Life 36-Item Short Form Survey Research Articles

Effects of intradialytic inspiratory muscle training at different intensities on diaphragm thickness and functional capacity: clinical trial protocol in patients undergoing haemodialysis

IntroductionPatients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) commonly present with a sedentary behaviour and reduced functional capacity, factors that can compromise their prognosis. Intradialytic inspiratory muscle training (IMT)...

Association among sleep, depression, and health-related quality of life in patients with non-dialysis chronic kidney disease during the coronavirus disease 2019 pandemic.

Sleep disturbance is well documented as a crucial element that impairs health. Depression and health-related quality of life (HRQOL), which on behalf of a patient's overall perception of emotional, physical and social well-being, are increasingly emphasized self-reported health outcomes especially during the coronavirus disease 2019 (COVID-19) pandemic. Among dialysis patients, sleep disturbance is associated with depression and poorer HRQOL. The study was designed to depict the prevalence of sleep disturbance, and to explore the association among sleep, depression, and HRQOL in patients with non-dialysis chronic kidney disease (CKD) during the COVID-19 pandemic. A total of 172 non-dialysis CKD patients enrolled in this cross-sectional study, with sociodemographic and clinical data recorded. Sleep, HRQOL, and depression were evaluated via the Pittsburgh Sleep Quality Index (PSQI), the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36), and the 9-item Patient Health Questionnaire (PHQ-9), respectively. A total of 100 (58%) met the criteria for poor sleep. Good sleepers had strikingly disparate HRQOL and depression scores compared to poor sleepers. Sleep disorders were significantly associated with decreased HRQOL and increased depression in regression models adjusted or unadjusted for sociodemographic and clinical characteristics. Mediation analysis indicated depression was a significant mediator explaining 51% of the relationship between sleep status with physical component summary (PCS) and played a fully mediating role in the association between sleep and mental component summary (MCS). Our study suggested the high incidence of sleep disorders in patients with non-dialysis CKD during the COVID-19 pandemic, as well as the tight associations among sleep, depression, and HRQOL. Considering the negative influences of sleep and depression on HRQOL, appropriate screening and treatment for these treatable health-related domains are necessary for patients with non-dialysis CKD.

Impact of Medium Cut-Off Dialyzers on Patient-Reported Outcomes: COREXH Registry

Introduction: A new generation of hemodialysis (HD) membranes called medium cut-off (MCO) membranes possesses enhanced capacities for middle molecule clearance, which have been associated with adverse outcomes in this population. These improvements could potentially positively impact patient-reported outcomes (PROs). Objective: The objective of this study was to evaluate the impact of MCO membranes on PROs in a cohort of HD patients in Colombia. Methods: This was a prospective, multicenter, observational cohort study of 992 patients from 12 renal clinics in Colombia who were switched from high-flux HD to MCO therapy and observed for 12 months. Changes in Kidney Disease Quality of Life 36-Item Short Form Survey (KDQoL-SF36) domains, Dialysis Symptom Index (DSI), and restless legs syndrome (RLS) 12 months after switching to MCO membranes were compared with time on high-flux membranes. Repeated measures of ANOVA were used to evaluate changes in KDQoL-SF36 scores; severity scoring was used to assess DSI changes over time; Cochran’s Q test was used to evaluate changes in frequency of diagnostic criteria of RLS. Results: During 12 months of follow-up, 3 of 5 KDQoL-SF36 domains improved compared with baseline: symptoms (p < 0.0001), effects of kidney disease (p < 0.0001), and burden of kidney disease (p < 0.001). The proportion of patients diagnosed with RLS significantly decreased from 22.1% at baseline to 10% at 12 months (p < 0.0001). No significant differences in the number of symptoms (DSI, p = 0.1) were observed, although their severity decreased (p = 0.009). Conclusions: In conventional HD patients, the expanded clearance of large middle molecules with MCO-HD membranes was associated with higher health-related quality of life scores and a decrease in the prevalence of RLS.

P0938HEALTH-RELATED QUALITY OF LIFE IN A CHILEAN POPULATION OF DIALYSIS PATIENTS

Abstract Background and Aims A growing number of patients treated with maintenance dialysis are older, frail and have functional impairment. In many instances, functional impairment is a more powerful predictor of adverse outcomes than traditional disease-based measures. The Kidney Disease Quality of Life 36-item short form survey (KDQOL-36) is widely used in dialysis patients; its scores are important predictor of outcome. Aim of the study is to evaluate the associations of KDQOL-36 scores with diabetes, dialysis modality, nutritional status and age in a cohort of dialysis patients from Chile. Method observational, multicenter, cross-sectional study performed in the region of Valparaiso, Chile. 207 adult patients on dialysis from more than 3 months (140 in HD, 67 in PD: mean age 58.9 ± 14.5 years with 37% &amp;gt;= 65 years, M/F 119/88) were asked to fill in the Spanish translation of the KDQOL-36 questionnaire (administered by a trained caregiver). The responses to the SF-36 questions were used to determine scores for the mental component summary (MCS), physical component summary (PCS), burden of kidney disease (BKD), symptoms and problems of kidney disease (SPKD), effects of kidney disease (EKD). The scores went from 0 to 100; the higher scores the better the quality of life. 50 was set as a cut-off level. Nutritional parameters were collected (BMI; mean 27.16 ± 4.7 kg/m2, brachial muscular or fat areas (&amp;lt; 25th percentile for age and sex defined as malnourished). All the patients signed an informed consent. Results Overall, mean scores and percentage of patients with values &amp;lt;50 on the PCS, MCS, BKD, SPKD, and EKD subscales were 45.54 ± 18.82 (60.9%), 57.38 ± 19.41 (36.2%), 73.43 ±18.33 (65.2%), 79.03 ±11.59 (1.9%), and 36.02 ± 34.74 (11.6%), respectively. The mean score of the combination of MCS and PCS was 51.46 ± 16.77 (52.2%). Compared to younger patients, those who were 65 or more years old had significantly higher score of EKD (79.91 ± 16.63 vs 69.59 ± 18.26, p&amp;lt;0.0001), with only 12% of older patients having a score below 50 (Χ2 7.79, p=0.005); the other subscales did not differ significantly. Ninety-one (43.5%) patients were diabetics. They were more likely of being older, having a higher BMI and lower signs of malnutrition (borderline significance). In comparison to non-diabetics, they had lower mean scores on BKD scale (30.42 ± 35.12 vs 40.4 ± 33.87, p=0.04) with a higher number having BKD scores &amp;lt; 50 (66/91 vs 69/116, Χ2 3.82, p=0.035). Moreover, they were more likely of having scores &amp;lt; 50 for the SPKD and EKD subscales. A significant reduction of the muscular and fat brachial areas (&amp;lt;25th percentile) were found in 88 (42.1%) and 49 (23.4%) of the patients, respectively. Mean scores of all subscales did not differ significantly between the groups of muscular and fat brachial areas. The dialysis modality had a significant impact on some subscales. in comparison to PD, a higher number of HD patients had scores &amp;lt; 50 for BKD (Χ2 18.24, p &amp;lt; 0.0001). On the other hand, PD patients were more likely of having lower MNS scores (Χ2 5.69, p &amp;lt; 0.013) and of the combination of PCS and MCS subscales (Χ2 12.82, p &amp;lt; 0.0001). Similar findings were obtained when analysing the scores as continuous variables. Conclusion This is the first formal evaluation of the performances of the KDQOL-36 questionnaire in a cohort of dialysis patients in Chile. Overall, the mean scores of PCS and EKD were well below the reference value of 50. General and kidney-related subscales were affected differently by age, dialysis modality and diabetes. In particular diabetic patients were more likely to perform poorly at kidney-related subscales, with no significant difference for general ones. Interestingly, dialysis modality had an impact on both BKD and MCS with opposite trends. The nutritional status seems to little affect patient quality of life.

Kidney Disease–Specific Scores and Health Utility of Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis Patients and Their Caregivers

ObjectivesThis study aimed to compare the EuroQol 5-dimension 5-level questionnaire (EQ-5D-5L), the visual analogue scale (VAS), and the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36) scores of Thai continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) patients and to compare the utility scores with the EQ-5D-5L and VAS scores of caregivers. MethodsThis was a cross-sectional study completed between April 2016 and May 2017. In total, 34 CAPD patients, 30 APD patients, and their caregivers were recruited from a large university hospital in Thailand. A trained interviewer conducted face-to-face interviews. We collected demographic data and used the KDQOL-36 and EuroQol questionnaires (EQ-5D-5L and VAS) to assess the health-related quality of life. Caregivers were asked to assess their own health status using the EQ-5D-5L and VAS. ResultsThe EQ-5D-5L and VAS responses of the CAPD and APD patients and their caregivers were not significantly different (P > .05). More than 50% of both patient groups had mobility problems, whereas most patients had no problems with self-care, doing usual activities, pain or discomfort, and anxiety or depression. As for the KDQOL-36, the physical and mental component summaries were not significantly different, and neither were the scores for all of the kidney disease-specific dimensions, including symptoms or problems, effects of kidney disease, and burden of kidney disease (all were P > .05). ConclusionsThe results indicated that the quality of life of CAPD and APD patients and their caregivers were mostly equivalent. A further longitudinal study of utility score assessments of the differences in modality would be advantageous.

Mapping the kidney disease quality of life 36-item short form survey (KDQOL-36) to the EQ-5D-3L and the EQ-5D-5L in patients undergoing dialysis

ObjectivesTo develop algorithms mapping the Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36) onto the 3-level EQ-5D questionnaire (EQ-5D-3L) and the 5-level EQ-5D questionnaire (EQ-5D-5L) for patients with end-stage renal disease requiring dialysis.MethodsWe used data from a cross-sectional study in Europe (France, n = 299; Germany, n = 413; Italy, n = 278; Spain, n = 225) to map onto EQ-5D-3L and data from a cross-sectional study in Singapore (n = 163) to map onto EQ-5D-5L. Direct mapping using linear regression, mixture beta regression and adjusted limited dependent variable mixture models (ALDVMMs) and response mapping using seemingly unrelated ordered probit models were performed. The KDQOL-36 subscale scores, i.e., physical component summary (PCS), mental component summary (MCS), three disease-specific subscales or their average, i.e., kidney disease component summary (KDCS), and age and sex were included as the explanatory variables. Predictive performance was assessed by mean absolute error (MAE) and root mean square error (RMSE) using 10-fold cross-validation.ResultsMixture models outperformed linear regression and response mapping. When mapping to EQ-5D-3L, the ALDVMM model was the best-performing one for France, Germany and Spain while beta regression was best for Italy. When mapping to EQ-5D-5L, the ALDVMM model also demonstrated the best predictive performance. Generally, models using KDQOL-36 subscale scores showed better fit than using the KDCS.ConclusionsThis study adds to the growing literature suggesting the better performance of the mixture models in modelling EQ-5D and produces algorithms to map the KDQOL-36 onto EQ-5D-3L (for France, Germany, Italy, and Spain) and EQ-5D-5L (for Singapore).

Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36) Normative Values for the United States Dialysis Population and New Single Summary Score.

The Kidney Disease Quality of Life 36-item short form survey (KDQOL-36) is a widely used, patient-reported outcome measure for patients on dialysis. Efforts to aid interpretation are needed. We used a sample of 58,851 dialysis patients participating in the Medical Education Institute (MEI) KDQOL Complete program, and 443,947 patients from the US Renal Data System (USRDS) to develop the KDQOL-36 Summary Score (KSS) for the kidney-targeted KDQOL-36 scales (Burdens of Kidney Disease [BKD], Symptoms and Problems of Kidney Disease [SPKD], and Effects of Kidney Disease [EKD]). We also used the MEI and USRDS data to calculate normative values for the Short Form-12 Health Survey's Physical Component Summary (PCS) and Mental Component Summary (MCS), and the KDQOL-36's BKD, SPKD, and EKD scales for the United States dialysis population. We used confirmatory factor analysis (CFA) models for KDQOL-36 kidney-targeted items, evaluated model fit with the comparative fit index (CFI; >0.95 indicates good fit) and root-mean-squared error of approximation (RMSEA; <0.06 indicates good fit), and estimated norms by matching the joint distribution of patient characteristics in the MEI sample to those of the USRDS sample. A bifactor CFA model fit the data well (RMSEA=0.046, CFI=0.990), supporting the KSS (α=0.91). Mean dialysis normative scores were PCS=37.8 and MCS=50.9 (scored on a T-score metric); and KSS=73.0, BKD=52.8, SPKD=79.0, and EKD=74.1 (0-100 possible scores). The KSS is a reliable summary of the KDQOL-36. The United States KDQOL-36 normative facilitate interpretation and incorporation of patient-related outcome measures into kidney disease care.

Negligible impact of differential item functioning between Black and White dialysis patients on the Kidney Disease Quality of Life 36-item short form survey (KDQOLTM-36).

Black dialysis patients report better health-related quality of life (HRQOL) than White patients, which may be explained if Black and White patients respond systematically differently to HRQOL survey items. We examined differential item functioning (DIF) of the Kidney Disease Quality of Life 36-item (KDQOLTM-36) Burden of Kidney Disease, Symptoms and Problems with Kidney Disease, and Effects of Kidney Disease scales between Black (n = 18,404) and White (n = 21,439) dialysis patients. We fit multiple group confirmatory factor analysis models with increasing invariance: a Configural model (invariant factor structure), a Metric model (invariant factor loadings), and a Scalar model (invariant intercepts). Criteria for invariance included non-significant χ2 tests, > 0.002 difference in the models' CFI, and > 0.015 difference in RMSEA and SRMR. Next, starting with a fully invariant model, we freed loadings and intercepts item-by-item to determine if DIF impacted estimated KDQOLTM-36 scale means. ΔCFI was 0.006 between the metric and scalar models but was reduced to 0.001 when we freed intercepts for the burdens and symptoms and problems of kidney disease scales. In comparison to standardized means of 0 in the White group, those for the Black group on the Burdens, Symptoms and Problems, and Effects of Kidney Disease scales were 0.218, 0.061, and 0.161, respectively. When loadings and thresholds were released sequentially, differences in means between models ranged between 0.001 and 0.048. Despite some DIF, impacts on KDQOLTM-36 responses appear to be minimal. We conclude that the KDQOLTM-36 is appropriate to make substantive comparisons of HRQOL between Black and White dialysis patients.

Psychometric Properties of the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36) in the United States

The Centers for Medicare & Medicaid Services require that dialysis patients' health-related quality of life be assessed annually. The primary instrument used for this purpose is the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36), which includes the SF-12 as its generic core and 3 kidney disease-targeted scales: Burden of Kidney Disease, Symptoms and Problems of Kidney Disease, and Effects of Kidney Disease. Despite its broad use, there has been limited evaluation of KDQOL-36's psychometric properties. Secondary analyses of data collected by the Medical Education Institute to evaluate the reliability and factor structure of the KDQOL-36 scales. KDQOL-36 responses from 70,786 dialysis patients in 1,381 US dialysis facilities that permitted data analysis were collected from June 1, 2015, through May 31, 2016, as part of routine clinical assessment. We assessed the KDQOL-36 scales' internal consistency reliability and dialysis facility-level reliability using coefficient alpha and 1-way analysis of variance. We evaluated the KDQOL-36's factor structure using item-to-total scale correlations and confirmatory factor analysis. Construct validity was examined using correlations between SF-12 and KDQOL-36 scales and "known groups" analyses. Each of the KDQOL-36's kidney disease-targeted scales had acceptable internal consistency reliability (α=0.83-0.85) and facility-level reliability (r=0.75-0.83). Item-scale correlations and a confirmatory factor analysis model evidenced the KDQOL-36's original factor structure. Construct validity was supported by large correlations between the SF-12 Physical Component Summary and Mental Component Summary (r=0.40-0.52) and the KDQOL-36 scale scores, as well as significant differences on the scale scores between patients receiving different types of dialysis, diabetic and nondiabetic patients, and patients who were employed full-time versus not. Use of secondary data from a clinical registry. The study provides support for the reliability and construct validity of the KDQOL-36 scales for assessment of health-related quality of life among dialysis patients.