Quality of Life in End-Stage Renal Disease

Survival in end-stage renal disease seems to depend more on age and associated diseases than on the form of treatment. Previously published comments on the quality of life experienced by patients treated by hemodialysis, peritoneal dialysis and transplantation were based on subjective estimates or on the use of unvalidated instruments. We have used a modified form of a “time trade-off” technique to estimate the patient's perception of the utility or worth of their ESRD health state. It was used successfully in 42 of 50 stable chronic hemodialysis patients. The correlation between paired observations six weeks apart (a test of temporal stability) was 0.80. Evidence for the validity of this instrument was obtained by comparing it with the physicians’ assessment of the patient's health state. Health was scored on a scale from 0 for death to 1 for perfect health. The mean values for hospital-based hemodialysis, CAPD and transplantation were 0.57, 0.57 and 0.80 respectively. For each form of treatment the distribution of scores was wide suggesting that factors other than form of treatment are important determinants of the per ceived quality of life for these patients.