In-Depth ReviewQuality of life in end-stage renal disease patients*,**,*
Section snippets
Measurement of QOL
Translating the various aspects and components of QOL into quantitative values is a complex task. It implies the need to evaluate multiple dimensions, with multi-item assessment of each dimension.11 A consequence of this complexity is that a great number of measurement instruments have been developed in the past few years within a rapidly developing science of health-care evaluation, psychometric and sociometric research. Physicians learn more systematically and objectively through such
QOL in ESRD
As renal insufficiency progresses, patients may experience symptoms that affect their daily lives. In more advanced phases when ESRD has been reached, the impact of the illness on functional state and health-related QOL as perceived by the patient is considerable. Such renal replacement therapies as hemodialysis and peritoneal dialysis only partially correct the symptoms experienced by the patient and provoke additional changes in the patient's lifestyle. These changes then can affect QOL. More
QOL as a factor in predicting morbidity and mortality
Lower levels of social support, decreased behavioral compliance with the dialysis prescription, and increased negative perception of the effects of illness were independently associated with increased mortality in 295 hemodialysis patients (266 black patients).121 The study by DeOreo14 of 1,000 dialysis patients measuring QOL using the SF-36 showed that functional status was as important in predicting mortality and hospitalization as Kt/V and PCR. With each five-point increase in physical
Renal transplantation and QOL
There is a broad consensus among health professionals and patients regarding the positive effect of a functioning transplant on QOL.11, 39 Renal transplant patients showed better QOL measured by various instruments than patients treated with different dialysis techniques. In some dimensions of QOL, results obtained in transplant recipients were similar to those obtained in the general population.39, 50, 117, 123 Transplantation is the treatment that most resembles normal renal function and
Conclusion
In evaluating outcomes in patients with ESRD, QOL assessment becomes as important as morbidity and mortality. Although specific tests for dialysis patients have been developed, generic questionnaires may be useful. Different factors have been associated with the health-related QOL perceived by the patient. Some of these are dependent on the patient (age, associated diseases [including diabetes], female sex, depression, nutrition), and others depend on the disease (lower GFR, late nephrology
Acknowledgements
The authors gratefully acknowledge the centers participating in the Spanish Study Group of Quality of Life in Chronic Renal Failure.
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Supported in part by grants from Laboratorio Esteve, Barcelona, Spain.
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Address reprint requests to Fernando Valderrábano, MD, PhD, Department of Nephrology, Hospital General Universitario, Gregorio Marañón, Dr Esquerdo 46, 28007 Madrid, Spain. E-mail: [email protected]
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