title: Quality-of-life and mortality in hemodialysis patients: roles of race and nutritional status.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, C1-Annex, Torrance, CA 90502, USA.
authors.forename: Usama
authors.initials: U
authors.lastname: Feroze
authors.forename: Nazanin
authors.initials: N
authors.lastname: Noori
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.forename: David J
authors.initials: DJ
authors.lastname: Martin
authors.forename: Astrid
authors.initials: A
authors.lastname: Reina-Patton
authors.forename: Debbie
authors.initials: D
authors.lastname: Benner
authors.forename: Rachelle
authors.initials: R
authors.lastname: Bross
authors.forename: Keith C
authors.initials: KC
authors.lastname: Norris
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kopple
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D000273:Adipose Tissue; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000401:mortality*; D020379:Risk Adjustment; D012709:Serum Albumin / Q000378:metabolism; D014481:United States / Q000453:epidemiology
chemical_list: D012709:Serum Albumin; D003404:Creatinine