Impact of malnutrition on health-related quality of life in persons receiving dialysis: a prospective study

Abstract

Health-related quality of life (HRQoL) is severely impaired in persons receiving dialysis. Malnutrition has been associated with some measures of poor HRQoL in cross-sectional analyses in dialysis populations, but no studies have assessed the impact of malnutrition and dietary intake on change in multiple measures of HRQoL over time. We investigated the most important determinants of poor HRQoL and the predictors of change in HRQoL over time using several measures of HRQoL. We enrolled 119 haemodialysis and 31 peritoneal dialysis patients in this prospective study. Nutritional assessments (Subjective Global Assessment [SGA], anthropometry and 24-hour dietary recalls) and HRQoL questionnaires (Short Form-36 [SF-36] mental [MCS] and physical component scores [PCS] and European QoL-5 Dimensions [EQ5D] health state [HSS] and visual analogue scores [VAS]) were performed at baseline, 6 and 12 months. Mean age was 64(14) years. Malnutrition was present in 37% of the population. At baseline, malnutrition assessed by SGA was the only factor independently (and negatively) associated with all four measures of HRQoL. No single factor was independently associated with decrease in all measures of HRQoL over 1 year. However, prevalence/development of malnutrition over one year was an independent predictor of 1-year decrease in EQ5D HSS and 1-year decrease in fat intake independently predicted the 1-year decline in SF-36 MCS and PCS, and EQ5D VAS. These findings strengthen the importance of monitoring for malnutrition and providing nutritional advice to all persons on dialysis. Future studies are needed to evaluate the impact of nutritional interventions on HRQoL and other long-term outcomes.

Factors Associated with Nutritional Status in Geriatric Outpatients

“…Studies have shown that malnutrition is closely associated with dependency in activities of daily living and poorer quality of life 12,13 . Additionally, Feldblum et al 14 found a significant association between geriatric syndromes, including impairments in cognitive and physical functions, malnutrition, and depressive symptoms.…”

Disease-related malnutrition in chronic kidney disease

“…For example, a recent study showed that the malnutrition inflammation complex score (MIS) was related to higher scores of depression and reduced cognitive function in 132 older adults (> 65 years) with CKD [21]. Another study noted reduced health-related quality of life scores with malnutrition in dialysis patients (119 HD and 31 peritoneal dialysis (PD)) [22].…”

EQ-5D in dialysis units: a PROM with a view

“…Parmi les nombreux outils de QVLS disponibles, l'EQ5D (34) et le Short Form 6-dimension (SF-6D) [35] sont les plus utilisés. Tous deux ont été utilisés chez les patients atteints d'IRT, mais comme l'ont rapporté Yang et al, l'EQ5D semble avoir un profil coût-efficacité plus favorable, conduisant à des ratios coût-efficacité incrémentaux plus intéressants que le SF-6D (36). Son utilisation systématique doit se faire dans des conditions stables et ambulatoires afin de minimiser le biais de confusion lié aux situations aiguës et aux événements aigus intercurrents.…”