Objective: To prospectively evaluate depressive symptoms, nutritional status, and quality of life (QoL) and search for possible associations in patients with end-stage renal disease undergoing hemodialysis. Methods: A cohort study of 104 adult patients with end-stage renal disease undergoing hemodialysis was conducted. Anthropometric, clinical, and biochemical variables were evaluated after a midweek hemodialysis session. The participants' body composition was assessed by direct segmental multifrequency bioimpedance analysis. The WHOQOL-Bref questionnaire was used to evaluate QoL. Participants were separated into two groups -depressive symptoms and no depressive symptoms -at inclusion and evaluated annually for 2 years thereafter using the Beck Depression Inventory. Survival analysis used the Kaplan-Meier method and Cox regression analysis for the goodness of fit of associated factors. All-cause mortality was the outcome of interest. Results: Participants' mean age was 55.3615.6 years, 60% were male, and the median time on hemodialysis was 17.5 (8.0-36.8) months. Thirty-two patients had depressive symptoms and a significantly lower QoL compared with the 72 patients in the no depressive symptoms group. The fitted outcome model showed that lean body mass had a protective effect against all-cause mortality (hazard ratio [HR] = 0.89; 95%CI 0.80-0.99; p = 0.038). Conclusion: Depressive symptoms were highly prevalent in the cohort, and correlated with the physical and psychological components of the QoL life questionnaire, as well as with C-reactive protein and phosphorus levels. Lean body mass was protective for the assessed outcome.

Hemodialysis therapy significantly impacts on patients' physical, psychological, and social performances. Such reduced quality of life depends on several factors, such as malnutrition, depression, and metabolic derangements. This study aims to evaluate the current nutritional status, quality of life and depressive symptoms, and determine the possible relationships with other risk factors for poor outcomes, in stable hemodialysis patients. This was a single-center, cross-sectional study that enrolled 59 adult patients undergoing hemodialysis. Laboratory tests that included high-sensitivity c-reactive protein (CRP), and quality of life and depressive symptom evaluation, as well as malnutrition-inflammation score, nutritional status and body composition (by direct segmental multi-frequency bioimpedance analysis) determinations were performed. Patients were classified as "underfat", "standard", "overfat", or "obese" by multi-frequency bioimpedance analysis. Seven patients were underfat, 19 standard, 19 overfat, and 14 obese. Triglyceride levels significantly differed between the underfat, standard, overfat, and obese groups (1.06 [0.98-1.98]; 1.47 [1.16-1.67]; 2.53 [1.17-3.13]; 2.12 [1.41-2.95] mmol/L, respectively; P=0.026), as did Kt/V between the underfat, overfat, and obese groups (1.49 ± 0.14; 1.23 ± 0.19; 1.19 ± 0.22; P=0.015 and P=0.006, respectively). Depressive symptoms, quality of life, and CRP and phosphate levels did not diverge among nutritional groups. Creatinine, albumin, and phosphate strongly correlated, as well as percent body fat, body mass index, and waist circumference (r=0.859 [P<0.001], and r=0.716 [P<0.001], respectively). Depressive symptoms and physical and psychological quality-of-life domains also strongly correlated (r(s) = -0.501 [P<0.001], r(s) = -0.597 [P<0.001], respectively). The majority of patients were overfat or obese and very few underfat. Inflammation was prevalent, overall. No association of nutritional status with malnutrition-inflammation, quality of life, or depressive symptoms could be established.

Fontes de recursos: Annerose Barros é bolsista de doutorado pelo Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq); Alex Oliboni Sussela é bolsista de iniciação científica PIBIC/CNPq; Luiza Silveira Lucas é bolsista de iniciação científica BPA/PUCRS. RESUMO Objetivos: Investigar a relação do estado inflamatório com a massa magra corporal de pacientes em hemodiálise. Métodos: Um estudo transversal observacional incluiu pacientes em hemodiálise há pelo menos três meses. A análise da composição corporal foi realizada por bioimpedância segmentar multi-frequência (InBody 520 ®). O estado nutricional associado à inflamação foi avaliado usando o instrumento que computa o Escore Desnutrição-Inflamação. Resultados: A amostra incluiu 59 indivíduos, sendo 30 mulheres. A idade média foi de 58,7±14,4 anos, a mediana do tempo em hemodiálise foi de 24 (9-49) meses, a média do peso seco estimado foi 67,0±14,7 kg e a média de massa magra foi 29,7±5,5 kg. A mediana do nível sérico de proteína C-reativa ultrassensível foi 8,6 (3,9-18,0) mg/L e acima do limite normal (≤ 5,0 mg/L), sugerindo a presença de inflamação. O escore desnutrição-inflamação teve mediana de 4 (2-6). Houve correlação significativa entre o escore desnutrição-inflamação e a idade (r s =0,350, p menor do que 0,01) e com o tempo em diálise: (r s =0,320, p menor do que 0,05). Inflamação avaliada pelo nível de proteína C-reativa ultrassensível foi significativamente associada à massa magra (r s =-0,283, p menor do que 0,05). Conclusões: O aumento do tempo em hemodiálise e a idade aumentada estiveram associados com pior estado nutricional. Nesta população, aparentemente quanto menor a massa magra corporal maior o nível de proteína C-reativa ultrassensível, sugerindo uma possível associação entre a inflamação e a massa magra corporal nestes pacientes.