Fukuhara et al.4 have reported significant reductions in all domains of SF-36 scores find more in comparison to population norms for USA, European and Japanese haemodialysis populations, using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) cohort. Korevaar et al.5 reported reduced scores for all domains of SF-36 and the EuroQOL visual analogue scale for Dutch pre-dialysis patients compared with the general population. Age is strongly related to QOL in patients undergoing dialysis treatment. Most studies show that physical aspects of QOL deteriorate with advancing age as reported by Moreno et al.6 in the Spanish multicentre study

of dialysis patients and by Mingardi7 in the Italian Dialysis-Quality of Life (DIA-QOL) study. However, this has not uniformly resulted in reduction of QOL. Rebollo et al.8 reported less loss of HRQOL in dialysis patients older than 65 years compared with younger patients. This study, the Italian DIA-QOL study and the North Thames study reported by Lamping et al.9 also show that while the physical component scores (PCS) of the SF-36 instrument are lower, the mental component scores

(MCS) are similar to normal population means. Kimmel et al.10 further show that using the satisfaction with life scale, older haemodialysis patients are more satisfied with life in the face of deteriorating physical function. These studies appear to suggest that older people may compensate for deteriorating function by a psychological Selumetinib cell line adjustment. Poor perceived mental health at the start of dialysis has been shown to be associated with mortality and hospitalization Enzalutamide in vitro as reported by Lopez Revuelta et al.11 This study was conducted in a predominantly diabetic (65.4% of patients) and relatively younger population (mean age: diabetic 61.9 years and non-diabetic 57.0 years) and included haemodialysis and peritoneal dialysis modalities. Kalantar-Zadeh et al.12 showed in a small group of prevalent haemodialysis patients

that a 10-unit decrease in mental health conferred a 2.46 OR of death in 12 months and also increased hospitalization. Merkus et al.13 from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) group showed lower PCS and MCS to be associated with a poor outcome in terms of mortality and hospitalization. Lower PCS had 7 times and lower MCS had 5 times greater risk for poor outcome. Mapes et al.14 showed a similar effect from the DOPPS data in their prevalent haemodialysis population. The response rate in this study for completing the KDQOL-SF was 58.2%, with non-responders having had much shorter time on dialysis and higher comorbidity characteristics. Racial and cultural factors are likely to impact on QOL. Unruh et al.15 showed that African-American patients on haemodialysis report significantly better psychological well-being and lower burden of disease than non-African-Americans. Mapes et al.