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The Quality of Life of Patients with End-Stage Renal Disease

List of authors.
  • Roger W. Evans, Ph.D.,
  • Diane L. Manninen, Ph.D.,
  • Louis P. Garrison, Jr., Ph.D.,
  • L. Gary Hart, M.S.,
  • Christopher R. Blagg, M.D.,
  • Robert A. Gutman, M.D.,
  • Alan R. Hull, M.D.,
  • and Edmund G. Lowrie, M.D.


We assessed the quality of life of 859 patients undergoing dialysis or transplantation, with the goal of ascertaining whether objective and subjective measures of the quality of life were influenced by case mix or treatment. We found that 79.1 per cent of the transplant recipients were able to function at nearly normal levels, as compared with between 47.5 and 59.1 per cent of the patients treated with dialysis (depending on the type). Nearly 75 per cent of the transplant recipients were able to work, as compared with between 24.7 and 59.3 per cent of the patients undergoing dialysis. On three subjective measures (life satisfaction, well-being, and psychological affect) transplant recipients had a higher quality of life than patients on dialysis. Among the patients treated with dialysis, those undergoing treatment at home had the highest quality of life. All quality-of-life differences were found to persist even after the patient case mix had been controlled statistically. Finally, the quality of life of transplant recipients compared well with that of the general population, but despite favorable subjective assessments, patients undergoing dialysis did not work or function at the same level as people in the general population. (N Engl J Med 1985; 312:553–9.)

Funding and Disclosures

Supported by a grant (95-P-97887/0) from the Health Care Financing Administration.

We are indebted to the medical, nursing, social work, and other staffs at Bishop–Clarkson Memorial Hospital (Omaha, Nebr.), Dallas Kidney Disease Center (Dallas), Dialysis Clinics, Inc. (Nashville), Downstate Medical Center (New York), Eastern Maine Hospital (Bangor, Maine), Indiana University (Indianapolis), The Kidney Center (Boston), Nalle Clinic Kidney Center (Charlotte, N.C.), Northwest Kidney Center (Seattle), Presbyterian Medical Center (Denver), and West Contra Costa Dialysis Clinics (San Pablo, Calif.); to the patients who participated in the study; to Mr. Carl Josephson of the Health Care Financing Administration; and to Ms. Millie Gregory for assistance in preparing the manuscript.

Author Affiliations

From the Health and Population Study Center, Battelle Human Affairs Research Centers, the Northwest Kidney Center, and the Department of Medicine, University of Washington, Seattle; the Center for Health Affairs, Project HOPE, Millwood, Va.; the Department of Medicine, Duke University Medical Center, Durham, N.C.; the Southwestern Dialysis Center, Dallas; and National Medical Care, Inc., Boston. Address reprint requests to Dr. Evans at Battelle Human Affairs Research Centers, Seattle, WA 98105.

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