Abstract
Purpose Chronic kidney disease (CKD) negatively affects health-related quality of life (HRQoL), which is often measured using the Medical Outcomes Study Short Form 36 (SF-36) questionnaire. However, the adequacy of SF-36 in this population has not been reported. We aimed to determine floor and ceiling effects and responsiveness to change of SF-36 in patients with conservatively managed stage 5 CKD.MethodsSF-36 data were collected prospectively. Floor and ceiling effects were estimated for each SF-36 scale and summary measure based on raw scores. The minimal clinically important difference (MCID) was estimated using a combination of anchor-based and distribution-based methods. Responsiveness to change was assessed by comparing MCID for each scale and summary measure to its smallest detectable change.ResultsSF-36 data were available for 73 of the 74 study participants. Using baseline data, floor and/or ceiling effects were detected for 3 of the 8 SF-36 scales. The anchor-based estimation of MCID based on differences in baseline functional status yielded the most reliable results. For the physical component summary, MCID was estimated at 5.7 points. Whilst the two SF-36 summary measures were responsive to change and free of floor and/or ceiling effects, six of the eight scales were not.ConclusionsThis small study of patients with conservatively managed stage 5 CKD found that only the summary measures of SF-36 and 2 of its 8 scales can be used to assess changes in HRQoL over time. These findings suggest that in this population, alternative HRQoL assessment tools should be considered for future studies.
Highlights
The health-related quality of life (HRQoL) of patients with chronic kidney disease (CKD) is poorer than that of the general population, both in the early stages of Chronic kidney disease (CKD) [1,2,3,4,5] and in advanced disease [6,7,8,9]
Measures were responsive to change and free of floor and/ or ceiling effects, six of the eight scales were not. This small study of patients with conservatively managed stage 5 CKD found that only the summary measures of Short Form 36 (SF-36) and 2 of its 8 scales can be used to assess changes in HRQoL over time
These findings suggest that in this population, alternative HRQoL assessment tools should be considered for future studies
Summary
The health-related quality of life (HRQoL) of patients with chronic kidney disease (CKD) is poorer than that of the general population, both in the early stages of CKD [1,2,3,4,5] and in advanced (stage 5) disease [6,7,8,9]. Stage 5 CKD is diagnosed when kidney function, measured by the estimated glomerular filtration rate (eGFR), falls below 15 mL/min/1.73 m2 [10]. In the UK, for example, prevalence has increased from 523 per million population (pmp) in 2000 to 861 pmp in 2012, and incidence rates have increased from 95 pmp in 2001 to 108 pmp in 2012 [11, 12]. Stage 5 CKD is a life-limiting disease for which renal replacement therapy (RRT) is often recommended. The survival advantage of RRT, and that of dialysis treatment, appears to
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