Quality-of-Life and Mortality in Hemodialysis Patients

Abstract

SummaryBackground and objectives Maintenance hemodialysis (MHD) patients often have protein-energy wasting, poor health-related quality of life (QoL), and high premature death rates, whereas African-American MHD patients have greater survival than non-African-American patients. We hypothesized that poor QoL scores and their nutritional correlates have a bearing on racial survival disparities of MHD patients.Design, setting, participants, & measurements We examined associations between baseline self-administered SF36 questionnaire-derived QoL scores with nutritional markers by multivariate linear regression and with survival by Cox models and cubic splines in the 6-year cohort of 705 MHD patients, including 223 African Americans.Results Worse SF36 mental and physical health scores were associated with lower serum albumin and creatinine levels but higher total body fat percentage. Spline analyses confirmed mortality predictability of worse QoL, with an almost strictly linear association for mental health score in African Americans, although the race-QoL interaction was not statistically significant. In fully adjusted analyses, the mental health score showed a more robust and linear association with mortality than the physical health score in all MHD patients and both races: death hazard ratios for (95% confidence interval) each 10 unit lower mental health score were 1.12 (1.05-1.19) and 1.10 (1.03-1.18) for all and African American patients, respectively.Conclusions MHD patients with higher percentage body fat or lower serum albumin or creatinine concentration perceive a poorer QoL. Poor mental health in all and poor physical health in non-African American patients correlate with mortality. Improving QoL by interventions that can improve the nutritional status without increasing body fat warrants clinical trials.

Transition of care from pre-dialysis prelude to renal replacement therapy: the blueprints of emerging research in advanced chronic kidney disease

“…These patients also have markedly higher hospitalization rates and worse health-related quality of life [5,6]. Ironically the first 3 to 6 months of dialysis therapy or transplantation is associated with an even higher risk of death compared with prevalent dialysis or transplant patients ( Figure 1) [7], yet it is not clear whether the earlier transition to dialysis in the USA is a contributing cause of this high death rate.…”

Asymptomatic Pulmonary Congestion and Physical Functioning in Hemodialysis Patients

“…Anemia, mineral and bone disorders, the inflammation-muscular-wasting complex, cardiomyopathy, neuropathy, and depression, all disturbances that frequently coexist in CKD-5D, may be involved in the poor physical functioning of this population (3)(4)(5)(6). Pulmonary congestion detected and quantified by lung ultrasonography recently emerged as a powerful correlate of poor physical functioning in a multicenter study in peritoneal dialysis (PD) patients (7), a population with an exceedingly high prevalence of fluid overload and left ventricular dysfunction (8)(9)(10), suggesting that volume expansion and cardiomyopathy, two potentially reversible risk factors, play a major role in the poor physical performance of this population.…”

Quality of Life in Hepatitis C Virus Seropositive Hemodialysis Patients

“…In group 1 (and not in group 2), a significant positive correlation between pre dialysis serum creatinine and physical functioning, mental health, general health subscales, PCS and MCS. Feroze et al [14] showed that better QoL was associated with higher pre dialysis serum creatinine which was surrogate for larger muscle mass and/or greater meat intake. Similarly, Fabrizi et al [8] reported direct relationship between serum creatinine and SF-36 scale scores in hemodialysis population and the largest correlations were recorded in the general health, mental health, and bodily pain subscales.…”

“…Feroze et al [14] suggested that better QoL was associated with higher serum albumin levels, which were surrogates for greater meat intake and for higher visceral protein stores. In this study liver enzymes ALT and AST were significantly higher in HCV seropositive patients than seronegative patients but, they had no significant correlation with SF-36 subscales.…”