[Audit on quality of life of patients with chronic kidney disease on dialysis and after transplant]

Since the improvement of quality of life (QOL) in patients with chronic disease on dialysis (D-CKD) has been demonstrated to have significant effects on clinical outcome, QOL has been included among the principal targets for these patients. QOL is among the objectives of the Healthy People 2010 program of the United Nations and CKD is one of the 18 focus areas of the program. The process of improving clinical outcome for D-CKD patients is obviously correlated with the continuing attempts to improve the adequacy of dialysis, and this remains a milestone. Some recent studies, including the HEMO study, have demonstrated that the present standards for dialytic efficiency are adequate for morbidity and mortality outcomes. However, these concepts are rapidly evolving and there are emerging factors which should be monitored, such as a) frequency of hospitalization, b) QOL, c) patient's satisfaction, and d) transplantation rate. Each aspect should be taken into consideration when the general well-being of D-CKD patients is at stake. However, there is a lack of validated standards, and there are confounding effects related to different geographical areas, different degrees of morbidity, and different therapies. Health is defined by the WHO as the complete feeling of well-being, and transplantation obviously is a way to overcome the many difficulties encountered by D-CKD patients. It is true that QOL after transplant is affected by uncertainty about the final result, fear of having to go back on dialysis, or anger about unexpected complications. For these reasons special questionnaires have been designed for transplanted patients (e.g., SF-36). These indicate an improvement of QOL for transplanted compared with D-CKD patients, although QOL remains below the level of that of the healthy population. Post-transplant QOL tends to improve over time and will become superimposable to that of the healthy population in the long run. It is of paramount importance that each dialysis and transplantation center provide psychological support not only to patients but also to doctors and nurses.