Assessment of quality of life in chronic illnesses has become a vital tool not only in the monitoring of treatment outcomes but also because it has been established to significantly influence morbidity and mortality. HRQOL assessment can be carried out using general or disease-specific instruments, which could be objective or subjective, or satisfaction- or function-based. It could be subdivided into measures of functional status, health status, and well-being and patient satisfaction. Each has its recognized merits and demerits, which include ease of interpretation, applicability and validation for different communities and comparability of results. A number of researchers utilize multiple instruments to be able to assess different subscales of HRQOL, as suggested by Gill and Feinstein.

While KPSS is physician-dependent with little or no input from the patient, the SF-36 rating is dependent on the patient’s assessment or perception of their health status, its high comprehensiveness and conciseness, and its validity have been variously demonstrated even in different languages. This study, which the first documented reported use of the SF-36 health survey in the Egyptian population found a good correlation between the various dimensions of SF-36 and KPSS though physical functioning, social functioning and role limitation due to emotional problems, significantly influences the other SF-36 domains. This agrees with the findings of other researchers who found a generally good correlation between SF-36 and KPSS. SF-36 scores were found to be poorer than that of the general U.S. population though better than that of U.S. patients with congestive heart failure, osteoarthritis or chronic obstructive pulmonary disease. This is particularly so in the physical fitness and emotional domains. tadacip

This study found that serum creatinine positively correlated with various SF-36 dimensions and the KPSS rating. This is not surprising, as improvement in the dialysis dose is known to lead to improvement in appetite, increased muscle mass and vitality, which, in the long run, may lead to increase in serum creatinine. Based on the aforementioned reasons, it is also not surprising that serum creatinine positively correlated with serum albumin and hemoglobin in this study. It is, however, startling that a negative association was found between serum creatinine and weekly kt/v; hence, there is a need for more studies to further investigate this relationship.

Although malnutrition has been established to portend worsening morbidity and an increase in mortality in dialyzed patients, we found a negative correlation between BMI and the KPSS rating and bodily pain component of the SF-36 health survey. The reasons for this finding are not clear, but other measures of nutritional status were not assessed; hence, no far-reaching deductions could be made.

There was preponderance of hypocalcemia and hyperphosphatemia in many (above 40%) of the studied patients. In addition, this study found a significant negative correlation between social functioning domain of SF-36 and calcium-phosphate products, which implies that features attributable to renal osteodystrophy could significantly impart on the quality of life in HD patients. buy antibiotics amoxicillin

Studies have clearly shown that improvement in hematocrit leads to improvement in cardiovascular status, physical fitness and exercise tolerance. It has also been demonstrated to lead to improvement in overall quality of life and mortality. It is, therefore, not surprising that in this study hemoglobin concentration positively correlated with KPSS and four SF-36 domains—namely, physical function, bodily pain, general health and social functioning. This is contrary to the findings of Mingardi et al., who found no association between HRQOL and hemoglobin.

The negative correlation between age and KPSS rating and two SF-36 items—namely, physical functioning and role limitation due to physical fitness— are in agreement with the findings of others. In contrast to our finding, a Spanish study revealed that elderly patients showed higher standardized scores and lower loss of HRQOL than younger patients. This was statistically significant, although they compared subjects above and below 65 years, while the majority of our patients were below 65years.

In this study, we found KPSS was relatively easy to apply, though it assesses only physical fitness; the SF-36 health survey, on the other hand, was more complex but assesses psychological and emotional domains in addition to assessment of physical fitness. The English version of the SF-36 health survey was used in this study with the aid of an interpreter in some cases, and this may have contributed to complexity and default rate observed. The Arabic version would be easier to apply and also save time for both patients and investigators. The Arabic version would be invaluable in assessing the different domains of HRQOL in all Arabic-speaking countries.
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In conclusion, there is a good correlation between KPSS and the SF-36 in this Egyptian HD patient population. Age, serum creatinine and hemoglobin significantly influence quality of life in this population.