Health Related Quality of Life in Patients with Chronic Kidney Disease

Abstract

Monitoring a patient's functional status and the subjective state of well being as it related to health condition, together known as health related quality of life (HRQOL) measurements, is of particular importance in patients with chronic kidney disease (CKD) including those with end stage renal disease (ESRD). The concept of quality of life in dialysis has evolved since the inception of renal replacement therapy from simple survival to enjoying a certain level of well being. The measurement of dialysis outcomes have paralleled the improvement in the delivery of renal replacement therapy progressing from level of functioning, symptom checklists, multi dimensional well being, and moving perhaps to more patient centered quality of life. HRQOL domains have been strongly associated with objective patient outcomes. The self reported physical functioning and mental well being correlate with serum albumin and body composition measures. The ability of those on hemodialysis to self administer questionnaires is a barrier to the widespread use of multidimensional HRQOL assessment in clinical practice. However, new technologies using computer adaptive testing and item response theory may allow those questionnaires to be quickly and more efficiently administered by clinic staff. The finding of different HRQOL scores among CKD patients of different racial and ethnic backgrounds supports the need to individualize the concept of HRQOL, so that we can assess the crucial aspects of life in our patients and integrate these domains into a comprehensive plan of care. These recent findings underline the critical need to measure HRQOL and to expand the boundaries of our multidimensional tools with technology and a more patient centered concept of quality of life.

Transition of care from pre-dialysis prelude to renal replacement therapy: the blueprints of emerging research in advanced chronic kidney disease

“…These patients also have markedly higher hospitalization rates and worse health-related quality of life [5,6]. Ironically the first 3 to 6 months of dialysis therapy or transplantation is associated with an even higher risk of death compared with prevalent dialysis or transplant patients ( Figure 1) [7], yet it is not clear whether the earlier transition to dialysis in the USA is a contributing cause of this high death rate.…”

Health-related Quality of Life in CKD Patients

“…The importance of measuring HRQOL has been underscored by recent studies indicating an association between various HRQOL measures and mortality and hospitalization rates in dialysis patients (11)(12)(13)(14)(15)(16). These studies have raised the question of whether addressing HRQOL problems in dialysis patients and patients with CKD can improve medical outcomes.…”

Health-Related Quality of Life in Chronic Renal Predialysis Patients Exposed to a Prevention Program - Medellín, 2007-2008

“…Assessing the well-being of CRF patients periodically with the SF-36 is important for measuring response to treatment and for improving healthcare. In fact, improving the HRQOL of CRF patients is a key objective in the U.S (Kalantar-Zadeh, 2005). This study's main limitation is its short follow-up period, which could not provide an appropriate account of the characteristics of a slow, progressive disease while explaining that many changes are not significant enough.…”

“…Measuring the HRQOL with validated instruments such as the SF-36 allows it to become a strong indicator of the health-related quality of life in ambulatory patients. In fact, it is considered a mortality and morbidity predictor in elderly and CRF patients (DeOreo, 1997;Han et al, 2009;Kalantar-Zadeh, 2005;Mapes et al, 2003). Assessing the well-being of CRF patients periodically with the SF-36 is important for measuring response to treatment and for improving healthcare.…”