Quality of life at the initiation of maintenance dialysis treatment ± a comparison between the SF-36 and the KDQ questionnaires J.F.R. Neto, M.B. Ferraz, M. Cendoroglo, S. Draibe, L. Yu & R. Sesso Division of Nephrology and Clinical Epidemiolgy Unit, Universidade Federal de Sa Äo Paulo, Escola Paulista de Medicina, Sa Äo Paulo, Brazil Accepted in revised form 21 January 2000 Abstract Objective: To evaluate the construct validity of the Medical Outcomes Study Questionnaire 36-Item Short Form Health Survey (SF-36) and to assess the quality of life of patients with end-stage renal disease (ESRD) at the initiation of maintenance dialysis treatment. Methods: Cross-sectional study. Setting: Eight ambulatory dialysis units in SaÄo Paulo city, Brazil. Study participants: Eighty ESRD patients at the initiation of chronic dialysis program and consecutively accepted for treatment in selected units in 1998. Main outcome measures: Quality of life as measured by the dimensions of the SF-36 questionnaire. The `Kidney Disease Questionnaire' was used in a subgroup of patients to evaluate the validity of the SF-36. Results: Median (range) scores of the SF-36 dimensions (ranging from 0 to 100, higher scores repre- senting better quality of life) were: Physical Function 70 (0±100), Role Limitations due to Physical Problems 25 (0±100), Bodily Pain 62 (0±100), General Health 57 (5±100), Vitality 55 (10±100), Social Function 63 (0±100), Role Limitations due to Emotional Problems 34 (0±100) and Mental Health 68 (0±100). SF-36 dimensions correlated signi®cantly with those of the `Kidney Disease Questionnaire' (correlation coecients ranging from 0.23 to 0.68). Conclusions: The SF-36 was shown to have construct validity when used in patients with ESRD in Brazil. The quality of life of ESRD patients is impaired at the initiation of dialysis treatment and this was clearly evidenced in the Role Limitations due to Physical Function and Emotional Function items. Greater attention should be given to interventions that could improve the quality of life parameters at the initiation of dialysis treatment. Key words: Dialysis, End-stage renal disease, Quality of life, SF-36 Introduction Quality of life has been receiving attention in the last decades as an outcome measure and it has been enthusiastically adopted by physicians, re- searchers, economists, politicians and health administrators. There is no consensus on what constitutes quality of life. Its de®nition usually includes items, such as health status with satis- faction in several domains: e.g., environment, economical resources, relationships, work and leisure time [1, 2]. There are very few data regarding the quality of life of patients with end-stage renal disease (ESRD) in the ®rst days of the dialysis treatment [3]. In this period, patients' health state is more compromised as a consequence of metabolic al- terations, hydro-electrolyte and acid±base unbal- ance that are still under correction process [4, 5]. A better knowledge of aspects related to the quality of life during this period may be important for a more eective management of these patients. The objectives of this study were to verify the construct validity of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) [6±8] in patients with ESRD, and to assess, through this instrument, the quality of life of ESRD patients at the initiation of chronic dialysis treatment. Quality of Life Research 9: 101±107, 2000. Ó 2000 Kluwer Academic Publishers. Printed in the Netherlands. 101