Quality of Life and Health-related Quality of Life in Patients with End-stage Kidney Disease Undergoing Hemodialysis: A Literature Review

Abstract

Measurements of quality are intended to drive improvements in care and provide accountability regarding costs and quality. Quality of life (QoL) and health-related QoL (HRQoL) comprise personal perceptions, health, and socioenvironmental dimensions. This structured integrative review aimed to present and analyze the nature and significance of the predictors of QoL and HRQoL in patients with end-stage kidney disease (ESKD). The articles found through searching the main databases were assessed for sample size, design, and methodological limitations. The revised Wilson-Cleary conceptual framework of HRQoL and the World Health Organization's definition of QoL guided this review. Forty-five articles were selected (36 were observational or cross-sectional studies; nine were prospective). These articles reported a range of factors related to QoL and HRQoL characterized as physical, mental, socioeconomic, biological, and symptomatic. Few studies considered spiritual beliefs and cultural beliefs. There was a lack of consistency in the use of measures of QoL and HRQoL in ESKD. The most validated measures of HRQoL and QoL identified were the Short-Form 36 v2, the QoL Index - Dialysis, the Hospital, Anxiety, and Depression Scale, the Fatigue Severity Scale, the Itch Scale, the Spiritual Well-being Scale, and the Schedule for the Evaluation of QoL - Direct Weighting. Most studies were conducted in developed countries, with only two from the Middle East. The possible measures of QoL and HRQoL are health status, disease-specific, symptom-specific, spiritual, and individualized QoL measures. This set of measures is expected to capture the patients' own perceptions concerning their QoL and HRQoL.