title: Quality of life predicts risks of end-stage renal disease and mortality in patients with chronic kidney disease.
abstract: BACKGROUND
  Quality of life (QOL) may be associated with morbidity and survival in end-stage renal disease (ESRD), and is considered to be an important outcome measure for patients with chronic kidney disease (CKD). However, the prognostic role of QOL for survival in CKD remains unclear. We studied the relationship between QOL and risks of ESRD and mortality in CKD patients.
  
  
  METHODS
  From 1 January 2007 to 31 December 2007, we prospectively used the Taiwan version of World Health Organization Quality-of-Life Questionnaire (Taiwan version) (WHOQOL-BREF(TW)) with 568 CKD patients at a medical centre in southern Taiwan, and patients were followed up for 1-2 years after enrollment. The primary outcome was the time to dialysis or death. We used Kaplan-Meier curve and Cox proportional hazard model for survival analyses.
  
  
  RESULTS
  Of the 568 patients enrolled, 423 were able to complete the questionnaires, and their data were analysed. The median follow-up time was 410 days. Progressive decreases in scores of QOL in all domains were noted with decrease in eGFR. In unadjusted analysis, dialysis and death were associated with lower scores of total and all four domains of WHOQOL-BREF(TW). In adjusted analysis, the total scores and scores of both physical and psychological domains predicted dialysis and mortality (every 1-point decrease hazard ratio (HR): 1.050, 95% CI: 1.008-1.095, P = 0.020; HR: 1.179, CI: 1.033-1.346, P = 0.014; HR: 1.167, CI: 1.016-1.339, P = 0.028, respectively). The adjusted risks of ESRD and mortality also increased in patients in the lowest tertile of psychological domain (P < 0.01), and physical domain and total scores (P < 0.05).
  
  
  CONCLUSIONS
  Physical, psychological and total scores of QOL are significantly correlated with increased risks of ESRD and death in CKD patients. QOL should be considered as an independent predictor of risks of ESRD and mortality.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Tsai
authors.forename: Chi-Chih
authors.initials: CC
authors.lastname: Hung
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Shu-Li
authors.initials: SL
authors.lastname: Wang
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Hsiao
authors.forename: Ming-Yen
authors.initials: MY
authors.lastname: Lin
authors.forename: Lan-Fang
authors.initials: LF
authors.lastname: Kung
authors.forename: Pei-Ni
authors.initials: PN
authors.lastname: Hsiao
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality* / Q000523:psychology*; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012306:Risk