Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study.
BACKGROUND
Health-related quality of life (QOL) is an important measure of how disease affects patients' lives. Dialysis patients have decreased QOL relative to healthy controls. Little is known about QOL in patients with chronic kidney disease (CKD) before renal replacement therapy.


METHODS
The Medical Outcomes Study Short Form-36 (SF-36), a standard QOL instrument, was used to evaluate 634 patients (mean glomerular filtration rate [GFR], 23.6 +/- 9.6 mL/min/1.73 m2 [0.39 +/- 0.16 mL/s/1.73 m2]) enrolled in a 4-center, prospective, observational study of CKD. SF-36 scores in these patients were compared with those in a prevalent cohort of hemodialysis (HD) patients and healthy controls (both from historical data). QOL data also were analyzed for correlations with GFR and albumin and hemoglobin levels in multivariable analyses.


RESULTS
Patients with CKD had higher SF-36 scores than a large cohort of HD patients (P < 0.0001 for 8 scales and 2 summary scales), but lower scores than those reported for the US adult population (P < 0.0001 for 7 of 8 scales and 1 of 2 summary scales). Patients with CKD stage 4 had lower QOL scores than patients with CKD stage 5, although differences were not significant. Hemoglobin level was associated positively with higher mental and physical QOL scores (P < 0.05) in all individual and component scales except Pain.


CONCLUSIONS
SF-36 scores were higher in this CKD cohort compared with HD patients, but lower than in healthy controls. GFR was not significantly associated with QOL. Hemoglobin level predicted both physical and mental domains of the SF-36. Longitudinal studies are needed to define at-risk periods for decreases in QOL during progression of CKD.
Perlman
Rachel L
RL
Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Finkelstein
Fredric O
FO
Liu
Lei
L
Roys
Erik
E
Kiser
Margaret
M
Eisele
George
G
Burrows-Hudson
Sally
S
Messana
Joseph M
JM
Levin
Nathan
N
Rajagopalan
Sanjay
S
Port
Friedrich K
FK
Wolfe
Robert A
RA
Saran
Rajiv
R
D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D000740:Anemia / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology / Q000523:psychology; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology; D012709:Serum Albumin / Q000032:analysis; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data
D006454:Hemoglobins; D012709:Serum Albumin; D004921:Erythropoietin