Reliability and Validity of the ESRD Symptom Checklist -- Transplantation Module in Norwegian kidney transplant recipients

Knut Stavem; * Rüdiger Ganss


BMC Nephrology 

In This Article


The characteristics of the 59 respondents are shown in Table 1 . ESRD-SCL and SF-36 scores are shown in Table 2 , including the percentage of respondents giving lowest (floor) and highest possible score (ceiling). The ESRD-SCL scores did not concentrate at the ceiling for any subscale. However, scores concentrated at the floor for the Limited cognitive capacity, Side effects of corticosteroids, and Increased growth of gum and hair subscales ( Table 2 ). For the SF-36 scales role – physical 30% of respondents scored the lowest possible value (floor). There were marked ceiling effects on the SF-36 scales role – physical (40%), bodily pain (25%), social functioning (50%), and role – emotional (67%) scales ( Table 2 ).

The Cronbach's α was high for all dimensions of the ESRD-SCL (α = 0.72–0.81), for the total scale (α = 0.94) ( Table 2 ), and for the scales of the SF-36 (α = 0.80–0.91). In the test-retest the respondents (n = 48) completed questionnaires median 14 days apart (interquartile range 9 to 20 days). In the test-retest, the intraclass correlation coefficients for the different subscales of the ESRD-SCL ranged 0.87 to 0.95, and for the SF-36 from 0.83 to 0.95.

In the assessment of construct validity, the hypothesized associations between scales of the ESRDL-SCL generally were among the highest, largely confirming the hypothesis, although some of the other subscales also correlated well ( Table 3 ). The correlations of the two scales measuring medication side effects with the SF-36 scales were among the weakest pairwise correlations.

Among the demographic and clinical variables, employment showed the highest correlation with most of the ESRDL-SCL subscales, although these correlations were all weak and <0.40 ( Table 4 ). Increased growth of gum and hair, a typical side effect of ciclosporin, was moderately associated with a ciclosporin-containing immunosuppressive regimen. With the above exceptions, associations of the ESRDL-SCL subscales with demographic and clinical variables were weak or close to nothing, as hypothesized ( Table 4 ).

Only the ESRD-SCL subscale Increased growth of gum and hair discriminated between patients with two different immunosuppressive regimens after adjustment for age, sex, and comorbidity ( Table 5 ). Only the two SF-36 scales Role -- physical and Bodily pain discriminated between patients below/above the median age in the multivariate model. On the ESRD-SCL subscale Side effects of corticosteroids, younger patients tended indicate more problems than those above the median age, although this difference was statistically not significant ( Table 5 ). The SF-36 physical functioning scale was the only scale that discriminated between patient groups according to Charlson comorbidity index ≤2 vs. >2 (p =< 0.001). The ESRD-SCL subscales Limited physical capacity and Cardiac and renal dysfunction showed differences that were almost statistically significant ( Table 5 ), however, we hypothesized that these scales were associated with the Physical functioning scale of the SF-36.


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