Recent research suggests that patients' perceptions may be more important than objective
clinical assessments in determining quality of life (QOL) for patients with end-stage
renal disease (ESRD).
We interviewed 165 hemodialysis patients from 3 sites using a QOL questionnaire that
included the Satisfaction With Life Scale (SWLS) and the McGill QOL (MQOL) scale,
which includes a single-item global measure of QOL (Single-Item QOL Scale [SIS]).
The MQOL scale asks patients to report their most troublesome symptoms. We also initiated
the use of a Support Network Scale and a Spiritual Beliefs Scale.
Mean patient age was 60.9 years, 52% were men, 63% were white, and 33% were African
American. Patients had a mean treatment time for ESRD of 44 months, mean hemoglobin
level of 11.8 g/dL (118 g/L), mean albumin level of 3.7 g/dL (37 g/L), and mean Kt/V
of 1.6. Forty-five percent of patients reported symptoms. Pain was the most common
symptom (21% of patients). There was an inverse relationship between reported number
of symptoms and SWLS (P < 0.01), MQOL scale score (P < 0.001), and SIS (P < 0.001).
The Spiritual Beliefs Scale correlated with the MQOL scale score, SWLS (both P < 0.01),
and SIS (P < 0.05). The Support Network Scale score correlated with the MQOL Existential
(P = 0.01) and MQOL Support (P < 0.01) subscales. No clinical parameter correlated
with any measure of QOL, spiritual beliefs, or social support.
Symptoms, especially pain, along with psychosocial and spiritual factors, are important
determinants of QOL of patients with ESRD. Additional studies, particularly a longitudinal
trial, are needed to determine the reproducibility and utility of these QOL measures
in assessing patient long-term outcome and their association with other QOL indices
in larger and more diverse patient populations.