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Interventions that Improve HRQOL

Certain interventions have been found to improve HRQOL scores among people with chronic kidney disease (most often on dialysis) in randomized, controlled trials. These include:

  • Automated (vs. manual) peritoneal dialysis.[1] After 6 months, APD patients had higher SF-36 scores. Nighttime treatments allowed time for work, family, and social life.
  • Icodextrin peritoneal dialysis fluid.[2] After 13 weeks, patients using icodextrin had fewer dialysis symptoms and higher mean change scores on the KDQOL than those on usual care.
  • More frequent hemodialysis.[3][4] Short daily or long nocturnal HD reduced cramping, headaches, hypotension, shortness of breath and other common dialysis symptoms and improved SF-36 scores in patients switched from standard in-center HD.
  • Goal-setting.[5] An intervention with interdisciplinary collaboration and support, significantly improved two PCS domains.
  • Help with coping. Adaptation training to help patients cope with the stresses of ESRD significantly improved SF-36 scores vs. usual care,[6] as did group psychosocial counseling.[7]
  • Exercise training. Exercise programs have significantly improved exercise duration and peak workload, reduced depression, and improved both PCS and MCS on the KDQOL-36 in people on standard in-center HD[8][9][10][11][12] and peritoneal dialysis.[13]
  • Use of intravenous iron. Compared to oral iron in 75 non-dialysis CKD patients, IV iron use was associated with significant increases in hemoglobin levels and KDQOL scores.
  • Anemia treatment. Significant improvements in SF-36 scores were found in dialysis patients whose anemia was treated with ESAs[14] or IV (vs. oral) iron.[15]
  • Echocardiogram adjustment of dry weight.[16] Reaching ideal dry weight as measured by the size of the inferior vena cava (n=68) was associated with SF-36 score improvements compared to usual care (n=51).
  • Improving bone mineral metabolism.[17] Compared to placebo, use of cinacalcet to reduce parathyroid hormone levels was associated with significantly lower risk of parathyroidectomy, hospitalization for cardiac reasons, fracture, and significantly higher PCS scores on the KDQOL.
  • Treatment of Restless Legs Syndrome with Gabapentin.[18] Treatment with gabapentin significantly relieved RLS symptoms and improved several subscales of the SF-36.
  • Treatment of carnitine deficiency with carnitine.[19] Patients randomized to receive carnitine for 24 weeks showed significant SF-36 score improvements over placebo.


  1. ^ Bro S, Bjorner JB, Tofte-Jensen P, Klem S, Almtoft B, Danielsen H, Meincke M, Friedberg M, Feldt-Rasmussen B. A prospective, randomized multicenter study comparing APD and CAPD treatment. Perit Dial Int. 1999 Nov-Dec;19(6):526-33
  2. ^ Guo A, Wolfson M, Holt R. Early quality of life benefits of icodextrin in peritoneal dialysis. Kidney Int Suppl. 2002 Oct;(81):S72-9
  3. ^ Heidenheim AP, Muirhead N, Moist L, Lindsay RM. Patient quality of life on quotidian hemodialysis. Am J Kidney Dis. 2003 Jul;42(1 Suppl):36-41.
  4. ^ Ting GO, Kjellstrand C, Freitas T, Carrie BJ, Zarghamee S. Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis. Am J Kidney Dis. 2003 Nov;42(5):1020-35.
  5. ^ Callahan MB, LeSage L, Johnstone S. A model for patient participation in quality of life measurement to improve rehabilitation outcomes. Nephrol News Issues. 1999 Jan;13(1):33-7
  6. ^ Tsay SL, Lee YC, Lee YC. Effects of an adaptation training programme for patients with end-stage renal disease. J Adv Nurs. 2005 Apr;50(1):39-46
  7. ^ Lii YC, Tsay SL, Wang TJ. Group intervention to improve quality of life in haemodialysis patients. J Clin Nurs. 2007 Nov;16(11C):268-75
  8. ^ Levendoglu F, Altintepe L, Okudan N, Ugurlu H, Gokbel H, Tonbul Z, Guney I, Turk S. A twelve week exercise program improves the psychological status, quality of life and work capacity in hemodialysis patients. J Nephrol. 2004 Nov-Dec;17(6):826-32
  9. ^ Painter P, Moore G, Carlson L, Paul S, Myll J, Phillips W, Haskell W. Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life. Am J Kidney Dis. 2002 Feb;39(2):257-65
  10. ^ Painter P, Carlson L, Carey S, Paul SM, Myll J. Low-functioning hemodialysis patients improve with exercise training. Am. J. Kidney Dis. 2000 Sep;36(3):600-8
  11. ^ Tawney KW, Tawney PJ, Hladik G, Hogan SL, Falk RJ, Weaver C, Moore DT, Lee MY. The life readiness program: a physical rehabilitation program for patients on hemodialysis. Am J Kidney Dis. 2000 Sep;36(3):581-91
  12. ^ Molsted S, Eidemak I, Sorensen HT, Kristensen JH. Five months of physical exercise in hemodialysis patients: effects on aerobic capacity, physical function and self-rated health. Nephron Clin Pract. 2004;96(3):c76-81
  13. ^ Lo CY, Li L, Lo WK, Chan ML, So E, Tang S, Yuen MC, Cheng IK, Chan TM. Benefits of exercise training in patients on continuous ambulatory peritoneal dialysis. Am J Kidney Dis. 1998 Dec;32(6):1011-8
  14. ^ Beusterien KM, Nissenson AR, Port FK, Kelly M, Steinwald B, Ware JE. The effects of recombinant human erythropoietin on functional health and well-being in chronic dialysis patients. J Am Soc Nephrol. 1996 May;7(5):763-73
  15. ^ Agarwal R, Rizkala AR, Bastani B, Kaskas MO, Leehey DJ, Besarab A. A randomized controlled trial of oral versus intravenous iron in chronic kidney disease. Am J Nephrol. 2006;26(5):445-54.
  16. ^ Chang ST, Chen CL, Chen CC, Lin FC, Wu D. Enhancement of quality of life with adjustment of dry weight by echocardiographic measurement of inferior vena cava diameter in patients undergoing chronic hemodialysis. Nephron Clin Pract. 2004;97(3):c90-7
  17. ^ Cunningham J, Danese M, Olson K, Klassen P, Chertow GM. Effects of the calcimimetic cinacalcet HCl on cardiovascular disease, fracture, and health-related quality of life in secondary hyperparathyroidism. Kidney Int. 2005 Oct;68(4):1793-800
  18. ^ Micozkadioglu H, Ozdemir FN, Kut A, Sezer S, Saatci U, Haberal M. Gabapentin versus levodopa for the treatment of Restless Legs Syndrome in hemodialysis patients: an open-label study. Ren Fail. 2004 Jul;26(4):393-7
  19. ^ Steiber AL, Davis AT, Spry L, Strong J, Buss ML, Ratkiewicz MM, Weatherspoon LJ. Carnitine treatment improved quality-of-life measure in a sample of Midwestern hemodialysis patients. J Parenter Enteral Nutr. 2006 Jan-Feb;30(1):1-5