Quality of life in kidney recipients: comparison of tacrolimus and cyclosporine-microemulsion.

Abstract

Treatment of end-stage renal disease (ESRD) is evaluated by survival, quality of life (QOL) and cost-effectiveness. Little is known about the influence of immunosuppressive agents on global and disease-specific QOL in kidney recipients. In winter 1997/98 (t0) as well as in winter 1998/99 (t1), all kidney recipients of our University were asked to participate in a QOL study. The psychodiagnostic approach combined a global QOL-measure (SF-36 Health Survey) and a disease-specific questionnaire (ESRD-SCL, Nephron 1999). Inclusion criteria for the final analysis were (a) participation in both surveys and (b) eligibility after the matching procedure: patients with tacrolimus-based immunosuppressive regimen were matched to patients with cyclosporin-microemulsion (CsA-ME)-based immunosuppressive-regimen as to age, gender and duration of graft function. Group data were compared by performing a two-variate ('immunosuppression', 'time') analysis of variance. Both groups consisted of 63 patients. Analysis of QOL revealed statistically significant advantages for the tacrolimus treated patients concerning global (SF-36 'Physical Component Summary') as well as disease-specific QOL (ESRD-SCLTM 'Global Severity Index'; both p < 0.05). In detail, these results were due to statistically significant better QOL in tacrolimus treated patients as to the SF-36 subscales 'Physical Functioning' and 'General Health' (p < 0.05) and the ESRD-SCL subscales 'Limited Physical Capacity' (p < 0.05), 'Cardial and Renal Dysfunction' (p < 0.01) and 'Increased Growth of Gum and Hair' (p < 0.001). The factor 'time' did not contribute statistically significant to explanation of variance. In terms of QOL in kidney recipients, tacrolimus is superior to CsA-ME. Tacrolimus improves disease-specific QOL and also shows slight advantages concerning global QOL compared with CsA-ME. To record differentiated aspects of QOL in kidney recipients, the diagnostic approach should include a global QOL measure completed by a sensitive disease-specific instrument.