Skip Navigation



NDT Advance Access published online on March 27, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn132
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
23/9/2810    most recent
gfn132v2
gfn132v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Chin, H. J.
Right arrow Articles by Chae, D.-W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chin, H. J.
Right arrow Articles by Chae, D.-W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Moderately decreased renal function negatively affects the health-related quality of life among the elderly Korean population: a population-based study

Ho Jun Chin1, Young Rim Song1, Jae Jung Lee2, Suk Beom Lee2, Ki Woong Kim2, Ki Young Na1, Suhnggwon Kim1 and Dong-Wan Chae1

1 Department of Internal Medicine 2 Department of Psychiatry, Seoul National University College of Medicine, Korea

Correspondence and offprint requests to: Dong-Wan Chae, 12304, Department of Internal Medicine, Seoul National University Bundang Hospital, Gumidong 300, Bundang-Gu, Seong-Nam, Kyeong-Ki Do, 463-707, Korea. Tel: +82-31-787-7025; Fax: +82-31-787-4052; E-mail: mednep{at}snubh.org, mednep{at}lycos.co.kr



   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 References
 
Background. The incidence of chronic kidney disease (CKD) is increasing in Korea, especially in the aged population. The health-related quality of life (HRQOL) of patients with chronic renal insufficiency is lower than that for the general population and a lower HRQOL is a predictor of adverse events. We report the impact of kidney function on the HRQOL and the risk factors for poor HRQOL in an elderly population living in one Korean city.

Methods. This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA) that was designed as a population-based, prospective cohort-study in a population aged >65 years living in a satellite city of Seoul in Korea. Among 1 000 randomly selected subjects, 944 were able to complete the SF-36 questionnaires to measure HRQOL. We categorized the participants into five GFR groups: group 1: 90 mL/min/1.73 m2 or more, group 2: 89–75 mL/ min/1.73 m2, group 3: 60–74 mL/min/1.73 m2, group 4: 45–59 mL/min/1.73 m2 and group 5: less than 45 mL/min/ 1.73 m2.

Results. Except for the general health perception and mental health scale, all the other scores of the SF-36 scales showed differences among five groups categorized according to GFR. However, the scores were significantly decreased only among participants with a GFR value of <45 mL/min/1.73 m2, compared to the other four GFR groups. After adjustment, the physical component summary score was the lowest in participants with GFR values <45 mL/min/1.73 m2. The dichotomized GFR factor with the criterion of 45 mL/min/1.73 m2 was an independent predictor of poor physical HRQOL. Other factors, such as age, gender, duration of education, regular exercising habits, depression and a history of cardiovascular accident, were also predictors of HRQOL. A lower haemoglobin level was related to the mental component summary.

Conclusion. The renal function deduced to be an important predictor of HRQOL, even in the old age group. The moderately decreased renal function of 45 mL/min/1.73 m2 GFR was the level at which HRQOL decreased in the elderly Korean population.

Keywords: elderly; chronic kidney disease; quality of life; renal impairment; SF-36



   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 References
 
Chronic kidney disease (CKD) is a worldwide health problem. The prevalence of CKD was 11.0% among U.S. adults [1] and the prevalence of estimated glomerular filtration rate (GFR) values <60 mL/min/1.73 m2 was 11.2% of Australian adults [2]. The disorders related to CKD are associated with the GFR levels. The risks of death, cardiovascular events and hospitalization were increased with decreasing GFR values [3] and the prevalence of hypertension, anaemia, limitations in mobility, hypoalbuminaemia or bone metabolism disorders was also gradually increased in accordance with an increase of CKD stage [4].

Several studies have reported the health-related quality of life (HRQOL) of patients with chronic renal insufficiency [5–11]. The HRQOL of patients with mild to moderate chronic renal insufficiency was shown to be lower than that for the general population [5,6,8,9] but higher than that of patients undergoing dialysis [6,7]. A lower HRQOL is a predictor of adverse events in ESRD patients [12] and is associated with increased hospitalization in peritoneal dialysis patients [13]. Therefore, knowledge of the level of renal function in relation to a decrease of HRQOL would be useful to ensure adequate and timely intervention. In a large population-based study in Australia, relatively mild impairment of GFR <60 mL/min/1.73 m2 was associated with a decline in all scales of SF-36 except social function, mental function and mental component summary [5]. Shlipak used the concept of frailty to measure the physiological reserve in an elderly CKD population in the USA and reported the elevated prevalence of each frailty characteristic among participants with a GFR value of <40 mL/min/1.73 m2 [8]. However, it remains to be elucidated which level of renal function is related to the initiation of a decreased HRQOL in CKD patients.

A second issue related to HRQOL in CKD is the possible racial or national variation in the level of renal function related to the decrease of HRQOL. The Japanese Society of Nephrology reported that the original modification of diet in renal disease (MDRD) equation to estimate GFR should be multiplied by a coefficient of 0.881 for the Japanese population [14]. Two studies from India addressed the issue of the mean GFR values of healthy kidney donors being smaller than those from America [15,16]. These studies implied that normal GFR values differ among various races. If the normal values of GFR were different, the level of GFR related to the manifestation of symptoms would be different. For example, although the risk of all-cause mortality began to increase at a GFR value of 60 mL/min/1.73 m2 in the American population [3], this began at a GFR value of 45 mL/minute/1.73 m2 in the Japanese [17]. In addition, HRQOL in patients with the same level of renal function may differ according to nationality, as suggested by Tsuji-Hayashi [18].

Therefore, we analysed this population-based data to determine the level of renal function related to the decreased HRQOL and to define the risk factors for poor HRQOL in the Korean elderly population.



   Methods
Top
 Abstract
 Introduction
 Methods
Results
 Discussion
 References
 
Design of KLoSHA
This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA). KLoSHA was designed as a population-based, prospective cohort-study of health, ageing and common geriatric diseases in a population aged >65 years in Seong-nam, a satellite city of Seoul in Korea. The baseline study of KLoSHA was started in September 2005. Two subject samples were prepared from the following populations: the total population of Seong-nam of 931 019, and a 6.6% sector of the population aged 65 or older. For the elderly sample (Sample-ED), a simple random sample (1118 persons, 1.81%) was drawn from a roster of 61 730 residents aged >65 years from 1 August 2005. The sampled subjects were invited to participate in the study by letter and telephone. Of the 1118 subjects, 698 agreed to participate in the baseline KLoSHA study. For the oldest age sample (Sample-OA), all the elderly aged 85 and over in Seong-nam (3 136 persons) were contacted by letter and telephone and 302 subjects were enrolled. In the baseline study, all the participants had a standardized clinical interview, consisting of physical and neurological examinations by three clinicians who were experts in geroneuropsychiatric research. An additional extensive interview using standardized questionnaires was carried out by three nurses who were certified as specialized nurses for dementia and had received additional training on the assessment of elderly patients for 3 months before the study commenced. Comprehensive neuropsychological assessment was carried out by four neurophysiologists, who were experts in dementia research. All the assessments were performed at Seoul National University Bundang Hospital.

Demographic and clinical characteristics
Income was graded by the criterion of the lowest monthly cost of living per household according to the number of family members, as provided by the Korean government. For example, the lowest monthly cost of living per household with four family members was 1081 US dollars. The designated level of income grade 1 was less than the lowest cost of living, whereas grade 2 was designated as income ranging from the lowest cost of living to twice the lowest cost of living and grade 3, as more than twice the lowest living cost. Regular exercise was defined as an exercise regimen for a minimum of 30 min three times or greater, per week. Diabetes mellitus was defined as use of anti-diabetic medicine or a serum fasting glucose level of >126 mg/dL. Hypertension was defined as a systolic blood pressure value of 140 mmHg or greater, a diastolic blood pressure of 90 mmHg or greater or the use of blood pressure-lowering medication. Coronary heart disease was defined as a self-reported history of angina pectoris, acute myocardial infarction, percutaneous coronary intervention or coronary artery bypass operation. Proteinuria was defined as albumin 1+ or greater, determined by a dipstick urine test while haematuria was defined as an RBC count of >5 per high power field examined by light microscopy of a urine sample.

Renal function
The estimated GFR was calculated using a modified MDRD equation [19]. The participants were categorized into five GFR group 1: 90 mL/min/1.73 m2 or more, group 2: 89–75 mL/min/1.73 m2, group 3: 60–74 mL/min/1.73 m2, group 4: 45–59 mL/min/1.73 m2 and group 5: less than 45 mL/min/1.73 m2.

Assessment of depression
Research psychiatrists conducted an assessment with mini international neuropsychiatric interview (MINI) version 5.0 [20]. The major depressive disorders were diagnosed according to the DSM-IV criteria, and the minor depressive disorders according to research criteria proposed in Appendix B of the DSM-IV criteria [21].

Measuring quality of life (QOL)
The QOL of subjects was assessed using the Korean version of SF-36. SF-36 measures eight health parameters: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health [22]. The subjects answered the questionnaires with the aid of explanations from three nurses regarding each parameter of the SF-36.

Statistical analysis
All analyses were conducted using SPSS (version 12.0, SPSS, IL, USA). Descriptive statistics were reported as mean/standard deviation for continuous variables or frequency for categorical variables. Differences in continuous variables were analysed by two-tailed, unpaired t-tests or one-way ANOVA tests and in categorical variables, by chi-square tests. Adjusted component summary scores were derived and compared among GFR groups using the covariance analysis that made use of the parameters that were associated with HRQOL in patients with CKD [23]. We identified the factors related to SF-36 component summary scores in the elderly population using simple linear regression analysis. To determine whether the GFR category or GFR value was associated independently with the SF-36 component summary scores, we used the multiple linear regression model adjusted for factors selected by simple linear regression analysis. We also repeated the multiple regression analysis for predictors of SF-36 component summary scores after dividing the groups by the criterion of GFR 60 mL/min/1.73 m2.



   Results
Top
 Abstract
 Introduction
 Methods
 Results
Discussion
 References
 
Subject characteristics
Among the 1000 subjects enrolled in the KLoSHA cohort, 944 were able to complete the SF-36 questionnaires and their data were analysed (Table 1). The mean serum creatinine levels in men and women were calculated to be 1.24 and 1.02 mg/dL, respectively. The mean GFR values for all participants, males and females were found to be 61.1, 63.3 and 59.2 mL/min/1.73 m2, respectively. Hypertension was identified in 71.1%, diabetes mellitus in 20.9%, a history of CHD in 7.6%, a history of cerebrovascular accident in 10.1% and depression in 16.5% of the participants. The mean systolic and diastolic blood pressures were 132.5 and 82.7 mmHg, respectively. Among the participants, 14 persons did not answer the question of marital status, and of the other 930, only three had not been married. The spouses of 393 participants were dead and 20 participants were reported to have been divorced. The remaining participants were still married and 496 were living with their spouses at the time of survey. Information about household income was obtained from 755 participants, of whom 23.7% had an income less than the lowest cost of living while 35.0% had more than twice the lowest cost of living. The mean duration of education was 7.3 years, and 19.1% of participants had been educated in a college or university.


View this table:
[in this window]
[in a new window]

  		Table 1 The clinical characteristics of participants

 
Characteristics of the GFR groups
Twelve participants omitted the serum creatinine test and GFR values were estimated in the remaining 932 subjects. The participant number according to the GFR group was as follows: group 1, 12 persons with GFR >90; group 1, 12 persons with GFR ≥ 90; group 3, 374 with GFR 74–60; group 4, 365 with GFR 59–45 and group 5, 79 with GFR <45 mL/min/1.73 m2. Only 10 and 2 participants had GFR <30 and 15 mL/min/1.73 m2, respectively. The mean age of GFR group 5 was the oldest (Table 1). The proportion of females was increased in groups with lower GFR. The frequency of being married was decreased with decreasing GFR. BMI values were increased in participants with GFR values of <75 mL/min/1.73 m2. Hypertension and a history of CHD were increased with decreasing GFR values. In particular, the frequency of hypertension in GFR group 5 was the highest and the rate of documented CHD in GFR group 5 was the highest significantly higher than that of the other groups. The cholesterol levels differed among the various GFR groups and the CRP value in GFR group 1 was the lowest. The haemoglobin level was significantly decreased in group 5. The frequency of proteinuria was predominantly high in GFR group 5.

HRQOL of GFR groups
Among all the participants, the score of general health perception was the lowest, followed by vitality scores (Table 2). Physical health scores tended to be lower than mental health scores, particularly in participants with lower GFR values. In GFR group 5, all physical health scores were lower than mental health scores, except vitality, which was on a similar level to that of bodily pain. All the scores of the SF-36 scales, except general health perception and mental health, showed differences among the GFR groups and were significantly decreased only in GFR group 5 compared to the other groups. Without adjustment, the physical component summary and the mental component summary were also decreased in GFR group 5. Figure 1 compares the SF-36 summary scores among the GFR groups after adjustment with demographic and clinical factors, which are closely associated with HRQOL in patients with chronic renal insufficiency. After correction for the factors of age, gender, income, marital status, duration of education, comorbidities, serum haemoglobin and serum albumin, the physical component summary score remained the lowest in GFR group 5.


View this table:
[in this window]
[in a new window]

  		Table 2 The SF-36 scales of participants

 

Figure 1
View larger version (32K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Fig. 1 The mean SF-36 component summary scores of GFR groups adjusted with factors that are known to be related to quality of life in pre-dialysis patients. Un-A: Unadjusted, adjusted: with the factors of age, gender, income, marital status, duration of education, comorbidities (hypertension, diabetes mellitus, coronary heart disease, cerebrovascular accident and depression), serum haemoglobin and serum albumin. Number over the bars: p-value among GFR groups. *: Difference among GFR groups by Duncan post hoc analysis in the one-way ANOVA test.

 
Predictors of HRQOL
To analyse the predictors for HRQOL, we selected univariate factors for the SF-36 summary scores by applying the simple linear regression test (Table 3). The GFR factor was used as both a dichotomized variable with the criterion of 45 mL/min/1.73 m2, as well as a continuous variable. Among 24 different factors, GFR, age, gender, duration of education, living spouse income status, regular exercise habits, depression, history of cerebrovascular accident, serum albumin level and serum haemoglobin level were related to the mental and the physical summary scores of SF-36. Serum cholesterol levels were also related to the physical component summary. The summary scores of SF-36 decreased with decreasing GFR values. The physical component summary of the participants with GFR values <45 mL/min/1.73 m2 were less than that of those with GFR values ≥45 mL/min/1.73 m2. Ageing was also associated with a decrease of both component summary scores. When we stratified the participants into the age criteria of 65–69, 70–74, 75–79, 80–84, 85–89 and ≥90 years, the mean score of the physical component summary was significantly decreased to 58.5, 56.6, 53.4, 51.1, 49.8 and 48.0, and the mean score of the mental component summary was also decreased to 53.2, 53.2, 51.1, 48.9, 49.8 and 48.6, respectively (all P = 0.000). The mean values of the physical and mental component summaries of females were lower than that of males (50.1 versus 59.9 and 49.2 versus 54.7, respectively, P < 0.05). The physical and mental component summaries in participants whose spouses were alive were larger than those of participants whose spouses were dead or absent (58.6 versus 49.9 and 53.7 versus 49.5, respectively, P < 0.05). Both summary scores of SF-36 were significantly lower among persons with less education and lower household income, an absence of regular exercise habits, depression, a history of cerebrovascular accident, lower serum albumin levels, lower serum glucose levels and lower haemoglobin levels.


View this table:
[in this window]
[in a new window]

  		Table 3 Results of simple linear regression test for the factors related to SF-36 component summary scores

 
The dichotomized GFR factor with the criterion of 45 mL/min/1.73 m2 was an independent predictor of poor physical HRQOL. Other factors, such as age, gender, duration of education, regular exercise habits, depression and a history of cardiovascular accident, were also predictors of mental and physical HRQOL. A lower haemoglobin level was related to the mental component summary (Table 4).


View this table:
[in this window]
[in a new window]

  		Table 4 Results of multiple linear regression model to SF-36 component summary scores

 
GFR as a continuous variable was not a predictor of HRQOL in all the participants but was related to the physical component summary score in the group limited to persons with GFR values of <60 mL/min/1.73 m2. In that limited group, GFR, age, duration of education, regular exercise habits, depression and haemoglobin levels were independent predictors of the physical component summary. For the mental component summary in that group, duration of education, regular exercise habits, depression and haemoglobin levels were significant predictors.



   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
References
 
This is the first population-based report to reveal the relationship between renal function and HRQOL in an elderly Korean population. The GFR criterion of 45 mL/min/1.73 m2 was an independent predictor of poor physical HRQOL.

SF-36 is applicable to healthy individuals as well as to patients with CKD, in whom the reliability, validity and sensitivity of the test have been verified [23]. Han translated SF-36 into Korean and verified its usefulness in 219 Korean elderly people with a mean age of 73.65 years, which was a similar age to that of this study group [24]. All physical SF-36 scale scores of this study were lower than those of the 60 healthy elderly people in Han's report although the social functioning and role-emotional scale scores, which were parts of the mental HRQOL scales, were similar in both studies. The physical component summary score in GFR group 5 was the lowest but the mental component summary score in this group was not different from that of other GFR groups after adjustment with known predictors to HRQOL. In the Renal Research Institute-CKD study (RRI-CKD), the mental component summary of patients with renal impairment was not different from that of healthy controls but their physical component summary was significantly lower than the population norm [7]. Similarly, the physical component summary was significantly lower than the mental component summary in the African American Study of Kidney Disease and Hypertension Trial (AASK) of 1094 African Americans with CKD [11]. Depression was reported to have been observed at a higher rate in patients who were starting dialysis therapy [25,26] or under dialysis [6]. The frequency of depression was lower in CKD patients than in haemodialysis patients [6] and was not different from that of subjects without CKD [9]. In the Heart and Soul Study, the prevalence of depression in CKD patients with GFR <60 mL/min/1.73 m2 and coronary disease was 17.0%, which was similar to both the 19% prevalence in subjects without CKD [9] and our own results (17.6% in participants with GFR values of <60 mL/min/1.73 m2 versus 15.4% in participants with GFR values of >60 mL/min/1.73 m2). Thus, we observed that physical health declined at an earlier stage of renal dysfunction than mental health did, as has previously been reported in other studies. With the Dialysis Outcomes and Practice Patterns Study data, HRQOL measures, particularly the physical component summary, have a greater capacity to identify patients at risk for death and hospitalization than serum albumin among dialysis patients. Moreover, HRQOL can serve as a sensitive indicator of subsequent patient morbidity and mortality [12]. Therefore, it is useful to determine the level of renal function related to the decreasing point of HRQOL for the adequate intervention to enhance HRQOL in time. Rocco analysed the Quality of Well-Being interview, the SCL-90R psychological profile, and a study-specific Patient Symptom Form in the MDRD study population with a mean GFR value of 33.2 mL/min/1.73 m2. They reported that the degree of HRQOL impairment was significantly associated with the degree of renal dysfunction [10]. Although they reported an increasing rate of occurrence of each symptom at decreasing GFR levels, it was uncertain which level of renal function was related to the point of decrease in the HRQOL of CKD patients. In the present study, the estimated GFR of 45 mL/min/1.73 m2 was determined to be the level from which the physical HRQOL began to decrease.

We categorized GFR in several ways to detect the optimal GFR level related to the decrease of HRQOL. Due to the small sample size, we categorized the participants only with a 10- or 15-digit GFR interval (mL/min/1.73 m2). When we stratified the groups according to those having GFR values of >90, 80–89, 70–79, 60–69, 50–59 and <50 mL/ min/1.73 m2, all summary scores decreased significantly in the group with GFR values <50 mL/min/1.73 m2 but there was no difference in the summary scores among the groups after adjustment with the known predictors of HRQOL. If we chose a 15-digit interval of GFR unit to categorize the participants, the physical component summary continued to decrease in the group with GFR values of <45 mL/min/1.73 m2 after adjustment. We also confirmed that the dichotomized GFR variable with the criterion of 45 mL/min/1.73 m2 still remained as an independent predictor of the physical component summary in the multiple linear regression analysis. We evaluated the link of GFR as a continuous variable to HRQOL in this population. It was not a predictor in the entire population but was an independent factor in the physical component summary in the limited group with GFR <60 mL/min/1.73 m2. There are several reasons why GFR may not be linked in a linear fashion to HRQOL in all participants whose renal functions were distributed from normal to moderately decreased status [8]. The disorders related to renal impairment are silent until renal dysfunction has progressed to the later stages. The interventions to treat disorders related to renal impairment, such as using erythropoietin in dialysis patients, might improve HRQOL in CKD patients. The common disorders combined with renal impairment which affect HRQOL in themselves, such as cerebrovascular accident, might be confounding factors to verify the independent linear relationship between GFR and HRQOL. In the RRI-CKD study, GFR was not associated in a linear fashion with HRQOL in subjects with a mean GFR value of 23.6 mL/min/1.73 m2 [8]. In the MDRD study population with a mean GFR of 33.2 mL/min/1.73 m2, GFR as a continuous variable, was positively correlated with overall QWB scores in multivariate analysis [10]. It remains unknown why the relationship between HRQOL and GFR as a continuous variable was different in studies that included subjects with similar renal function. However, the RRI-CKD study collected complete HRQOL information in only 222 out of 505 patients who filled out the SF-36 form, which in combination with the different subject characteristics in the various studies may have affected the results. HRQOL assessments may help identify biological and psychological factors as targets of intervention to improve the HRQOL of individual patients [12]. In our data, the predictors of HRQOL differed according to the level of renal dysfunction. The haemoglobin level was not a predictor in all the participants but was an important factor in the limited group of persons with GFR <60 mL/min/1.73 m2. Anaemia has been recognized to have a negative association with QOL in patients with pre-dialytic CKD [7] as well as ESRD [27]. Treatment of anaemia with erythropoietin in ESRD patients has been associated with improved HRQOL [28]. The other easily modifiable predictor for HRQOL in this study was the habit of regular exercise. One study reported an improved HRQOL measured by the SF-36 questionnaire after an exercise program was implemented in patients on haemodialysis [29].

This study had several limitations. Since the MDRD equation was not fully verified to estimate kidney function in the Korean population, differences in SF-16 scores between the Korean and the American population might just reflect the comparison of different GFR stages and not true differences in CKD experiences of patients in both areas. We used two different selection methods for the subjects. The elderly sample consisted of the respondents among the sample population aged >65 years from the total population of the same age in Seong-nam and the oldest age sample consisted of the respondents among the total elderly population aged 85 or over. Among 1000 participants, the 56 people who did not complete the SF-36 form were older, less educated, poorer and more anaemic than those who completed the questionnaire. This study was planned as a prospective study but these results were from the analysis of the first year survey and could not be used to predict the influence of HRQOL on the outcome in the elderly population. Although we tried to categorize the participants with a 10- or 15-digit interval of the GFR unit to verify the level of GFR related to the decrease of HRQOL, the sample was small and more studies are therefore needed to confirm the suggested GFR level.

In conclusion, the notable findings of this study were that the moderately decreased renal function indicated by a GFR of 45 mL/min/1.73 m2 was the level at which the HRQOL decreased in the elderly Korean population, and that regular exercise and haemoglobin were two easily modifiable factors among the predictors for HRQOL. Renal function was an important predictor for HRQOL, even in the oldest age group. Further studies are needed to verify whether interventions to enhance HRQOL can improve the clinical outcomes in the elderly with moderately decreased renal function.



   Acknowledgments
 
This work was supported by an independent Research Grant (IRG) from Pfizer Global Pharmaceuticals (grant no. 06-05-039) and a Grant for developing Seongnam Health Promotion Program for the Elderly from Seongnam City Government in Korea (grant no. 800-20050211).

Conflict of interest statement. None declared.



   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 

  1. Coresh J, Astor BC, Greene T, et al. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis (2003) 41:1–12.[Web of Science][Medline]
  2. Chandban SJ, Briganti EM, Kerr PG, et al. Prevalence of kidney damage in Australian adults: the AusDiab Kidney Study. J Am Soc Nephrol (2003) 14:s131–s138.[CrossRef][Web of Science][Medline]
  3. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Eng J Med (2004) 351:1296–1305.[Abstract/Free Full Text]
  4. K/DOQI. Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis (2002) 39(Suppl_1):S1–S266.[CrossRef][Web of Science][Medline]
  5. Chow FYF, Briganti EM, Kerr PG, et al. Health-related quality of life in Australian adults with renal insufficiency: a population-based study. Am J Kidney Dis (2003) 41:596–604.[CrossRef][Web of Science][Medline]
  6. Kalender B, Ozdemir AC, Dervisoglu E, et al. Quality of life in chronic kidney disease: effects on treatment modality, depression, malnutrition and inflammation. Int J Clin Pract (2007) 61:569–576.[CrossRef][Web of Science][Medline]
  7. Perlman RL, Finkelstein FO, Liu L, et al. Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the renal research institute-CKD study. Am J Kidney Disease (2005) 45:658–666.[CrossRef][Web of Science][Medline]
  8. Shlipak MG, Stehman-Breen C, Fried LF, et al. The presence of frailty in elderly persons with chronic renal insufficiency. Am J Kidney Dis (2004) 43:861–867.[CrossRef][Web of Science][Medline]
  9. Odden MC, Whooley MA, Shilpak MG. Depression, stress, and quality of life in persons with chronic kidney disease: the Heart and Soul Study. Nephron Clin Pract (2006) 103:C1–C7.[CrossRef][Web of Science][Medline]
  10. Rocco MV, Gassman JJ, Wang S, et al. Cross-sectional study of quality of life and symptoms in chronic renal disease patients: the Modification of Diet in Renal Disease Study. Am J Kidney Dis (1997) 29:888–896.[Web of Science][Medline]
  11. Kusek JW, Greene P, Wang S, et al. Cross-sectional study of health-related quality of life in African Americans with chronic renal insufficiency: the African American Study of Kidney Disease and Hypertension Trial. Am J Kidney Dis (2002) 39:513–524.[Web of Science][Medline]
  12. Mapes DL, Bragg-Gresharm JL, Bommer J, et al. Health-related quality of life in the dialysis outcomes and practice pattern study (DOPPS). Am J Kidney Dis (2004) 44(Suppl 2):S54–S60.[Web of Science]
  13. Bakewell AB, Higgins RM, Edmunds ME. Quality of life in peritoneal dialysis patients: decline over time and association with clinical outcomes. Kidney Int (2002) 61:239–248.[CrossRef][Web of Science][Medline]
  14. Imai E, Horio M, Nitta K, et al. Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease. Clin Exp Nephrol (2007) 11:41–50.[CrossRef][Medline]
  15. Barai S, Bandopadhayaya GP, Patel CD, et al. Do healthy potential kidney donors in India have an average glomerular filtration rate of 81.4 ml/min? Nephron Physiol (2005) 101:21–26.[CrossRef]
  16. Mahajan S, Mukhiya GK, Singh R, et al. Assessing glomerular filtration rate in healthy Indian adults: a comparison of various prediction equations. J Nephrol (2005) 18:257–261.[Web of Science][Medline]
  17. Nakamura K, Okamura T, Hyakawa T, et al. Chronic kidney disease is a risk factor for cardiovascular death in a community-based Japan population in Japan-Nippon Data90-. Circ J (2006) 70:954–959.[CrossRef][Web of Science][Medline]
  18. Tsuji-Hayashi Y, Fitts SS, Takai I, et al. Health-related quality of life among dialysis patients in Seattle and Aichi. Am J Kidney Dis (2001) 37:987–996.[Web of Science][Medline]
  19. Levey AS, Greene T, Kusek J, et al. Simplified equation to predict glomerular filtration rate from serum creatinine [Abstract]. J Am Soc Nephrol (2000) 11:A0828.
  20. Sheehan DV, Lecrubier Y, Sheehan KH, et al. The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry (1998) 59(Suppl 20):22–33.[Medline]
  21. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (1994) 4th edn. Washington DC: American Psychiatric Association Press.
  22. Ware JE, Kosinski M, Keller SK, eds. SF-36 Physical and Mental Health Summary Scales: A User's Manual (1994) Boston: The Health Institute.
  23. Valderrabano F, Jofre R, Lopez-Gomez JM. Quality of life in end-stage renal disease Patients. Am J Kidney Dis (2001) 38:443–464.[Web of Science][Medline]
  24. Han CW, Lee EJ, Iwaya T, et al. Development of the Korean version of Short-Form 36-item health survey: health related QOL of healthy elderly people and elderly patients in Korea. Tohoku J Exp Med (2004) 203:189–194.[CrossRef][Web of Science][Medline]
  25. Waters BA, Hays RD, Spiritzer KL, et al. Health-related quality of life, depressive symptoms, anemia, and malnutrition at hemodialysis initiation. Am J Kidney Dis (2002) 40:1185–1194.[CrossRef][Web of Science][Medline]
  26. Watnick S, Kirwin P, Mahnensmith R, et al. The prevalence and treatment of depression among patients starting dialysis. Am J Kidney Dis (2003) 41:105–110.[CrossRef][Web of Science][Medline]
  27. Yang SC, Kuo PW, Wang JD, et al. Quality of life and its determinants of hemodialysis patients in Taiwan measured with WHOQOL-BREF(TW). Am J Kidney Dis (2005) 46:635–641.[CrossRef][Web of Science][Medline]
  28. Beusterien KM, Nissenson AR, Port FK, et al. The effects of recombinant human erythropoietin on functional health and well-being in chronic dialysis patient. J Am Soc Nephrol (1996) 7:763–773.[Abstract]
  29. Painter P, Carlson L, Carey S, et al. Physical functioning and health-related quality of life changes with exercise training in hemodialysis patients. Am J Kidney Dis (2000) 35:482–492.[Web of Science][Medline]
Received for publication: 21.12.07
Accepted in revised form: 18. 2.08


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Nephrol Dial TransplantHome page
H. J. Chin, J. M. Ahn, K. Y. Na, D.-w. Chae, T. W. Lee, N. J. Heo, and S. Kim
The effect of the World Kidney Day campaign on the awareness of chronic kidney disease and the status of risk factors for cardiovascular disease and renal progression
Nephrol. Dial. Transplant., September 25, 2009; (2009) gfp512v1.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
23/9/2810    most recent
gfn132v2
gfn132v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Chin, H. J.
Right arrow Articles by Chae, D.-W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chin, H. J.
Right arrow Articles by Chae, D.-W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?