How does KDQoL-36 questionnaire predict quality of life in Indian hemodialysis patients?

Sir,

We read with interest an article published by Veerappan et al.[1] in the Indian journal of nephrology titled “predictors of quality of life of hemodialysis patients in India”. They focused on the factors that affect quality of life in hemodialysis patients based on the KDQoL-36 questionnaire. In addition, the authors have compared some results with Dialysis Outcomes and Practice Patterns Study (DOPPS).

From the 1980s until now, there has been a growing interest in the evaluation of Health Related Quality of Life (HRQoL) among end-stage renal disease (ESRD) patients. HRQoL is a multidimensional concept that includes physical, mental, pysico-social, and spiritual aspects of health.[2,3] In addition, nonbiological factors such as patient culture, religious behaviors, and ethics, may play an important role in HRQOL because they can influence patients’ perceptions and expectations. This concept has been examined by several investigators.[4–6] For example, Antonio et al. 2003 and Donna et al. 2004 showed that mortality risk was lower for African Americans and Asians than for non-Hispanic whites treated by dialysis, though black and Asians people were more susceptible to diabetes and lower levels of socioeconomic status.[5,6] Furthermore, Donna et al. suggested that survival differences among dialysis patients from different ethnic groups must be assessed in terms of variation in HRQOL.[6] Anne et al. studied large established Asian communities from the Indian subcontinent that existed in UK.[7] They believed that there was a high incidence of renal disease in this ethnicity. A total of 42 Indians were compared with 51 white Europeans to evaluate the effect of ethnicity on QoL among hemodialysis patients. They found similar QoL in the two groups (MCS scores 45±23 vs. 65±20 and PCS score 34±17 vs. 45±18). Asian patients with other chronic conditions, such as diabetes and asthma has shown that they have a poor awareness of their illness compared with white patients.[7]

Since our people have no strict program for CKD screening and follow-up, they are not aware about their disease and majority of them presented with advanced renal failure for the first time. A great deal of them experience an urgent acute dialysis requirement and few of the CKD patients are scheduled for elective dialysis; it means that ESRD patients in our countries suffer from uremic symptoms for a long time. Hence, after starting dialysis treatment, they rarely achieve well-being. Moreover, after dialysis initiation, as Veerappan et al.[1] mentioned, the dialysis prescription is empiric in the majority of our dialysis centers.