Quality of Life Research

, Volume 18, Issue 9, pp 1185–1193 | Cite as

Factors associated with health-related quality of life after successful kidney transplantation: a population-based study

  • Maristela BohlkeEmail author
  • Stela S. Marini
  • Marcos Rocha
  • Lisoneide Terhorst
  • Rafael H. Gomes
  • Franklin C. Barcellos
  • Maria Claudia C. Irigoyen
  • Ricardo Sesso



Kidney transplantation improves the quality of life of end-stage renal disease patients. The quality of life benefits, however, pertain to patients on average, not to all transplant recipients. The aim of this study was to identify factors associated with health-related quality of life after kidney transplantation.


Population-based study with a cross-sectional design was carried out and quality of life was assessed by SF-36 Health Survey Version 1. A multivariate linear regression model was constructed with sociodemographic, clinical and laboratory data as independent variables.


Two hundred and seventy-two kidney recipients with a functioning graft were analyzed. Hypertension, diabetes, higher serum creatinine and lower hematocrit were independently and significantly associated with lower scores for the SF-36 oblique physical component summary (PCSc). The final regression model explained 11% of the PCSc variance. The scores of oblique mental component summary (MCSc) were worse for females, patients with a lower income, unemployed and patients with a higher serum creatinine. The regression model explained 9% of the MCSc variance.


Among the studied variables, comorbidity and graft function were the main factors associated with the PCSc, and sociodemographic variables and graft function were the main determinants of MCSc. Despite comprehensive, the final regression models explained only a little part of the heath-related quality of life variance. Additional factors, such as personal, environmental and clinical ones might influence quality of life perceived by the patients after kidney transplantation.


Health-related quality of life Kidney transplantation Population-based study Outcome 


  1. 1.
    Laupacis, A., Keown, P., Pus, N., Krueger, H., Ferguson, B., Wong, C., et al. (1996). A study of quality of life and cost-utility of renal transplantation. Kidney International, 50, 235–242.PubMedCrossRefGoogle Scholar
  2. 2.
    Sesso, R., Eisenberg, J. M., Stabile, C., Draibe, S., Ajzen, H., & Ramos, O. (1990). Cost-effectiveness analysis of the treatment of end-stage renal disease in Brazil. International Journal of Technology Assessment in Health Care, 6(1), 107–114.PubMedCrossRefGoogle Scholar
  3. 3.
    Evans, R. W., & Kitzmann, D. J. (1998). An economic analysis of kidney transplantation. Surgical Clinics of North America, 78, 149–174.PubMedCrossRefGoogle Scholar
  4. 4.
    Wolfe, R. A., Ashby, V. B., & Milford, E. L. (1999). Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. New England Journal of Medicine, 341, 1725–1730.PubMedCrossRefGoogle Scholar
  5. 5.
    Dew, M. A., Switzer, G. E., Goycoolea, J. M., Allen, A. S., DiMartini, A., Kormos, R. L., et al. (1997). Does transplantation produce quality of life benefits: A quantitative analysis of the literature. Transplantation, 64(9), 1261–1273.PubMedCrossRefGoogle Scholar
  6. 6.
    Jofre, R., Lopez-Gomez, J. M., Moreno, F., Sanz-Guajardo, D., & Valderrabano, F. (1998). Changes in quality of life after renal transplantation. American Journal of Kidney Diseases, 32, 93–100.PubMedCrossRefGoogle Scholar
  7. 7.
    Evans, R. W., Manninen, D. L., Garrison, L. P., Jr., et al. (1985). The quality of life of patients with end-stage renal disease. New England Journal of Medicine, 312, 553–559.PubMedCrossRefGoogle Scholar
  8. 8.
    Liem, Y. S., Bosch, J. L., Arends, L. R., Heijenbrok-Kal, M. H., & Hinink, M. G. M. (2007). Quality of life assessed with the medical outcomes study short form 36-item health survey of patients on renal replacement therapy: A systematic review and meta-analysis. Value in Health, 10(5), 390–397.PubMedCrossRefGoogle Scholar
  9. 9.
    Van der Mei, S. F., Krol, B., Van Son, W. J., Jong, P. E., Groothoff, J. W., & Van den Heuvel, W. J. A. (2006). Social participation and employment status after kidney transplantation: A systematic review. Quality of Life Research, 15, 979–994.PubMedCrossRefGoogle Scholar
  10. 10.
    Rebollo, P., Ortega, F., Baltar, J. M., et al. (2000). Health-related quality of life (HRQoL) of kidney transplant patients: Variables that influence it. Clinical Transplantation, 14, 199–207.PubMedCrossRefGoogle Scholar
  11. 11.
    Rebollo, P., Gonzalez, M. P., Bobes, J., Saiz, P., & Ortega, F. (2000). Interpretación de los resultados de la calidad de vida relacionada con la salud de pacientes en terapia substitutiva de la insuficiencia renal terminal. Nefrologia, 20, 431–439.PubMedGoogle Scholar
  12. 12.
    Zimmermann, P. R., Poli de Figueiredo, C. E., & Fonseca, N. A. (2001). Depression, anxiety and adjustment in renal replacement therapy: A quality of life assessment. Clinical Nephrology, 56(5), 387–390.PubMedGoogle Scholar
  13. 13.
    Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Mahwah, NJ: Lawrence Earlbaum Associates.Google Scholar
  14. 14.
    Ciconelli, R. M., Ferraz, M. B., Santos, W., Meinão, I., & Quaresma, M. R. (1999). Brazilian-Portuguese version of the SF-36. A reliable and valid quality of life outcome measure. Revista Brasileira De Reumatologia, 39, 143–150.Google Scholar
  15. 15.
    Farivar, S. S., Cunningham, W. E., & Hays, R. D. (2007). Correlated physical and mental health summary scores for the SF-36 and SF-12 health survey, V.1. Health and Quality of Life Outcomes, 5, 54.PubMedCrossRefGoogle Scholar
  16. 16.
    Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression. New York: Wiley.CrossRefGoogle Scholar
  17. 17.
    Butt, Z., Yount, S. E., Caicedo, J. C., Abecassis, M. M., & Cella D. (2008). Quality of life assessment in renal transplant: Review and future directions. Clinical Transplantation, 22(3), 292–303.PubMedGoogle Scholar
  18. 18.
    Reimer, J., Franke, G. H., Philipp, T., & Heemann, U. (2002). Quality of life in kidney recipients: Comparison of tacrolimus and cyclosporine-micro emulsion. Clinical Transplantation, 16, 48–54.PubMedCrossRefGoogle Scholar
  19. 19.
    Oberbauer, R., Hutchison, B., Eris, J., Arias, M., Claesson, K., Mota, A., et al. (2003). Health-related quality-of-life outcomes of sirolimus-treated kidney transplant patients after elimination of cyclosporin A: Results of a 2-year randomized clinical trial. Transplantation, 75, 1277–1285.PubMedCrossRefGoogle Scholar
  20. 20.
    Ware, J. E., Kosinski, M., & Keller, S. D. (1994). SF-36 physical and mental health summary scales: A user’s manual. Boston, MA: The Health Institute.Google Scholar
  21. 21.
    Wight, J. P., Edwards, L., & Brazier, J. (1998). The SF36 as an outcome measure of services for end stage renal failure. Quality in Health Care, 7, 209–221.PubMedCrossRefGoogle Scholar
  22. 22.
    Griva, K., Ziegelmann, J., & Thompson, D. (2002). Quality of life and emotional responses in cadaver and living related renal transplant recipients. Nephrology, Dialysis, Transplantation, 17, 2204–2211.PubMedCrossRefGoogle Scholar
  23. 23.
    Hathaway, D. K., Winsett, R. P., & Johnson, C. (1998). Post kidney transplant quality of life prediction models. Clinical Transplantation, 12, 168–174.PubMedGoogle Scholar
  24. 24.
    Chiu, S. F. A., Wong, H. S., Morad, Z., & Loo, L. H. (2004). Quality of life in cadaver and living-related renal transplant recipient in Kuala Lumpur Hospital. Transplantation Proceedings, 36, 2030–2031.PubMedCrossRefGoogle Scholar
  25. 25.
    Julius, M., Hawthorne, V. M., & Carpentier Alting, P. (1989). Independence in activities of daily living for end-stage renal patients: Biomedical and demographic correlates. American Journal of Kidney Diseases, 13, 61–69.PubMedGoogle Scholar
  26. 26.
    Khedmat, H., Karami, G. R., Pourfarziani, V., Assari, S., Rezailashkajani, M., & Naghizadeh, M. M. (2007). A logistic regression model for predicting health-related quality of life in kidney transplant recipients. Transplantation Proceedings, 39, 917–922.PubMedCrossRefGoogle Scholar
  27. 27.
    Matas, A. J., Halbert, R. J., Barr, M. L., Helderman, J. H., Hricik, D. E., Pirsch, J. D., et al. (2002). Life satisfaction and adverse effects in renal transplant recipients: A longitudinal analysis. Clinical Transplantation, 16, 113–121.PubMedCrossRefGoogle Scholar
  28. 28.
    Rosenberger, J., van Dijk, J. P., Nagyova, I., Zezula, I., Geckova, A. M., Roland, R., et al. (2006). Predictors of perceived health status in patients after kidney transplantation. Transplantation, 81, 1306–1310.PubMedCrossRefGoogle Scholar
  29. 29.
    Rosenberger, J., van Dijk, J. P., Nagyova, I., Roland, R., Geckova, A. M., van den Heuvel, W. J. A., et al. (2005). Do dialysis and transplantation related medical factors affect perceived health status? Nephrology, Dialysis, Transplantation, 20(10), 2153–2158.PubMedCrossRefGoogle Scholar
  30. 30.
    Baiardi, F., Degli, E. E., Cocchi, R., Fabbri, A., Sturani, A., Valpiani, G., et al. (2002). Effects of clinical and individual variables on quality of life in chronic renal failure patients. Journal of Nephrology, 15(1), 61–67.PubMedGoogle Scholar
  31. 31.
    Kasiske, B. L., Snyder, J. J., Gilbertson, D., & Matas, A. J. (2003). Diabetes mellitus after kidney transplantation in the United States. American Journal of Transplantation, 3, 178–185.PubMedCrossRefGoogle Scholar
  32. 32.
    Winkelmayer, W. C., Kewalramani, R., Rutstein, M., Gabardi, S., Vonvisger, T., & Chandraker, A. (2004). Pharmacoepidemiology of anemia in kidney transplant recipients. Journal of the American Society of Nephrology, 15, 1347–1352.PubMedCrossRefGoogle Scholar
  33. 33.
    Muehrer, R. J., & Becker, B. N. (2005). Life after transplantation: New transitions in quality of life and psychological distress. Seminars in Dialysis, 18, 124–131.PubMedCrossRefGoogle Scholar
  34. 34.
    Keogh, A. M., & Feehally, J. (1999). A quantitative study comparing adjustment and acceptance of illness in adults on renal replacement therapy. ANNA Journal, 26, 471–477.PubMedGoogle Scholar
  35. 35.
    Fujisawa, M., Ichikawa, Y., Yoshiya, K., Isotani, S., Higuchi, A., Nagano, S., et al. (2000). Assessment of health-related quality of life in renal transplant and hemodialysis patients using the SF-36 Health Survey. Urology, 56, 201–206.PubMedCrossRefGoogle Scholar
  36. 36.
    Saracino, A., Gollo, I., Di Noia, I., Caldone, M. G., Santarsia, G., Procida, C., et al. (2008). Loss of renal function is associated with deterioration of health-related quality of life in kidney transplant patients. Transplantation Proceedings, 40, 3460–3465.PubMedCrossRefGoogle Scholar
  37. 37.
    Lubetkin, E. I., Jia, H., Franks, P., & Gold, M. R. (2005). Relationship among sociodemographic factors, clinical conditions, and health-related quality of life: Examining the EQ-5D in the US general population. Quality of Life Research, 14, 2187–2196.PubMedCrossRefGoogle Scholar
  38. 38.
    Johnson, C. D., Wicks, M. N., Milstead, J., Hartwig, M., & Hathaway, D. K. (1998). Racial and gender differences in quality of life following kidney transplantation. Journal of Nursing Scholarship, 30, 125–130.CrossRefGoogle Scholar
  39. 39.
    Muennig, P., Franks, P., Jia, H., Lubetkin, E., & Gold, M. (2005). The income-associated burden of disease in the United States. Social Science and Medicine, 61, 2018–2026.PubMedCrossRefGoogle Scholar
  40. 40.
    Krupski, T., Fink, A., Kwan, L., et al. (2005). Health-related quality of life in low-income, uninsured men with prostate cancer. Journal of Health Care for the Poor and Underserved, 16, 375–390.PubMedCrossRefGoogle Scholar
  41. 41.
    Hann, D., Jacobsen, P., Martin, S., Kronish, L., Azzarello, L., & Fields, K. (1997). Quality of life following bone marrow transplantation for breast cancer: A comparative study. Bone Marrow Transplantation, 19, 257–264.PubMedCrossRefGoogle Scholar
  42. 42.
    Short, P., & Mallonee, E. (2006). Income disparities in the quality of life of cancer survivors. Medical Care, 44, 16–23.PubMedCrossRefGoogle Scholar
  43. 43.
    McCabe, M., & de Judicibus, M. (2005). The effects of economic disadvantage on psychological well-being and quality of life among people with multiple sclerosis. Journal of Health Psychology, 10, 163–173.CrossRefGoogle Scholar
  44. 44.
    Wubben, D., & Porterfield, D. (2005). Health-related quality of life among North Carolina adults with diabetes mellitus. North Carolina Medical Journal, 66, 179–185.PubMedGoogle Scholar
  45. 45.
    Sesso, R., Rodrigues-Neto, J. F., & Ferraz, M. B. (2003). Impact of socioeconomic status on the quality of life of end-stage renal disease patients. American Journal of Kidney Diseases, 41(1), 186–195.PubMedCrossRefGoogle Scholar
  46. 46.
    Grady, K., Naftel, D., White-Williams, C., et al. (2005). Predictors of quality of life at 5–6 years after heart transplantation. Journal of Heart and Lung Transplantation, 24, 1431.PubMedCrossRefGoogle Scholar
  47. 47. [homepage na Internet]. Nashville: Vanderbilt University Medical Center; c 2004 [atualizada em 2005 Feb 02; acesso em 2008 Jan 10]. Available at:
  48. 48.
    Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473–483.PubMedCrossRefGoogle Scholar
  49. 49.
    Seršić, D. M., & Vuletić, G. (2006). Psychometric evaluation and establishing norms of croatian SF-36 health survey: Framework for subjective health research. Croatian Medical Journal, 47(1), 95–102.Google Scholar
  50. 50.
    Behavioral Epidemiology Unit. South Australian population norms for the Short Form 36 (SF-36) Health Status Questionnaire. Adelaide, South Australian Health Commission, August 1995.Google Scholar
  51. 51.
    Aaronson, N. K., Muller, M., Cohen, P. D., Essink-Bot, M. L., Fekkes, M., Sanderman, R., et al. (1998). Translation, validation, and norming of the Dutch language version of the SF-36 health survey in community and chronic disease populations. Journal of Clinical Epidemiology, 51, 1055–1068.PubMedCrossRefGoogle Scholar
  52. 52.
    Apolone, G., & Mosconi, P. (1998). The Italian SF-36 health survey: Translation, validation and norming. Journal of Clinical Epidemiology, 51, 1025–1036.PubMedCrossRefGoogle Scholar
  53. 53.
    Leplege, A., Ecosse, E., Verdier, A., & Perneger, T. V. (1998). The French SF-36 health survey: Translation, cultural adaptation and preliminary psychometric evaluation. Journal of Clinical Epidemiology, 51, 1013–1023.PubMedCrossRefGoogle Scholar
  54. 54.
    Bjorner, J. B., Kreiner, S., Ware, J. E., Damsgaard, M. T., & Bech, P. (1998). Differential item functioning in the Danish translation of the SF-36. Journal of Clinical Epidemiology, 51, 1189–1202.PubMedCrossRefGoogle Scholar
  55. 55.
    Phipps, S. (2003). The impact of poverty on health. Ottawa: Canadian Institute for Health Information.Google Scholar
  56. 56.
    Russ, G., Jamieson, N., Oberbauer, R., Arias, M., Murgia, M. G., Blancho, G., et al. (2007). Three-year health-related quality-of-life outcomes for sirolimus-treated kidney transplant patients after elimination of cyclosporine. Transplant International, 20(10), 875–883.PubMedCrossRefGoogle Scholar
  57. 57.
    Chambers, E. S., Bridge, M. W., & Jones, D. A. (2009). Carbohydrate sensing in the human mouth: Effects on exercise performance and brain activity. Journal of Physiology, 587, 1779–1794.PubMedCrossRefGoogle Scholar
  58. 58.
    Unruh, M. L., Weisbord, S. D., & Kimmel, P. L. (2005). Health-related quality of life in nephrology research and clinical practice. Seminars in Dialysis, 18(2), 82–90.PubMedCrossRefGoogle Scholar
  59. 59.
    Ortega, F., Valdés, C., & Ortega, T. (2007). Quality of life after solid organ transplantation. Transplantation Reviews, 21, 155–170.CrossRefGoogle Scholar
  60. 60.
    Diaz-Buxo, J. A., Lowrie, E. G., Lew, N. L., Zhang, H., & Lazarus, J. M. (2000). Quality of life evaluation using short form 36: Comparison in hemodialysis and peritoneal dialysis patients. American Journal of Kidney Diseases, 35, 293–300.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Maristela Bohlke
    • 1
    Email author
  • Stela S. Marini
    • 1
  • Marcos Rocha
    • 1
  • Lisoneide Terhorst
    • 1
  • Rafael H. Gomes
    • 1
  • Franklin C. Barcellos
    • 1
  • Maria Claudia C. Irigoyen
    • 2
    • 3
  • Ricardo Sesso
    • 3
  1. 1.Universidade Católica de PelotasPelotasBrazil
  2. 2.Heart InstituteUniversity of São PauloSão PauloBrazil
  3. 3.Federal University of São PauloSão PauloBrazil

Personalised recommendations