Use of the KDQOL-36 for assessment of health-related quality of life among dialysis patients in the United States

BackgroundHealth-related quality of life (HRQOL) is a key outcome for dialysis patients, and its assessment is mandated by the Centers for Medicaid and Medicare Services. The Kidney Disease Quality of Life (KDQOL-36) survey is widely used for this assessment. KDQOL-36 completion rates, and the distributions of scores and item responses, have not been examined in a large, nationally representative cohort of dialysis patients.MethodsThis retrospective, observational study considered413,951 survey opportunities contributed by adult patients who received dialysis at a large dialysis organization in the United States during calendar years 2014, 2015, and 2016 and were not Veterans Affairs beneficiaries.ResultsDuring the study period, 240,343 unique patients completed a total of 330,412 surveys (overall completion rate 79.8%). Mean domain scores on the physical component summary (PCS), mental component summary (MCS), burden of kidney disease (BKD), symptoms and problems of kidney disease (SPKD), and effects of kidney disease (EKD) subscales were 36.6, 49.0, 51.3, 78.1, and 73.0, respectively. Scores were similar across dialysis modalities. Patient perceptions of general health were not correlated (R<0.05) with PCS or SPKD. The SPKD showed ceiling effects: among patients treated with in-center hemodialysis, for all 12 items, <10% of patients were extremely bothered, while >65% of patients reported being not at all or only somewhat bothered; for 3 items, >85% of patients gave these latter two responses. Interdialytic weight gain was not correlated with patient-reported shortness of breath, PCS, or SPKD.ConclusionsSurvey completion rates for the KDQOL-36 were high, and scores were similar across dialysis modalities. Ceiling effects were observed for SPKD. Revision of the KDQOL-36 to address factors that are most important to contemporary dialysis patients may be warranted.