[3] Since the inception of dialysis in the 1960s and with technological advances, more patients had access to dialysis. In the last decade there has been more of a focus on the burden of dialysis, QOL and survival benefit. This article aims to promote the use of QOL tools and QOL discussion with kidney disease patients throughout their disease trajectory to assist in informed decision-making regarding dialysis decisions and promote research within the renal community. Hospital haemodialysis

patients have reported worse QOL than patients treated with other renal replacement therapy (RRT), particularly transplantation.[1, 4] A number of factors have previously been identified to impact positively on QOL and include timely referral to a nephrologist,[5, beta-catenin mutation selleck products 6] exercise during dialysis[7-9] and optimizing renal anaemia.[10] QOL is also described in the literature as a predictor of mortality and hospitalizations.[11-14] Despite this knowledge, the assessment of QOL is not part of routine dialysis clinical practice in Australia

or New Zealand. Hamilton and Locking-Cusolito[15] found significant positive relationships between dialysis adequacy scores using Kt/V and social/emotional QOL variables using the Kidney Disease Questionnaire. McMahon et al.[10] found no change in physical variables with higher haemoglobins, but significant improvements in psychosocial variables with improved haemoglobins. Poorer physical and mental health scores, poor social support and psychosocial factors and self-reported depression

are all predictors of hospitalization and mortality rates,[11-14] of in addition poorer QOL scores are reported as a better predictor of mortality and hospitalization than serum albumin.[13] The physical dimensions of QOL are known to deteriorate with increasing age; however, studies by Garcia-Mendoza et al.[16] and Rebollo et al.[17] report less loss of QOL over time in the elderly patients compared with the younger patients. Elderly patients may readjust their life or health goals as their health declines. QOL is shown in studies to differ between dialysis modalities. The Broadening Options for Long-term Dialysis in the Elderly (BOLDE) study shows that although haemodialysis patients experience higher illness intrusion, elderly patients experience similar QOL whether on haemodialysis or peritoneal dialysis.[18] It should still be kept in mind that QOL of dialysis patients is still reported to be similar to that of patients living with a terminal malignancy.[19] Renal patients with a high symptom burden often have worse self-reported QOL.[20] Access to evidence-based literature regarding QOL on dialysis is important when presenting patients with the information they need to make a decision regarding RRT; although a QOL tool should not be used as a measure of whether someone should be accepted onto dialysis.