Validation of the English Version of the Kidney Disease Quality of Life Questionnaire (KDQOL-36) in Haemodialysis Patients in Singapore

  • Fan Yang
  • Vivian Wei Wang
  • Veena Dhananjay Joshi
  • Titus Wai Leong Lau
  • Nan LuoEmail author
Original Research Article



To validate a widely used health outcomes instrument for patients with chronic kidney disease and on dialysis, the Kidney Disease Quality of Life questionnaire (KDQOL-36), in English-speaking haemodialysis patients in Singapore.


This study is a secondary data analysis using the KDQOL-SF (version 1.3) data collected from a cross-sectional survey of haemodialysis patients in Singapore. Cronbach’s α was used to test internal consistency reliability. Multi-item scales were assessed using item-to-scale correlation and factor analysis. Both confirmatory and exploratory factor analyses were performed separately for generic and disease-targeted scales. Construct validity was assessed by correlation between disease-targeted and generic scales. Criterion validity was assessed by correlation of the physical component summary (PCS-12) and mental component summary (MCS-12) from KDQOL-36 with the corresponding PCS-36 and MCS-36 from the KDQOL-SF.


Three hundred ninety-four patients who completed the interviews in English [male 55.8 %, mean age (SD) 52.4 (11.7) years] were involved. Kidney disease scales exhibited desirable internal consistency (Cronbach’s α 0.822–0.906) and item-to-scale correlation (range 0.763–0.903), and a three-factor model fit the data well [comparative fit index (CFI) 0.934, root mean square error of approximation (RMSEA) 0.085]. For the generic Short Form 12 Health Survey (SF-12) items, a two-factor model (physical and mental) showed poor overall fit, but a three-factor structure (role, physical and mental functions) achieved good model fit (CFI 0.999, RMSEA 0.027). Correlation between disease-targeted and generic scales was weak to moderate (range 0.286–0.418). Correlation between SF-12 and SF-36 was 0.750 for PCS and 0.797 for MCS.


The English version of the KDQOL-36 appears to be reliable and valid to measure quality of life for haemodialysis patients in Singapore.


Exploratory Factor Analysis Haemodialysis Patient Physical Component Summary Mental Component Summary ESRD Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We would like to thank the Center for Health Services Research, Singapore Health Services, for sharing the data with us.

Authors’ contributions

Ms. Fan Yang and Dr. Nan Luo designed the study, did the data analysis and interpretation, and drafted the manuscript. Ms. Vivian Wei Wang, Dr. Veena Joshi and Dr. Titus Lau provided intellectual content of critical importance to the paper. All authors read and approved the final manuscript.

Conflict of interest

All authors (Ms. Fan Yang, Ms. Vivian Wei Wang, Dr. Veena Joshi, Dr. Titus Lau and Dr. Nan Luo) declare that they have no competing interests.


  1. 1.
    Moeller S, Gioberge S, Brown G. ESRD patients in 2001: global overview of patients, treatment modalities and development trends. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc. 2002;17(12):2071–6.Google Scholar
  2. 2.
    Schieppati A, Remuzzi G. Chronic renal diseases as a public health problem: epidemiology, social, and economic implications. Kidney Int Suppl. 2005;98:S7–10.CrossRefGoogle Scholar
  3. 3.
    Choong HL. Seventh report of the Singapore Renal Registry 2007/2008.
  4. 4.
    Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB. Development of the kidney disease quality of life (KDQOL) instrument. Qual Life Res Int J Qual Life Aspects Treat Care Rehabil. 1994;3(5):329–38.CrossRefGoogle Scholar
  5. 5.
    Walters BAJ, Hays RD, Spritzer KL, Fridman M, Carte WB. Health-related quality of life, depressive symptoms, anemia, and malnutrition at hemodialysis initiation. Am J Kidney Dis. 2002;40(6):1185–94.CrossRefGoogle Scholar
  6. 6.
    The KDQOL Working Group.
  7. 7.
    Carmichael P, Popoola J, John I, Stevens PE, Carmichael AR. Assessment of quality of life in a single centre dialysis population using the KDQOL-SF (TM) questionnaire. Qual Life Res. 2000;9(2):195–205.CrossRefGoogle Scholar
  8. 8.
    Saban KL, Bryant FB, Reda DJ, Stroupe KT, Hynes DM. Measurement invariance of the kidney disease and quality of life instrument (KDQOL-SF) across veterans and non-veterans. Health Qual Life Outcomes. 2010;8:120.CrossRefGoogle Scholar
  9. 9.
    Braga SF, Peixoto SV, Gomes IC, de Assis Acurcio F, Andrade EI, Cherchiglia ML. Factors associated with health-related quality of life in elderly patients on hemodialysis. Rev Saude Publica. 2011;45(6):1127–36.CrossRefGoogle Scholar
  10. 10.
    Veerappan I, Arvind RM, Ilayabharthi V. Predictors of quality of life of hemodialysis patients in India. Indian J Nephrol. 2012;22(1):18–25.CrossRefGoogle Scholar
  11. 11.
    Gorodetskaya I, Zenios S, McCulloch CE, Bostrom A, Hsu CY, Bindman AB, Go AS, Chertow GM. Health-related quality of life and estimates of utility in chronic kidney disease. Kidney Int. 2005;68(6):2801–8.CrossRefGoogle Scholar
  12. 12.
    Joshi VD, Mooppil N, Lim JF. Validation of the kidney disease quality of life-short form: a cross-sectional study of a dialysis-targeted health measure in Singapore. BMC Nephrol. 2010;11:36.CrossRefGoogle Scholar
  13. 13.
    Cheung YB, Seow YY, Qu LM, Yee AC. Measurement properties of the Chinese version of the Kidney Disease Quality of Life-Short Form (KDQOL-SF) in end-stage renal disease patients with poor prognosis in Singapore. J Pain Symptom Manag. 2012;13:13.Google Scholar
  14. 14.
    Nunnally JC, Bernstein IH. Psychometric theory. 3rd edn. New York: McGraw-Hill; 1994.Google Scholar
  15. 15.
    Ware JE Jr, Gandek B. Methods for testing data quality, scaling assumptions, and reliability: the IQOLA Project approach. International Quality of Life Assessment. J Clin Epidemiol. 1998;51(11):945–52.CrossRefGoogle Scholar
  16. 16.
    Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.CrossRefGoogle Scholar
  17. 17.
    Hays RD, Kallich J, Mapes DL, Coons SJ, Amin N, Carter WB, Kamberg C. Kidney Disease Quality of Life Short Form (KDQOL-SF) version 1.3: a manual for use and scoring. 1997.Google Scholar
  18. 18.
    Kline RB. Principles and practice of structure equation modeling. 2nd edn. New York: Guilford; 2005.Google Scholar
  19. 19.
    Chen FN, Curran PJ, Bollen KA, Kirby J, Paxton P. An empirical evaluation of the use of fixed cutoff points in RMSEA test statistic in structural equation models. Sociol Method Res. 2008;36(4):462–94.CrossRefGoogle Scholar
  20. 20.
    UCLA Academic Technology Services/Stat Computing.
  21. 21.
    Ware JE, Kosinski M, Keller SD. SF-12: how to score the SF-12 physical and mental health summary scales. 3rd edn: Lincoln: QualityMetric Incorporated; 1998.Google Scholar
  22. 22.
    Pakpour AH, Yekaninejad M, Molsted S, Harrison AP, Hashemi F, Saffari M. Translation, cultural adaptation assessment, and both validity and reliability testing of the Kidney Disease Quality of Life—Short Form version 1.3 for use with Iranian patients. Nephrology. 2011;16(1):106–12.CrossRefGoogle Scholar
  23. 23.
    Park HJ, Kim S, Yong JS, Han SS, Yang DH, Meguro M, Han CW, Kohzuki M. Reliability and validity of the Korean version of Kidney Disease Quality of Life instrument (KDQOL-SF). Tohoku J Exp Med. 2007;211(4):321–9.CrossRefGoogle Scholar
  24. 24.
    Ren XS, Kazis LE, Lee A, Rogers WH. The role of generic and disease-specific measures of physical and role functioning in assessing patient outcomes: a longitudinal study. J Ambul Care Manag. 2005;28(2):157–66.CrossRefGoogle Scholar
  25. 25.
    Korevaar JC, Merkus MP, Jansen MA, Dekker FW, Boeschoten EW, Krediet RT. Validation of the KDQOL-SF: a dialysis-targeted health measure. Qual Life Res Int J Qual Life Aspects Treat Care Rehabil. 2002;11(5):437–47.CrossRefGoogle Scholar
  26. 26.
    Montazeri A, Vahdaninia M, Mousavi SJ, Omidvari S. The Iranian version of 12-item Short Form Health Survey (SF-12): factor structure, internal consistency and construct validity. BMC Public Health. 2009;9:341.CrossRefGoogle Scholar
  27. 27.
    Wee CC, Davis RB, Hamel MB. Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health Qual Life Outcomes. 2008;6:11.CrossRefGoogle Scholar
  28. 28.
    Failde I, Medina P, Ramirez C, Arana R. Construct and criterion validity of the SF-12 health questionnaire in patients with acute myocardial infarction and unstable angina. J Eval Clin Pract. 2010;16(3):569–73.PubMedGoogle Scholar
  29. 29.
    Suzukamo Y, Fukuhara S, Green J, Kosinski M, Gandek B, Ware JE. Validation testing of a three-component model of Short Form-36 scores. J Clin Epidemiol. 2011;64(3):301–8.CrossRefGoogle Scholar
  30. 30.
    Thumboo J, Fong KY, Machin D, Chan SP, Leon KH, Feng PH, Thio ST, Boe ML. A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore. Qual Life Res Int J Qual Life Aspects Treat Care Rehabil. 2001;10(2):175–88.CrossRefGoogle Scholar
  31. 31.
    Fuh JL, Wang SJ, Lu SR, Juang KD, Lee SJ. Psychometric evaluation of a Chinese (Taiwanese) version of the SF-36 health survey amongst middle-aged women from a rural community. Qual Life Res Int J Qual Life Aspects Treat Care Rehabil. 2000;9(6):675–83.CrossRefGoogle Scholar
  32. 32.
    Yu J, Coons SJ, Draugalis JR, Ren XS, Hays RD. Equivalence of Chinese and US-English versions of the SF-36 health survey. Qual Life Res Int J Qual Life Aspects Treat Care Rehabil. 2003;12(4):449–57.CrossRefGoogle Scholar
  33. 33.
    Ware JE Jr. Conceptualization and measurement of health-related quality of life: comments on an evolving field. Arch Phys Med Rehabil. 2003;84(4 Suppl 2):S43–51.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Fan Yang
    • 1
  • Vivian Wei Wang
    • 2
  • Veena Dhananjay Joshi
    • 2
  • Titus Wai Leong Lau
    • 3
  • Nan Luo
    • 1
    Email author
  1. 1.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
  2. 2.Center for Health Services ResearchSingapore Health ServicesSingaporeSingapore
  3. 3.Division of NephrologyUniversity Medicine Cluster, National University Health SystemSingaporeSingapore

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