Ware explains to Nephrology News and Issues how a new CKD-specific QOL measure and computer adaptive tests are more efficient than current methods

Ware J, et al.J Am Soc Nephrol.2019;doi:JASN-2018-08-0814.R3

March 22, 2019

Nephrology News and Issues noted that the current method of measuring patient quality of life using the Kidney Disease Quality of Life-36 scale is less efficient than using a CKD-specific survey; and computerized adaptive tests had proven more effective than static ones, according to a published study.

It also noted that the current method of measuring patient quality of life using the Kidney Disease Quality of Life-36 scale is less efficient than using a CKD-specific survey; and computerized adaptive tests had proven more effective than static ones, according to a published study.

It is noted that current patient-reported outcome measures are not as practical or clinically useful as is needed for patients with CKD. Therefore, researchers analyzed the efficacy of a new CKD-specific quality of life scale against the commonly used kidney disease quality of life-36 (KDQOL-36) measure.

“Despite its widespread use, the KDQOL-36 has disadvantages. In an attempt to be short to reduce overall respondent burden, important CKD-specific domains are omitted,” the authors wrote. “Short forms also may yield scores that are too imprecise for use in individual patient clinical care. In addition, static surveys such as the KDQOL-36 administer the same questions to everyone, including some questions that may be irrelevant to a specific individual. The range of reliable measurement is restricted, limiting the ability to detect score change associated with changes in disease severity or with treatment [effects].”

Three groups of patients (either non-dialysis stages 3 to 5, on dialysis or post-transplant) were included for a total of 145 patients. According to the study, each patient completed the KDQOL-36, SF-12v2, CKD-QOL-6 item static form and the CKD-QOL computer adaptive test (CAT) at baseline and 3 months. Researchers compared baseline results with 3-month outcomes to determine the efficiency and validity of each survey.

Researchers found that KDQOL-36 and CKD-QOL saw more success in determining patient outcomes than the SF-12v2. Two of the relative validity results favored the CKD-QOL over the KDQOL, according to the study. Both static and CAT surveys were comparable in determining CKD outcomes. The physical domain scores of the SF-12v2 survey, as well as the symptoms domain scores of the KDQOL-36, worsened as the number of comorbid conditions increased.

Nephrology News & Issues corresponded with John E. Ware Jr., PhD, chief science officer and chair of John Ware Research Group Inc. and co-author of this study. Ware explained the clinical significance of the research

“Study results showed that new fixed-length and computerized adaptive patient-based surveys can quickly provide improved information about health-related quality of life that is more specific to kidney disease,” Ware said. “Across multiple clinical tests, the new approach better captured group differences in treatment status and severity at a point in time and better responded to changes in severity of CKD over time, in comparison with currently used KDQOL-36 general and CKD-specific surveys.”

“What this means for clinical practice is that information about health-related quality of life, an outcome of great if not greatest importance to patients, can be efficiently captured in a way that is kidney-specific enough to inform the care of individual patients with CKD,” he said.

Ware said that while study participants were representative of their respective populations, further study is needed using a larger and more diversified samples.

“Although some specific symptoms and other effects measured by currently used KDQOL-36 scales are conceptually not quality of life, we still expected those scales to discriminate better than they did across the different clinically defined CKD comparison groups,” Ware said. “In addition, the better performance of the shortest computerized adaptive version of the new quality of life measurement approach in every CKD-specific test was a surprise and speaks to the clinical value of improved quality of life information.” – by Scott Buzby

Disclosures: Ware reports grants from NIH and from Amgen Foundation during the conduct of the study and support from John Ware Research Group, and being developer and original copyright holder of generic measures used in KDQOL-36 and developer of new CKD-specific measures studied and copyright holder of improved measures developed subsequently. All other authors reported no relevant financial disclosures.