ASPECTS OF QUALITY-OF-LIFE IN HEMODIALYSIS-PATIENTS

The proper means of measuring quality of life in chronically ill patie nts is unclear. Because different measures may assess varied aspects o f patients' experience and because they may be interrelated in differe nt ways, the relationship between several of these quality-of-life mea sures, including indices of psychological well-being, social support, and severity of illness in ESRD patients treated with hemodialysis (HD ), was prospectively assessed. In addition, it was determined whether patients' assessment of quality of life, along any dimension, was rela ted to patient compliance in three urban HD units, in a population lar gely composed of African-American patients. Severity of illness scores correlated with both attendance and compliance with the dialysis pres cription. Karnofsky scores correlated inversely with age, depression, social environment, and level of severity of illness, as expected, but not with behavioral compliance measures. Social support scores correl ated with perception of illness, depression, satisfaction with life, a nd adjustment to illness scores, but not with behavioral or standard c ompliance measures. Perception of illness scores correlated with depre ssion, social support, adjustment to illness, and satisfaction with li fe scores, but not with Karnofsky ratings, severity scores, or standar d and/or behavioral compliance measures. Social environment scores cor related with almost all assessed variables, with the exception of anth ropometric measurements, predialysis phosphorus levels, and behavioral compliance measures. Satisfaction with life scores (a global, subject ive measure of quality of life) correlated with advancing age, level o f social support, severity of illness, and the presence of a relations hip, but were not correlated with Karnofsky scores. These data suggest that quality of life in patients treated with HD must be measured in several ways. The Psychological Adjustment to Illness Scale Social Env ironment score may be a useful, generalizable adjunct measure of quali ty of life in HD patients, in addition to the Satisfaction With Life S cale. Quality of life and perception of the effects of illness are not necessarily associated with functional ability in HD patients. These findings must be considered where making decisions about the discontin uation of HD treatment.