Keywords
Kidney Transplantation
Transplant Recipients
Self-Concept
Renal Insufficiency
Post-transplant outcomes
Health-related quality of life
Data Availability Statement
The data supporting the findings of this study are available from the corresponding author upon reasonable request.
How to Cite
Abstract
Objective: To assess health-related quality of life and the associations between selected quality-of-life domains among kidney transplant recipients in Astana, Kazakhstan. Methods: A cross-sectional study was conducted involving 31 kidney transplant recipients from 2022 to 2024. A validated Russian-language version of the KDQOL-SF™ version 1.3 was used to assess health-related quality of life. Results: The mean age of participants is 43,6 ± 12 .019 years. Central Asian ethnic groups predominate among the study participants (63.4%). Analysis of the SF-36 dimensions revealed that the lowest score was observed for general health (50.2 ± 13.6), whereas the highest score was recorded for bodily pain (77.2 ± 24.4). Among the specific KDQOL-SF quality-of-life measures, the lowest score was observed for Sleep (47.6 ± 12.3). The Sexual Function score, calculated for 22 participants who reported sexual activity during the previous four weeks, was 89.2 ± 19.4. Correlation analysis of the lowest scores on the scales: Sleep, Burden of Kidney Disease (KDQOL-SF), and General Health, Physical Role (SF-36) revealed a significant association between Burden of Kidney Disease and General Health (r = 0.527, p = 0.002), and between the Burden of Kidney Disease and Physical Role (r = 0.546, p = 0.001). A moderate association was found between Sleep and Physical Activity (r = 0.418, p = 0.019) and between Sleep and General Health Status (r = 0.363, p = 0.044). Conclusion: In this cross-sectional study of kidney transplant recipients in Astana, HRQoL varied considerably across physical, functional, and kidney disease-specific domains, with the lowest scores observed for general health, kidney disease burden, and sleep. Nevertheless, it has limitations, primarily the requirement for lifelong immunosuppressive treatment and ongoing clinical follow-up. Characterizing quality-of-life outcomes in kidney transplant recipients can provide important information for identifying care gaps, standardizing post-transplant monitoring, preserving long-term transplant function, and reducing adverse complications throughout the post-transplant period.
References
[1] Alotaibi, M., Trollinger, B., & Kant, S. (2024). Management of kidney transplant recipients for primary care practitioners. BMC nephrology, 25(1), 102. https://doi.org/10.1186/s12882-024-03504-2
[2] Arend, S. M., Mallat, M. J., Westendorp, R. J., van der Woude, F. J., & van Es, L. A. (1997). Patient survival after renal transplantation; more than 25 years follow-up. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association, 12(8), 1672–1679. https://doi.org/10.1093/ndt/12.8.1672
[3] Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. Chronic kidney disease. Lancet. 2021 Aug 28;398(10302):786-802. https://doi.org/10.1016/S0140-6736(21)00519-5.
[4] Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet. 2017 Mar 25;389(10075):1238-1252. https://doi.org/10.1016/S0140-6736(16)32064-5.
[5] Levin, A.; Stevens, P.E.; Bilous, R.W.; Coresh, J.; De Francisco, A.L.M.; De Jong, P.E.; Griffith, K.E.; Hemmelgarn, B.R.; Iseki, K.; Lamb, E.J.; et al. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. Suppl. 2012, 3, 5–14. https://doi.org/10.1038/kisup.2012.73
[6] GBD 2017 Risk Factor Collaborators (2018). Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England), 392(10159), 1923–1994. https://doi.org/10.1016/S0140-6736(18)32225-6
[7] Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney Int. 2019 Nov;96(5):1048-1050. https://doi.org/10.1016/j.kint.2019.07.012.
[8] Sarafidis, P. A., Persu, A., и др. (2017). Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH). Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association, 32(4), 620–640. https://doi.org/10.1093/ndt/gfw433
[9] Rangaswami, J., Mathew, R. O., и др. (2019). Cardiovascular disease in the kidney transplant recipient: epidemiology, diagnosis and management strategies. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association, 34(5), 760–773. https://doi.org/10.1093/ndt/gfz053
[10] Marc-Andre Cornier, Dana Dabelea, Teri L. Hernandez, Rachel C. Lindstrom, Amy J. Steig, Nicole R. Stob, Rachael E. Van Pelt, Hong Wang, Robert H. Eckel, The Metabolic Syndrome, Endocrine Reviews, Volume 29, Issue 7, 1 December 2008, Pages 777–822, https://doi.org/10.1210/er.2008-0024
[11] GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1151-1210. doi: 10.1016/S0140-6736(17)32152-9. Erratum in: Lancet. 2017 Oct 28;390(10106):e38. https://doi.org/10.1016/S0140-6736(17)32646-6.
[12] K. E. Lamb, S. Lodhi and H.-U. Meier-Kriesche. Long-Term Renal Allograft Survival in the United States: A Critical Reappraisal. American Journal of Transplantation 2011; 11: 450–462, https://doi.org/10.1111/j.1600-6143.2010.03283.x
[13] Briggs J. D. (2001). Causes of death after renal transplantation. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association, 16(8), 1545–1549. https://doi.org/10.1093/ndt/16.8.1545
[14] Kasiske, B. L., Anjum, S., Shah, R., Skogen, J., Kandaswamy, C., Danielson, B., O'Shaughnessy, E. A., Dahl, D. C., Silkensen, J. R., Sahadevan, M., & Snyder, J. J. (2004). Hypertension after kidney transplantation. American journal of kidney diseases: the official journal of the National Kidney Foundation, 43(6), 1071–1081. https://doi.org/10.1053/j.ajkd.2004.03.013
[15] Gaipov A, Issanov A, Kadyrzhanuly K, Galiyeva D, Khvan M, Aljofan M, Molnar MZ, Kovesdy CP. Epidemiology of dialysis-treated end-stage renal disease patients in Kazakhstan: data from nationwide large-scale registry 2014-2018. BMC Nephrol. 2020 Sep 21;21(1):407. https://doi.org/10.1186/s12882-020-02047-6.
[16] Baigenzhin A, Doskaliyev Z, Tuganbekova S, Zharikov S, Altynova S, Gaipov A. Organ Transplants in Kazakhstan. Exp Clin Transplant. 2015 Nov;13 Suppl 3:4-6. https://doi.org/10.6002/ect.tdtd2015.L5
[17] Malik RF, Jia Y, Mansour SG, Reese PP, Hall IE, Alasfar S, Doshi MD, Akalin E, Bromberg JS, Harhay MN, Mohan S, Muthukumar T, Schröppel B, Singh P, Weng FL, Thiessen Philbrook HR, Parikh CR. Post-transplant Diabetes Mellitus in Kidney Transplant Recipients: A Multicenter Study. Kidney360. 2021 Jun 2;2(8):1296-1307. https://doi.org/10.34067/KID.0000862021.
[18] Sharif A, Chakkera H, de Vries APJ, Eller K, Guthoff M, Haller MC, Hornum M, Nordheim E, Kautzky-Willer A, Krebs M, Kukla A, Kurnikowski A, Schwaiger E, Montero N, Pascual J, Jenssen TG, Porrini E, Hecking M. International consensus on post-transplantation diabetes mellitus. Nephrol Dial Transplant. 2024 Feb 28;39(3):531-549. https://doi.org/10.1093/ndt/gfad258.
[19] Wilson S, Mone P, Jankauskas SS, Gambardella J, Santulli G. Chronic kidney disease: Definition, updated epidemiology, staging, and mechanisms of increased cardiovascular risk. J Clin Hypertens (Greenwich). 2021 Apr;23(4):831-834. https://doi.org/10.1111/jch.14186.
[20] Augustine J. Kidney transplant: New opportunities and challenges. Cleve Clin J Med. 2018 Feb;85(2):138-144. https://doi.org/10.3949/ccjm.85gr.18001.
[21] Azegami T, Kounoue N, Sofue T, Yazawa M, Tsujita M, Masutani K, Kataoka Y, Oguchi H. Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysis. Ren Fail. 2023 Dec;45(1):2169618. https://doi.org/10.1080/0886022X.2023.2169618.
[22] Alvares J, Cesar CC, Acurcio Fde A, et al. Quality of life of patients in renal replacement therapy in Brazil: comparison of treatment modalities. Qual Life Res. 2012;21(6):983–991. https://doi.org/10.1007/s11136-011-0013-6.
[23] Cappadona R, De Giorgi A, Di Simone E, Di Muzio M, Di Muzio F, Di Muzio F, Lamberti N, Manfredini F, Storari A, Manfredini R, Fabbian F. Infodemiology of solid organ transplantation: relationship to the Global Observatory on Donation and Transplantation data. Eur Rev Med Pharmacol Sci. 2020 Dec;24(24):12630-12637. https://doi.org/10.26355/eurrev_202012_24159.
[24] Martin F, Carmona M, Mahillo B, Alvarez M, Luengo A, Chatzixiros E, López-Fraga M, Domínguez-Gil B, Tullius SG. Organ Donation and Transplantation Worldwide: The Global Observatory on Donation and Transplantation 2024 Report. Transplantation. 2026 Mar 1;110(3):e655-e669. https://doi.org/10.1097/TP.0000000000005657.
[25] Voora S, Adey DB. Management of Kidney Transplant Recipients by General Nephrologists: Core Curriculum 2019. Am J Kidney Dis. 2019 Jun;73(6):866-879. https://doi.org/10.1053/j.ajkd.2019.01.031.
[26] Habbous S, Arnold J, Begen MA, Boudville N, Cooper M, Dipchand C, Dixon SN, Feldman LS, Goździk D, Karpinski M, Klarenbach S, Knoll GA, Lam NN, Lentine KL, Lok C, McArthur E, McKenzie S, Miller M, Monroy-Cuadros M, Nguan C, Prasad GVR, Przech S, Sarma S, Segev DL, Storsley L, Garg AX; Donor Nephrectomy Outcomes Research (DONOR) Network. Duration of Living Kidney Transplant Donor Evaluations: Findings From 2 Multicenter Cohort Studies. Am J Kidney Dis. 2018 Oct;72(4):483-498. https://doi.org/10.1053/j.ajkd.2018.01.036.
[27] Molnar, M. Z., Foster, C. E., 3rd, Sim, J. J., Remport, A., Krishnan, M., Kovesdy, C. P., & Kalantar-Zadeh, K. (2014). Association of pre-transplant blood pressure with post-transplant outcomes. Clinical transplantation, 28(2), 166–176. https://doi.org/10.1111/ctr.12292
[28] Kuźmiuk-Glembin, I., Adrych, D., Tylicki, L., Heleniak, Z., Garnier, H., Wiśniewski, J., Rutkowski, P., Rutkowski, B., & Dębska-Ślizień, A. (2018). Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses. Kidney & blood pressure research, 43(1), 45–54. https://doi.org/10.1159/000486905
[29] Ahmed, S. H., Biddle, K., Augustine, T., & Azmi, S. (2020). Post-Transplantation Diabetes Mellitus. Diabetes therapy: research, treatment and education of diabetes and related disorders, 11(4), 779–801. https://doi.org/10.1007/s13300-020-00790-5
[30] Chowdhury T. A. (2019). Post-transplant diabetes mellitus. Clinical medicine (London, England), 19(5), 392–395. https://doi.org/10.7861/clinmed.2019-0195
[31] Claes, K., Meier-Kriesche, H. U., Schold, J. D., Vanrenterghem, Y., Halloran, P. F., & Ekberg, H. (2012). Effect of different immunosuppressive regimens on the evolution of distinct metabolic parameters: evidence from the Symphony study. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 27(2), 850–857. https://doi.org/10.1093/ndt/gfr238
[32] Gafter-Gvili, A., & Gafter, U. (2019). Posttransplantation Anemia in Kidney Transplant Recipients. Acta haematologica, 142(1), 37–43. https://doi.org/10.1159/000496140
[33] Goldman, J. D., & Julian, K. (2019). Urinary tract infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clinical transplantation, 33(9), e13507. https://doi.org/10.1111/ctr.13507
[34] Vest, L. S., Koraishy, и др. (2018). Metformin use in the first year after kidney transplant, correlates, and associated outcomes in diabetic transplant recipients: A retrospective analysis of integrated registry and pharmacy claims data. Clinical transplantation, 32(8), e13302. https://doi.org/10.1111/ctr.13302
[35] Wojciechowski D, Wiseman A. Long-Term Immunosuppression Management: Opportunities and Uncertainties. Clin J Am Soc Nephrol. 2021 Aug;16(8):1264-1271. https://doi.org/10.2215/CJN.15040920. Epub 2021 Apr 14.
[36] Szumilas K, Wilk A, Wiśniewski P, Gimpel A, Dziedziejko V, Kipp M, Pawlik A. Current Status Regarding Immunosuppressive Treatment in Patients after Renal Transplantation. Int J Mol Sci. 2023 Jun 18;24(12):10301. https://doi.org/10.3390/ijms241210301.
[37] Fletcher BR, Damery S, Aiyegbusi OL, Anderson N, Calvert M, Cockwell P, Ferguson J, Horton M, Paap MCS, Sidey-Gibbons C, Slade A, Turner N, Kyte D. Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis. PLoS Med. 2022 Apr6;19(4):e1003954. https://doi.org/10.1371/journal.pmed.1003954.
[38] Fiebiger W, Mitterbauer C, Oberbauer R. Health-related quality of life outcomes after kidney transplantation. Health Qual Life Outcomes. 2004 Jan 8;2:2. https://doi.org/10.1186/1477-7525-2-2.
[39] Rocha FLD, Echevarría-Guanilo ME, Silva DMGVD, Gonçalves N, Lopes SGR, Boell JEW, Mayer BLD. Relationship between quality of life, self-esteem and depression in people after kidney transplantation. Rev Bras Enferm. 2020 Feb 10;73(1):e20180245. English, Portuguese. https://doi.org/10.1590/0034-7167-2018-0245.
[40] Saracci R. The World Health Organisation needs to reconsider its definition of health. BMJ. 1997 May 10;314(7091):1409-10. https://doi.org/10.1136/bmj.314.7091.1409.
[41] Bautmans I, Knoop V, Amuthavalli Thiyagarajan J, Maier AB, Beard JR, Freiberger E, Belsky D, Aubertin-Leheudre M, Mikton C, Cesari M, Sumi Y, Diaz T, Banerjee A; WHO Working Group on Vitality Capacity. WHO working definition of vitality capacity for healthy longevity monitoring. Lancet Healthy Longev. 2022 Nov;3(11):e789-e796. https://doi.org/10.1016/S2666-7568(22)00200-8.
[42] Pretto CR, Winkelmann ER, Hildebrandt LM, Barbosa DA, Colet CF, Stumm EMF. Quality of life of chronic kidney patients on hemodialysis and related factors. Rev Lat Am Enfermagem. 2020;28:e3327. doi: 10.1590/1518-8345.3641.3327. Epub 2020 Jul 15. PMID: 32696925; PMCID: PMC7365615.
[43] Hays, R.D., et. al. (1997). Kidney Disease Quality of Life Short Form (KDQOL-SF™), Version 1.3: A Manual for Use and Scoring. Santa Monica, CA: RAND, P-7994 https://www.rand.org/health/surveys/kdqol.html
[44] Hermanns CL, Young K, Parks A, Brooks WM, Lepping RJ, Montgomery RN, Gupta A. A Prospective Study of Depression and Quality of Life after Kidney Transplantation. Kidney360. 2024 Sep 1;5(9):1350-1358. https://doi.org/10.34067/KID.0000000000000538.
[45] Cordeiro EDO, Costa TCD, Teixeira MF, Toledo NDN, Almeida GS. Quality of life of individuals receiving kidney transplantation in Amazonas State. Rev Lat Am Enfermagem. 2020 Jun 8;28:e3291. https://doi.org/10.1590/1518-8345.3775.3291.
[46] Abacı SH, Alagoz S, Salihoglu A, Yalin SF, Gulcicek S, Altiparmak MR, Seyahi N. Assessment of Anemia and Quality of Life in Patients With Renal Transplantation. Transplant Proc. 2015 Dec;47(10):2875-80. https://doi.org/10.1016/j.transproceed.2015.10.043.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Journal of Public Health and Preventive Medicine