Quality of Life in Chronic Kidney Disease: CKD, ESRD, Anemia

219 Pages·2013·1.46 MB·English

Quality of Life in Chronic Kidney
Disease:
CKD, ESRD,
Anemia and Erythropoietin
Paul L. Kimmel, MD
Professor of Medicine
Division of Renal Diseases and Hypertension
The George Washington University Medical Center
QOL

QOL can be defined as the physical,
psychological, social and spiritual domains
of health that are influenced by a person’s
experiences, beliefs, expectations and
perceptions.
Quality of Life: Measurement Concepts
Subjective vs objective
 
Functional vs well-being
 
Satisfaction
 
General Population
 
Chronic illness population: Health-related QOL
 
(HRQOL)
Generic
 
Disease-based
 
Functional, psychological,
 
social (FDA 2006)
Health-related Quality of Life
Domains
Physical functioning
 
Mental health
 
General affect (mood)
 
Perception of well-being (illness effects or
 
burden of illness)
Life satisfaction (happiness)
 
Social relationships
 

Patient satisfaction

Measures
Illness Effects Questionnaire (IEQ) to
 
assess perception of illness effects.
Subjective, generic
 
High test-retest reliability
 
20 item, 7 pt Likert scale, 0-140
 
Correlates with SWLS, BDI and other QOL
 
measures
Predicts survival in ESRD patients

Measures
Satisfaction With Life Scale (SWLS)
 
to assess satisfaction with life.
Subjective, generic
 
5 item
 
used in ESRD studies
 
correlates with well-being scales
 
Increases with age
 
Not correlated with Karnofsky
 
Does not predict survival

Measures
Patient Satisfaction

 
DiMatteo and Hays
 
Modification -- satisfaction with
 
nephrologist vs satisfaction with staff
Satisfaction with nephrologist correlates
 
with behavioral compliance and Salb
Measures
Single sentence quality of life scale
 
Alvan Feinstein
 
Used in Yale and GW ESRD studies
 
LASA (Energy, Activity, Overall QOL)
 
Simple
 
Enormous face validity
 
Comprehensible to patients
 
Range of responses
 
Correlations of SQQOLS with SWLS
 
and IEQ
Single Question QOL Score
“considering all parts of my life –
 
physical, social, spiritual and financial –
over the past two days the quality of my
life has been…”
QLS ranges from zero (very bad) to ten
 
(excellent).
QOL Measures
Approach in Re search Studies
Multiple simultaneous measures
Use of a single item question that asks the
subject about his/her perception of QOL
Measures used in studies of patients with Chronic
Kidney Disease :
1. RAND 36-Item Health Survey
(SF-36)
2. The Kidney Disease Quality of Life
(KDOQL) Instrument (dialysis version)
3. Sickness Impact Profile (SIP)
4. Kidney Disease Questionnaire (KDQ)