The proper measures for assessing quality of life (QOL) in patients with chronic kidney disease (CKD) remain unclear. QOL measures are subjective or objective, functional or satisfaction-based, and generic or disease-specific. Treatment of end-stage renal disease with transplantation and treatment of anemia with erythropoietin in patients with CKD have been associated with dramatic improvements of QOL. Other factors such as age, ethnic or national background, stage of CKD, modality of dialytic therapy, exercise interventions, sleep disturbances, pain, erectile dysfunction, patient satisfaction with care, depressive affect, symptom burden, and perception of intrusiveness of illness may be associated with differential perception of QOL. Recent studies showed an association between assessment of QOL and morbidity and mortality in end-stage renal disease patients, suggesting the measures do matter. Further studies are necessary in patients with early stages of CKD and in children. QOL measures should include validated psychosocial measures of depressive affect, perception of burden of illness, and social support. The challenge for the next decade will be to continue to devise interventions that meaningfully increase the QOL of patients with CKD at all stages.

Section snippets

Some QOL Measures for ESRD Patients

A seemingly enormous number of scales have been used to assess QOL in patients.1 Gill and Feinstein1 advocated the use of more than 1 instrument in research studies of patient QOL to yield a diverse evaluation of patient status. In addition, they suggested the use of a simple instrument, perhaps a 1-sentence Likert scale, in which a patient is asked to evaluate his or her QOL, using those exact words.1, 26 The measures used for assessing HRQOL in ESRD patients have been reviewed previously.2, 3

Correlations, Interventions, and Outcomes

In this section, we describe some of the factors associated with QOL in patients with CKD. These summaries are not meant to be exhaustive. Rather they are meant to highlight nonmodifiable and modifiable factors that may be amenable to intervention. We discuss associations of age, ethnicity, socioeconomic status, modality of ESRD therapy, including renal transplantation, HD and PD, stage of disease, treatment with erythropoietin, and intensity of hemodialytic therapy with patients’ perceptions

Conclusions

The proper measures of QOL in patients with renal disease are unknown. Measures include subjective and objective tools, and generic and disease-specific scales. The past several years have witnessed an explosion in the number of studies and the populations of patients with CKD in which various aspects of HRQOL have been assessed. It is clear that the many QOL measures are intertwined. A challenge remains to make these domains clinically meaningful. The meaning of the MCS remains unclear.

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