Nutritional Status Evaluated by Multi‐Frequency Bioimpedance Is Not Associated With Quality of Life or Depressive Symptoms in Hemodialysis Patients

Abstract

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.

Loss of appendicular muscle mass in haemodialysis patients is associated with increased self‐reported depression, anxiety and lower general health scores

“…General health and average health SF36 scores were greater for those men with a normal ALM index. On univariate analysis, we found no associations with fat mass index and depression, anxiety or general health scores, in keeping with a previous report that measured total bodyfat . On the other hand, patients with reduced ALM index had higher BDI‐II scores, and higher HADS scores, showing an association between reduced appendicular muscle and increased depression and anxiety.…”

“…On univariate analysis, we found no associations with fat mass index and depression, anxiety or general health scores, in keeping with a previous report that measured total bodyfat. 34 On the other hand, patients with reduced ALM index had higher BDI-II scores, and higher HADS scores, showing an association between reduced appendicular muscle and increased depression and anxiety. Whereas higher SF36 self-reported scores, suggestive of better general health were associated with greater appendicular muscle mass.…”

Urea to creatinine ratio: a forgotten marker of poor nutritional state in patients undergoing hemodialysis treatment

“…The results of studies assessing the association between depression and malnutrition showed variable results [27][28][29]. These studies most commonly used BDI as screening tool for depression.…”

The Psychological Impact of Hemodialysis on Patients with Chronic Renal Failure

“…Poor exercise tolerance and muscle weakness may limit daily activity, again causing poor QoL (Hsieh et al, 2007;Sakkas et al, 2003). However, Barros et al (2011) suggested there was no association of nutritional status with malnutrition-inflammation, QoL, or depressive symptoms. There is still debate about whether patients' QoL can be directly correlated to malnutrition-inflammation markers.…”