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

Knut Stavem; * Rüdiger Ganss


BMC Nephrology 

In This Article


In this cross-sectional study, the Norwegian version of the ESRD-SCL demonstrated high internal consistency reliability for all six subscales, in line with the original German version (α = 0.76–0.85).[7] Furthermore the test-retest reliability over 2 weeks for all scales was excellent. Reproducibility for the scales of this questionnaire has previously only been assessed over 1 year in stable patients.[7] It has been suggested that HRQoL instruments can be used for comparisons at group level if reliability is above 0.70.[23] All subscales of both the ESRD-SCL and the SF-36 instruments had higher internal consistency reliability than this. For use at the level of the individual patient, a suggested minimum requirement for reliability is 0.90 while 0.95 is desirable[23] although perhaps too stringent.[24]

The pattern of correlations between the two instruments largely confirmed hypothesized associations from literature review and item content analysis, hence supporting convergent and discriminant validity of the ESRD-SCL.[25] Furthermore, the associations of the ESRD-SCL subscales with demographic and clinical variables were in line with expectations. The patients accepted the questionnaire well, as demonstrated by the high completion rates.

We found no difference in HRQoL between a tacrolimus-based and a ciclosporin-based regimen using the SF-36, and no systematic difference on the ESRD-SCL subscales except the Increased growth of gum an hear subscale, however our sample was small. Previous studies have reported comparable effects on global HRQoL of the two regimens, while Tacrolimus has tended to improved the disease-specific HRQoL.[11,26,27,28,29,30]

A previous study has reported lower scores, denoting less side effects, on the Side effects of corticosteroids dimension of the ESRD-SCL and more suffering in the Limited cognitive function and Increased growth of gum and hair dimension among the elderly.[7] In the present study we noted a statistically nonsignificant tendency to lower Side effects of corticosteroids in the elderly, however there was no indication of a difference according to age in the Limited cognitive dimension or Increased growth of gum and hair dimension in the present study.

Some weaknesses of the study should be noted. This study was a cross-sectional study in one hospital with a limited sample size, and all patients were successful renal transplant recipients.

The questionnaire contains items intended to assess side effects of immunosuppressive medication. Hence, the questionnaire can be a useful supplement to other questionnaires in studies of kidney transplantation, in particular in studies of variations in immunosuppressive medication following transplantation.


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