Jul 2026· One Health & Risk Management· Vol 7, pp. 39-52· 0 citations· 26 references
TL;DR
HRQoL is substantially impaired in pre-dialysis CKD, particularly among women and patients with advanced disease, highlighting the need for targeted, patient-centered interventions.
Abstract
Introduction. Chronic kidney disease (CKD) negatively affects health-related quality of life (HRQoL) even in the pre-dialysis stages. However, data regarding gender- and stage-related differences in Eastern European CKD populations remain sparse compared to major international cohorts like CRIC and DOPPS. In this study, Low quality of life (low QoL) was defined as a Physical Component Summary (PCS) score below the 25th percentile of the cohort distribution.
Materials and Methods. This cross-sectional study included 989 adults with CKD stages I–V undergoing conservative management. HRQoL was evaluated using the KDQOL-36™ questionnaire. We performed gender and CKD stage comparisons, Pearson correlations, and multivariate logistic regression to identify predictors of low QoL. Symptom burden was assessed via structured patient interviews, complemented by the KDQOL-36™ symptom domain to ensure standardized reporting.
Results. The mean patient age was 58.3 ± 12.5 years, and 52.8% were male. The mean PCS and Mental Component Summary (MCS) scores were 40.2 ± 10.8 and 43.5 ± 11.2, respectively. Women had lower PCS scores than men (38.0 vs. 41.0; p < 0.05) and a higher prevalence of fatigue (95.0% vs. 85.0%) and dysuria (70.8% vs. 52.6%; p < 0.001). QoL declined progressively with advancing CKD stage (PCS 44.2 in stages I–II vs. 34.5 in stages IV–V; p < 0.001), and PCS correlated positively with eGFR (r ≈ 0.45; p < 0.001). Independent predictors of low QoL included advanced CKD stage (OR 2.72), diabetes (OR 1.94), anemia (OR 1.80), hypoalbuminemia (OR 1.70), a disease duration of >5 years (OR 1.50), and female sex (OR 1.38).
Conclusions. HRQoL is substantially impaired in pre-dialysis CKD, particularly among women and patients with advanced disease, highlighting the need for targeted, patient-centered interventions.
Abstract Background and hypothesis Patients receiving maintenance dialysis experience substantial pill burden from complex comorbidities and intensive treatment regimens. Although higher pill burden is linked to treatment burden and poorer health-related quality of life (HRQoL), optimized pharmacologic management may improve overall well-being. We evaluated the association between pill burden and HRQoL across dialysis modalities. Methods We conducted a cross-sectional study of adult patients receiving maintenance hemodialysis (HD), hemodiafiltration (HDF), or peritoneal dialysis (PD) at a tertiary care center. Pill burden was defined as the total number of oral tablets taken daily and categorized as <10, 10–15, or >15 tablets/day. HRQoL was assessed using validated Thai versions of the Kidney Disease Quality of Life-36 (KDQOL-36) and EQ-5D-5L questionnaires. Univariable and multivariable linear regression analyses evaluated associations between pill burden and HRQoL outcomes after adjustment for confounders. Results A total of 156 patients were included: 64 HD, 64 HDF, and 28 PD patients. Median pill burden was 11.5, 10, and 7.5 tablets/day in the HD, HDF, and PD groups, respectively. Antihypertensive and CKD–mineral and bone disorder medications were the main contributors. After adjustment, pill burden was not significantly associated with PCS-12, MCS-12, SPKD, EKD, or EQ-5D-5L-VAS scores. However, patients receiving >15 tablets/day had significantly lower BKD scores, while higher pill burden was independently associated with higher EQ-5D-5L index scores. HDF and PD were consistently associated with better HRQoL than HD. Conclusions Pill burden demonstrated a complex relationship with HRQoL. Dialysis modality appeared to exert a stronger influence on HRQoL than pill burden itself.
Background: Hemodialysis sustains life for chronic kidney disease patients but imposes heavy physical, psychological, and social burdens. Poor adherence worsens complications and reduces quality of life, emphasizing the need to explore how compliance and patient well-being interact to improve outcomes.
Purpose: This study examined how quality of life and patient factors shape treatment adherence in chronic hemodialysis.
Methods: A cross-sectional design was employed with 158 adult patients recruited from hospitals in Central Java. Data were collected using validated instruments: KDQOL-36 for quality of life and MMAS for adherence. Multivariable linear regression analysis was performed to examine associations between variables.
Results: Moderate adherence was observed (47.66 ± 5.90), with the highest quality of life domain in the problem list (78.30 ± 9.67). Strong positive correlations were found between adherence and all QoL domains: SF-12 (r = 1.000, p < 0.001). Regression analysis showed that age, employment, education, income, dialysis duration, and CKD length negatively influenced adherence, while quality of life was a significant positive predictor (B = 0.021, p < 0.001), confirming that better adherence is strongly linked to improved quality of life across physical, psychological, and social domains, with patient-reported challenges being the most critical factor.
Conclusion: Quality of life influences adherence by affecting burden, motivation, and self-management, while age and longer dialysis history weaken this link through fatigue and reduced resilience. Socioeconomic factors help only with psychosocial support, so nursing should reduce treatment burden.
Wenny Trisnaningtyas, N. Wulandari, Sherly Metasari et al.· Journal of Nursing and Pract...· 0 citations
End-stage renal disease (ESRD), the most advanced form of chronic kidney disease, severely impacts patients' quality of life (QoL), especially in low- and middle-income countries like Nepal. This study aimed to assess the QoL of ESRD patients undergoing maintenance hemodialysis at Chitwan Medical College. A cross-sectional quantitative study was conducted from October 2024 to January 2025 among 107 ESRD patients on hemodialysis for at least six months. QoL was measured using the WHOQOL-BREF tool across four domains: physical, psychological, social, and environmental. Descriptive and inferential statistics were used for analysis. The overall mean QoL score was 48.36 ± 7.44. The environmental domain scored highest (53.85 ± 11.10), followed by social (51.65 ± 11.85), physical (46.06 ± 7.46), and psychological (41.59 ± 8.19). ESRD patients undergoing dialysis in Nepal experience moderate to poor QoL, particularly in psychological and physical domains. Targeted, age-sensitive interventions are essential to enhance their well-being.
Shrisa Kandel, Bidhan Shrestha, Sakar Paudel et al.· Nepal Medical College Journa...· 0 citations
BACKGROUND
Several novel pharmacological therapies for chronic kidney disease (CKD) have been shown to reduce risks of disease progression, cardiovascular events, and mortality. However, their effects on health-related quality of life (HRQoL) remain scattered across trials and are difficult to interpret, owing to variability in instruments used and other design related factors.
METHODS
PubMed and Web of Science were searched for randomized clinical trials of pharmacological interventions aimed at slowing CKD progression in adults with non-dialysis CKD, published between January 2000 and January 2026. Two authors independently screened and extracted data. Data on study characteristics, HRQoL instruments used, and intervention effects were synthesized descriptively, and key methodological considerations were reviewed.
RESULTS
Of 16,624 screened records, 13 trials collected HRQoL data. HRQoL was measured mainly using the EuroQol 5-Dimension questionnaire (EQ-5D; n=8), the 36-Item Short Form Health Survey (SF-36; n=4), or the Kidney Disease Quality of Life-36 questionnaire (KDQOL-36; n=5). Nine trials reported the effects of interventions on HRQoL. Three demonstrated statistically significant effects in at least one HRQoL domain, all involving interventions that also slowed CKD progression. Effects were generally greater for physical than for mental health domains and were detected more frequently using the disease-specific KDQOL-36, particularly in the symptoms and effects domains, than using the generic EQ-5D. Observed population average intervention effects generally were below conventional minimal clinically important difference thresholds at the population level, though individual-level benefits were evident.
CONCLUSIONS
The impact of disease-modifying therapies on HRQoL in non-dialysis CKD is heterogeneous, instrument-dependent, and domain-specific. Consideration of the selected instrument, baseline HRQoL, duration of follow-up, missing data, and potential mediation through clinical events is important when interpreting HRQoL findings. Future trials should incorporate kidney-specific HRQoL instruments and report results for all domains using multiple effect measures.
Changyuan Yang, Devika Nair, P. Vart· Journal of the American Soci...· 0 citations
Objectives: This study aimed to assess the quality of life (QoL) of patients with end-stage renal disease undergoing hemodialysis (HD) and to evaluate its association with selected sociodemographic and clinical factors.
Methods: A cross-sectional analytic study was conducted at the dialysis center of Imamein Kadhimein Medical City, Baghdad, from February to July 2025. A convenience sample of 200 adult patients receiving maintenance HD was included. Data were collected through direct interviews using a structured sociodemographic questionnaire and the Kidney Disease QoL-36 (KDQOL-36) instrument. QoL scores were transformed to a 0–100 scale, with higher scores indicating better QoL. For descriptive interpretation, an overall QoL score below 50 was considered poor QoL. Multivariate regression analysis was performed to identify independent predictors of QoL.
Results: The mean overall QoL score was 50.2±12.1. Using a cutoff value of <50 on the KDQOL-36 scale, 51% of patients were classified as having poor QOL. Domain-specific mean scores were as follows: Mental component summary (41.8), physical component summary (36.3), burden of kidney disease (33.7), symptoms/problem list (72.4), and effects of kidney disease (67.0). Multivariate analysis showed that sufficient income was the strongest independent predictor of better QoL across all domains (p<0.05). Male sex and longer dialysis duration were associated with improved mental health, while higher educational level predicted better physical health. In contrast, the presence of three or more comorbidities was independently associated with poorer physical and disease-related outcomes. Age and residency showed no significant independent associations.
Conclusion: More than half of the HD patients experienced poor QoL, particularly in physical, mental, and disease-burden domains. Socioeconomic status and comorbidity burden were key determinants of QoL, highlighting the importance of comprehensive and multidisciplinary interventions.
HANEEN ALI ABDULSAHIB, NIBRAS ALAA HUSSAIN· Asian Journal of Pharmaceuti...· 0 citations
BACKGROUND
Social support is an important correlate of quality of life in patients living with chronic illness. Little work has examined this association in a longitudinal manner among patients with chronic kidney disease (CKD).
METHOD
The current work utilized ancillary data from the Chronic Renal Insufficiency Cohort (CRIC) study, focusing on the Hispanic sub-cohort (n = 250). The Medical Outcomes Study (MOS) social support survey and Kidney Disease Quality of Life (KDQOL-36) were analyzed over a 12-year period. Only participants who progressed to end-stage renal disease (ESRD; n = 140) during the study were included in analyses.
RESULTS
Piecewise multivariate growth models assessed change in KDQOL subscales with the MOS before and after patients entered ESRD. Average MOS and KDQOL scores declined both before and after ESRD. Before ESRD, there were significant correlations between change in the MOS and KDQOL Burden (r = 0.38, p < 0.001) and Effects (r = 0.59, p < 0.001), indicating that less decline on the MOS was associated with less decline in quality of life. After entering ESRD, associations were found between change in MOS Overall Support and change in all KDQOL subscales: Burden (r = 0.34, p < 0.001), Effects (r = 0.85, p < 0.001), and Symptoms (r = 0.98, p < 0.001). These results reveal that after entering ESRD, patients with less decline in support showed less decline in KDQOL across all CKD-specific domains.
CONCLUSION
Results suggest social support can have a protective effect on QoL before and after ESRD diagnosis.
T. Stallings, Anne Sorrell, A. Schoemann et al.· International Journal of Beh...· 0 citations