Assessment of health-related quality of life among patients with chronic kidney disease.

The health-related quality of life (HRQOL) of patients with chronic kidney disease influences the timing of the initiation of dialysis, whether they continue to work with progressive kidney failure and whether they maintain an active role in the home and community. The importance of HRQOL to the goals of therapy has been widely documented for dialysis patients who chose not to receive a kidney transplant and those with substantial comorbidities who are not candidates for kidney transplantation, patients who are confined to the chronic rigors of maintenance dialysis. The usual conceptualization of HRQOL has been based on the World Health Organization's definition of QOL as a complete state of physical, mental, and social well-being and not merely an absence of disease in infirmity. This conceptual model has limitations because few standard HRQOL questionnaires assess satisfaction with family despite being a critical domain to patients. Measuring and monitoring HRQOL in CKD patients can be achieved with the widespread implementation of facile HRQOL assessment. The importance of HRQOL has been increasingly recognized by health care payers, health care providers, regulatory agencies, and researchers, both within and outside the renal community. Despite the apparent need and potential benefits of HRQOL assessments in dialysis patients, there are limitations to the translation of such assessments from the research domain into the clinical arena such as the length of questionnaires and display of the information at the point of care. These limitations can be addressed through the development of computer-adaptive testing (CAT). CAT permits the response of the patient to inform the selection of the next question. In this way, the length of HRQOL questionnaires may be dramatically shortened while not sacrificing the sensitivity or reliability of a longer instrument. The routine use of HRQOL assessments in the care of patients with CKD represents an important opportunity for the nephrologist to better incorporate the values and concerns of the patient into their care.