健康相關生活品質是一涵括生理、心理、社會以及環境的多面向概念，研究已證實慢性腎臟病患者生活品質與住院率以及死亡率有關，若能透過健康相關生活品質的評估，除了可預防疾病進展，更可提供醫療人員擬定有效的照護計畫。但因疾病各期症狀表現不同，影響生活品質的因素亦有差別，若未能選擇合適的量表進行量測，不僅影響研究結果，更與患者感受的生活品質有所落差。
本研究為一橫斷性研究，收集慢性腎臟病第一至第五期共329人，藉由台灣簡明版世界衛生組織生活品質量表（WHOQOL-BREF）以及腎臟疾病生活品質量表（KDQOL-36）的填寫，分析各量表的心理計量特質以及於慢性腎臟病患者之適用性。研究結果顯示患者以已婚（88％）、男性（63％）居多，平均年齡為59.2 ± 11.9歲，96％患者患有一種以上的合併症，其中以高血壓居多（73％），平均腎絲球過濾率為38.85 ± 25.11 mL/min/1.73m2。WHOQOL-BREF與KDQOL-36運用於慢性腎臟病患者均具有良好的信度，Cronbach’s alpha均大於.90，前者各範疇Cronbach’s alpha介於.73至.81，後者各範疇Cronbach’s alpha介於.77至.88，但卻有較嚴重的天花板效應，可能較無法分辨出貼切病人感受的生活品質。WHOQOL-BREF之生理範疇得分平均為67.29 ± 14.50，心理範疇為61.28 ± 15.00，社會關係範疇為63.60 ± 12.33，環境範疇為69.80 ± 11.39；KDQOL-36之生理範疇平均為42.97 ± 9.67，心理為50.07 ± 9.97，症狀／問題為89.16 ± 12.86，腎臟疾病負荷為63.27 ± 31.40，腎臟疾病對日常生活影響為86.59 ± 13.97。在兩份量表中，患者的生活品質均隨著腎功能的降低而變差，但僅有KDQOL-36之SF-12生理範疇以及腎臟疾病對日常生活影響範疇在前後期患者呈現顯著差異，WHOQOL-BREF則無，顯示KDQOL-36應較能反映出前後期慢性腎臟病生活品質之差異。兩份量表各範疇相關部分，WHOQOL-BREF各範疇相關程度介於中度至高度相關（r = .44 ~ .69，p＜.01），與效標題項「自覺生活品質」呈現低度至中度相關（r = .34 ~ .56，p＜.01）；KDQOL-36各範疇相關程度介於微弱至高度相關（r = .02 ~ .67，p＜.01），與「自覺生活品質」呈現低度至中度相關（r = .28 ~ .41，p＜.01），其中原在前期與「自覺生活品質」呈現低度相關的腎臟疾病對日常生活影響以及SF-12心理範疇，在後期則增強為中度相關，推論KDQOL-36在後期患者所測得的生活品質與其自覺生活品質可能較相近。但WHOQOL-BREF除了較KDQOL-36更能反映社會關係與環境範疇的生活品質外，其生理範疇不僅可反映出後期慢性腎臟病患者KDQOL-36各範疇的生活品質，運用於前期患者生活品質的量測亦為一良好的測量工具。希望透過本研究探討兩份量表運用於不同期別慢性腎臟病患者的適用性，提供臨床醫療人員測量患者生活品質時的參考。

Health-related quality of life (HRQoL) is a concept including physical, psychological, social and environment aspects. Reasearches indicated that lower HRQoL scores are associated with higher risk of hospitalization and mortality in patients with chronic kidney disease (CKD). The care plan can be made effectively by the assessment of quality of life. However, the factors affecting quality of life varied among different disease stages. The research result would be affected and the quality of life how patients perception would be different if improper instruments were used.
A cross-sectional study was conducted and 329 patients diagnosed with CKD stage 1 to 5 were enrolled. HRQoL were measured by using the WHOQOL-BREF and KDQOL-36 to determine their psychometric properties and to explore the appropriateness of the instruments when administering to different disease stages.
Among the studied subjects, the mean age was 59.2 ± 11.9 years, 63％ were male, 88％ were married. Ninety-six percent of these subjects were diagnosed with at least one comorbidity, and 73％ had hypertension. The mean eGFR was 38.85 ± 25.11 mL/min/1.73m2. Both WHOQOL-BREF and KDQOL-36 were consisted of good internal consistency（α ＞ .90）but ceiling effect appeared in the KDQOL-36 and might not be able to identify the good quality of life. Each of the mean domain scores of the two scales decreased by the CKD stage progressed. The mean domain scores of SF-12 physical health and the effect of kidney disease in the early stage were significantly higher than in the late stage, which indicated that KDQOL-36 was able to identify the differences of QOL among subjects in the late stage. There were moderate to high inter-domain correlation within the domain of the WHOQOL-BREF (r = .44 ~ .69) and there were fair to moderate correlation between the indicator of the general QOL and all domains within WHOQOL-BREF (r = .34 ~ .56). There were little to high inter-domain correlation within the domain of the KDQOL-36 (r = .02 ~ .67), and there were fair to moderate correlation between the indicator of the general QOL and all domains within the KDQOL-36 (r = .28 ~ .41). The fair correlation between the indicator and the domain”effect of kidney disease”and SF-12 mental health domain in the early stage became moderate in the late stage, and we speculated that the quality of life KDQOL-36 measured was closer to patients perception in the late stage. However, WHOQOL-BREF was more appropriate to reflect the quality of life whether patients with early or late stage. The result suggested that the appropriate instruments to use for health professionals in the assessment of QOL among patients with CKD.

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