Nutritional status affects quality of life in Hemodialysis (HEMO) Study patients at baseline.
OBJECTIVE
To evaluate associations between frequently used indicators for assessing nutritional status and health-related quality of life in hemodialysis patients after controlling for demographics, comorbidity, and dialysis dose.


METHODS
Survey of 1,387 hemodialysis patients enrolled at baseline in the Hemodialysis (HEMO) Study. Nutritional status indicators included dietary energy intake, equilibrated normalized protein catabolic rate (enPCR), serum creatinine (SCr), serum albumin (SAlb), body mass index (BMI), calf circumference, and appetite. Health-related quality of life was measured by the Medical Outcomes Study Short Form-36 (MOS-SF-36) summary measures: the Physical Component Scale (PCS) and Mental Component Scale (MCS).


METHODS
Fifteen clinical sites throughout the United States providing in-center hemodialysis.


RESULTS
The mean PCS score was 36.1 +/- 10 SD, lower than normative data in healthy populations. PCS scores were lower among women, whites, and those with diabetes, severe comorbidities, and poor appetites. Appetite, dietary energy intake, SAlb, and SCr were strongly associated with PCS scores even after controlling for demographics and comorbidity. The sum of the parameter estimates for the effects of nutritional status on PCS was large, 7 points or more depending on the individual's nutritional status indicators. The mean MCS score was 49.7 +/- 10.1 SD, similar to scores in healthy populations, but lower among those with severe comorbidities, poor appetites, advanced age, and more years on dialysis. Appetite, age, and years on dialysis were significantly associated with MCS after controlling for other demographics and comorbidity. Dialysis dose did not significantly alter these relationships.


CONCLUSIONS
Easy-to-use indicators for assessing nutritional status (appetite, energy intake, SAlb, and SCr) together are strongly associated with health-related quality of life, even after controlling for comorbidities and dose of dialysis in hemodialysis patients, providing an additional reason for maximizing patients' nutritional status and health.
Dwyer
Johanna T
JT
Frances Stern Nutrition Center, Tufts-New England Medical Center, Boston, MA 02111, USA
Larive
Brett
B
Leung
June
J
Rocco
Michael
M
Burrowes
Jerrilynn D
JD
Chumlea
Wm Cameron
WC
Frydrych
Anne
A
Kusek
John W
JW
Uhlin
Leigh
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001066:Appetite; D015415:Biomarkers / Q000032:analysis; D015992:Body Mass Index; D015897:Comorbidity; D003404:Creatinine / Q000032:analysis; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000523:psychology* / Q000628:therapy; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009752:Nutritional Status; D011506:Proteins / Q000378:metabolism; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects* / Q000523:psychology / Q000706:statistics & numerical data; D012709:Serum Albumin / Q000032:analysis
D015415:Biomarkers; D011506:Proteins; D012709:Serum Albumin; D003404:Creatinine