INTRODUCTION

Health-related quality of life (HRQOL) is often defined as “the value assigned to duration of life as modified by impairments, functional states, perceptions and social opportunities that are affected by disease, injury, treatment or policy.” Its assessment has become a vital tool not only in the monitoring of treatment outcomes in patients on various modalities of renal replacement therapy but also because it has been established to significantly influence morbidity and mortality. The assessment of HRQOL is important, as it determines how closely the treatment modality achieves the fundamental principles of prolonging life, relieving distress, restoring function and preventing disability, consequently leading to a more productive and effective life. This is pertinent, as the World Health Organization definition of health brings to limelight the need for holistic approach to treatment.

Both generic and disease-specific instruments have been used in the assessment of HRQOL in chronic renal failure patients on various treatment modalities, each with its specific advantages and disadvantages but with generally good correlation. In a recent Turkish study that utilized the Nottingham Health Profile (NHP) and Kidney Disease Questionnaire (KDQ) in the assessment of HRQOL in hemodialysis (HD) patients, it was found that the multiple-degree scoring in the KDQ was complex, though there was a good correlation between the dimensions of the NHP and KDQ. In this study, we set out to compare two generic instruments—the Karnofsky Performance Status Scale (KPSS) and the Short-Form-36 Health Survey (SF-36)—in our HD population.
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KPSS is a physician rating scale that guarantees an objective assessment of the patient’s clinical state. It was originally designed to assess quality of life in patients receiving cancer chemotherapy but has since been used in different disease states. It is perhaps the most commonly used HRQOL instrument. The scale ranges from scores of 0 (at death) to 100, which implies full-functional capability to carry out normal daily activities without clinical evidence (symptoms or signs) of disease. A score below 70 represents a functional capacity that requires some assistance, but the patient could still care for most personal needs while that below 50 represent incapacitation that requires hospitalization or institutionalization. Some of its demerits are the fact that it is independent of the patient’s judgment and the fact that psychological state is downplayed. Hutchison et al. have also raised questions on reproducibility of scores occasioned by poor interater reliability.

SF-36, on the other hand, looks at quality of life as a multidimensional model, assessing eight different perspectives of HRQOL—namely physical functioning; role limitations due to physical health problems; bodily pain; general health; vitality (energy/ fatigue); social functioning; role limitations due to emotional problems; and mental health, which implies psychological distress and psychological well-being. It utilizes a 36-item questionnaire, which was constructed as an improvement on the older SF-8 and SF-20 scales. This scale has internal consistency reliability of between 62% and 90% for the different domains in HD patients. It also has test-retest reliability of between 60% and 81% for the different domains.

Both generic scales have been used in the assessment of HRQOL in end-stage renal disease (ESRD) patients in different populations with generally good correlation but, to the best of our knowledge, there is no available documented report of use of SF-36 health survey in any Arab population; hence, the need for this study. online pharmacy no prescription

Aims and Objectives

In this study, we aim to compare two generic instru­ments—the KPSS and the SF-36—in our HD population. We also seek to find out the association (if any) between HRQOL scores using these two scales and various clinical and biochemical parameters.