- Select a tool tab: KDQOL-36 Symptoms, Dialysis Symptom Index, or IPOS-Renal.
- Optionally enter your name, age, sex, and date in the Patient Information box — these appear only on your printed report and are never transmitted anywhere.
- For each item, choose the response that best describes your experience over the specified time period. All items must be answered before the score calculates.
- Press the Calculate button to see your score, severity band, and a brief interpretation.
- Use the Download / Print Report button to generate a formatted PDF-ready report to share with your nephrologist at your next visit.
- You may complete all three tools in one sitting and generate a separate report for each. Scores are independent — completing one does not reset another.
All computation runs in your browser. No scores, names, or answers are stored or transmitted.
When to Use
Use this PROM suite for any adult patient on maintenance hemodialysis or peritoneal dialysis who can self-report symptoms. The three instruments complement each other: KDQOL-36 targets the specific symptom burden of kidney disease; DSI covers a broad 30-item symptom inventory across all organ systems affected by uremia and the dialysis procedure; and IPOS-Renal quantifies the degree of palliative and supportive care need, including family anxiety.
Appropriate population
Adults on maintenance hemodialysis or peritoneal dialysis who are cognitively able to self-report. Best used serially — at intake and every 3–6 months — so the nephrologist can track trends rather than isolated scores. Particularly valuable when initiating a new dialysis modality, after a hospital admission, or when a patient reports a change in how they feel "overall."
When NOT to rely on these tools alone
These instruments assess symptom burden and quality of life — they do not diagnose specific causes. A high IPOS-Renal score does not automatically indicate a need for palliative sedation; a high DSI does not replace workup for specific correctable causes (e.g., pruritus from hyperphosphatemia, restless legs from iron deficiency, fatigue from anemia). Every high score should prompt a structured clinical conversation, not algorithmic escalation.
Pearls & Pitfalls
Serial measurement matters more than a single score
A KDQOL-36 score of 48 at one visit means very little in isolation. What matters is the trajectory — a score falling from 72 to 48 over six months signals worsening symptom burden that warrants investigation, even if 48 is not below any critical threshold. Use these tools longitudinally, not as one-time snapshots.
High DSI scores are opportunities, not dead ends
A DSI score of 60 means 15+ symptoms are present at moderate-to-severe intensity. Most dialysis symptoms are treatable: fatigue responds to anemia correction, pruritus to phosphate control and emollients, restless legs to iron supplementation or gabapentin (dose-adjusted for eGFR/dialysis). Each symptom on the DSI is a therapeutic target, not an inevitable consequence of dialysis.
Pitfalls
(1) Do not use IPOS-Renal scores as a triage threshold for automatic palliative care referral — family anxiety (item 12) alone can raise the total score without indicating that the patient's own burden is high. (2) The KDQOL Symptom subscale presented here is a subset of the full KDQOL-36; it does not replace the complete instrument for research purposes. (3) These tools are not sensitive to rapid acute deterioration — if a dialysis patient reports a sudden new symptom, proceed directly to clinical assessment rather than waiting for the next PROM cycle.
Why Use It
Dialysis patients carry one of the highest symptom burdens of any chronic disease — comparable to advanced cancer in some studies. Yet symptoms are systematically under-reported and under-treated because nephrologists focus on targets (Kt/V, phosphorus, hemoglobin) rather than patient experience. Validated PROMs create a structured channel for symptom communication: patients who complete a PROM before their visit discuss twice as many symptoms with their clinician compared to those who do not.
In the Philippines, where long dialysis session wait lists, transport barriers, and limited palliative infrastructure make proactive symptom detection even more critical, using these tools at every visit allows the care team to prioritize the most distressing symptoms, tailor supportive therapies, and identify patients approaching end-of-life who may benefit from a goals-of-care conversation.
Dialysis Symptom & Quality-of-Life PROM Suite
Complete the tools below before your clinic visit. Each takes 2–5 minutes. Your scores are calculated locally in your browser — nothing is stored or transmitted. Use the Print / Download button to save a report to show your nephrologist.
In the past 4 weeks, how bothered were you by each of the following? Rate each: 0 = Not at all bothered → 4 = Extremely bothered. Score 0–100 (higher = fewer symptoms = better).
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KDQOL-36 Symptom/Problem subscale. Hays RD et al. Kidney Int 1994;46(3):860–866. Adapted for patient self-monitoring; not a clinical diagnostic tool.
In the past week, how bothersome was each symptom? Rate each: 0 = Not present, 1 = Barely bothersome, 2 = Somewhat, 3 = Quite a bit, 4 = Very much. Score 0–120 (lower = better).
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Dialysis Symptom Index. Weisbord SD et al. J Palliat Med. 2004;7(1):23–32. Adapted for patient self-monitoring; not a clinical diagnostic tool.
Over the past week, how much have the following affected you? Rate each: 0 = Not at all, 1 = Slightly, 2 = Moderately, 3 = Severely, 4 = Overwhelmingly. Score 0–48 (lower = better).
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IPOS-Renal. Murtagh FE et al. Palliative Medicine 2019;33(1):20–29. Adapted for patient self-monitoring; not a clinical diagnostic tool.
Next Steps
Use the result to support — not replace — clinical judgment.
- Interpret the value against the targets shown in the calculator and the Evidence section below, in the context of the full clinical picture.
- Trend serial measurements rather than acting on a single result; confirm abnormal or unexpected values before changing management.
- Apply the relevant KDIGO / specialty-guideline threshold and document the indication.
- Escalate or refer to nephrology when results are out of range, rapidly changing, or discordant with the clinical picture — and discuss the implications with the patient.
Evidence & References
Formula & Equations
KDQOL-36 — Symptom/Problem Subscale
| Item | Response Options | Range |
|---|---|---|
| 12 items (sore muscles, chest pain, cramps, itchy skin, dry skin, shortness of breath, faintness/dizziness, appetite loss, washed out/drained, numbness, nausea, access-site problems) | 0 (Not at all bothered) to 4 (Extremely bothered) per item | Raw sum 0–48 → transformed to 0–100 scale (higher = better, fewer symptoms) |
| Score (0–100) | Interpretation |
|---|---|
| 75–100 | Good symptom control — continue monitoring |
| 50–74 | Moderate symptom burden — discuss with nephrologist |
| 25–49 | High symptom burden — structured review recommended |
| 0–24 | Very high symptom burden — urgent nephrologist contact indicated |
Scoring formula: KDQOL Score = 100 × (48 − raw sum) / 48. Higher scores indicate fewer symptoms and better quality of life.
Dialysis Symptom Index (DSI)
| Item group | Response options | Range |
|---|---|---|
| 30 items covering sleep, fatigue, mood, GI tract, neurology, cardio-respiratory, skin, musculoskeletal, sexual function, and procedural symptoms | 0 (Not present) to 4 (Very much) per item | Raw sum 0–120 (lower = better) |
| Score (0–120) | Interpretation |
|---|---|
| 0–20 | Low symptom burden — continue monitoring |
| 21–50 | Mild-to-moderate burden — discuss at next visit |
| 51–80 | Moderate-to-high burden — structured symptom review recommended |
| 81–120 | High burden — contact care team for urgent review |
IPOS-Renal (Integrated Palliative Outcome Scale — Renal)
| Domain (items) | Response options | Range |
|---|---|---|
| 10 physical symptoms (pain, dyspnea, weakness, nausea, vomiting, appetite, constipation, dry mouth, drowsiness, mobility) + 2 psychosocial items (patient anxiety, family anxiety) | 0 (Not at all) to 4 (Overwhelmingly) per item | Raw sum 0–48 (lower = better) |
| Score (0–48) | Palliative care need |
|---|---|
| 0–10 | Low — manageable, continue monitoring |
| 11–24 | Moderate — raise at next nephrology visit |
| 25–36 | High — palliative/supportive care review strongly recommended |
| 37–48 | Very high — urgent supportive care contact indicated |
Evidence & References
All three instruments are validated for use in dialysis populations and are recommended by KDIGO 2020 and the ERA-EDTA for routine patient-reported outcome monitoring in end-stage kidney disease. They have been deployed in clinical trials, dialysis registries, and quality-improvement programs worldwide.
- Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB. Development of the Kidney Disease Quality of Life (KDQOL) instrument. Qual Life Res. 1994;3(5):329–338.
- Weisbord SD, Fried LF, Arnold RM, et al. Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index. J Pain Symptom Manage. 2004;27(3):226–240.
- Murtagh FE, Ramsenthaler C, Firth A, et al. A brief, patient- and proxy-reported outcome measure in advanced illness: validity, reliability and responsiveness of the Integrated Palliative care Outcome Scale (IPOS). Palliat Med. 2019;33(9):1045–1057.
- Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2020;98(4S):S1–S115. (References PROM use in CKD/ESKD.)
- Flythe JE, Dorough A, Narendra JH, et al. Symptom experiences and related dialysis modality preferences among incident dialysis patients. Nephrol Dial Transplant. 2018;33(11):1995–2005.
- Davison SN, Levin A, Moss AH, et al. Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease. Kidney Int. 2015;88(3):447–459.
