Health-related quality of life in chronic kidney disease patients in low- and lower-middle income countries: a systematic review and meta-analysis

Alimzhan Muxunov, Joseph U. Almazan, Dina Kalinina, Zhanat Kuanshaliyeva, Abduzhappar Gaipov, Dinara Makhadiyeva, Aida Kabibulatova, Meruyert Madikenova, Altay Nabiyev, Antonio Sarría‐Santamera

2026

Full text Open access: Hybrid Metadata (CSL-JSON)
DOI 10.1007/s11136-025-04154-z
Data confidence 70 medium
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Abstract

Health-related quality of life (HRQoL) is a key outcome in chronic kidney disease (CKD), yet data from low- and lower-middle income countries (LLMICs) are underrepresented. The study systematically reviewed and meta-analyzed HRQoL among CKD patients in LLMICs by disease stage and treatment modality. Registered in PROSPERO (CRD420251016382), the review searched PubMed, Ovid MEDLINE, Scopus, and Web of Science (January 1, 2000 – March 28, 2025) for studies including adults with CKD stages 1–5, on dialysis, or post-transplant, using validated HRQoL instruments. Two reviewers independently screened studies, extracted data, and assessed quality using Joanna Briggs Institute tools. Pooled mean scores were estimated using random-effects meta-analysis, with meta-regression and Egger’s test exploring heterogeneity and small-study effects. A total of 123 studies (n = 24,007) from 22 countries were included. Pooled SF-36 scores were 42.8 (95% CI 39.4–46.3) for Physical Component Summary (PCS) and 47.7 (43.8–51.6) for Mental Component Summary (MCS) in early CKD, versus 36.9 (34.0–39.9) and 42.5 (38.9–46.1), respectively, in late CKD. Transplant recipients showed higher HRQoL than dialysis patients across WHOQOL-BREF domains. The EQ-5D index declined from 0.706 (0.589–0.823) in CKD 1–3 to 0.486 (0.357–0.614) in dialysis. CKD patients in LLMICs experience substantial deterioration in quality of life, particularly at advanced stages. Compared to high-income settings, HRQoL scores in LLMICs remain markedly lower, revealing major global inequities. This first region-specific synthesis provides benchmarks for HRQoL across CKD stages and underscores the need for earlier intervention and broader access to transplantation. Chronic kidney disease (CKD) is a growing health problem worldwide, especially in poorer countries. While doctors often track how CKD damages the body, less is known about how it affects daily life, emotions, and wellbeing. This is especially true in countries limited in resources, where most people with CKD live, but where research on quality of life is limited. Our study combined information from more than 120 studies in 22 such countries, covering over 24,000 people with CKD. We looked at how people’s quality of life changes as their kidney disease becomes more severe and after treatments like dialysis or kidney transplant. We found that people’s wellbeing usually gets worse as the disease progresses. People who had a kidney transplant felt much better physically and emotionally than those receiving dialysis. Overall, people living with CKD in resource-limited countries have lower quality of life than those in wealthier countries. This shows that kidney disease has a bigger impact in poorer settings, where treatment options are limited. Our results highlight the need for earlier diagnosis, better support for patients, and wider access to kidney transplantation.