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

Muxunov A. Almazan J. Kalinina D. Kuanshaliyeva Z. Gaipov A. Makhadiyeva D. Kabibulatova A. Madikenova M. Nabiyev A. Sarria-Santamera A.
February 2026 Springer Science and Business Media Deutschland GmbH

Quality of Life Research
2026 #35 Issue 2

Purpose: 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. Methods: 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. Results: 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. Conclusion: 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 , Dialysis , Health-related quality of life , Kidney transplantation , Low-income countries , Lower-middle income countries , Meta-analysis , Systematic review

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Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan
Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
Clinical Academic Department of Internal Medicine, CF “University Medical Center”, Astana, Kazakhstan

Department of Biomedical Sciences
Department of Medicine
Clinical Academic Department of Internal Medicine

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