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Berhe T, Tegegne GT, Berha AB. Quality of life and associated factors among chronic kidney disease patients at Zewditu Memorial and Tikur Anbessa Specialised Hospitals, Ethiopia: a cross-sectional study design. BMJ Open 2023; 13:e069712. [PMID: 37263701 DOI: 10.1136/bmjopen-2022-069712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is associated with significant morbidity, mortality, healthcare cost and reduced health-related quality of life (HRQoL). This study aimed to assess HRQoL and associated factors among patients with CKD at both Zewditu Memorial and Tikur Anbessa Specialised Hospitals, Ethiopia. METHOD A cross-sectional study design was performed. All patients who visited the renal clinics in both hospitals from March to July 2019 were targeted, and data were collected using interviews and medical records. HRQoL was assessed using the Kidney Disease and Quality of Life-36 tool. Normality assessment was done for HRQoL subscales. Descriptive statistics, logistic regression, t-test and one-way analysis of variance were performed. RESULT A total of 300 patients with CKD were included. Around 62% of them were in either stage 3 or 4 CKD. The mean domain scores of physical component summary (PCS), mental component summary (MCS), burden of kidney disease, effect of kidney disease and symptoms and problems of kidney disease (SPKD) subscales were 50.4, 59.5, 63.1, 74.6 and 80.4, respectively. The lowest HRQoL was seen in the PCS scale, while the highest was in SPKD. In addition, the study revealed that a lower level of education, elevated serum creatinine and a history of smoking were significantly associated with poor PCS score. Further, the presence of three or more comorbidities, CKD-related complications and a lower haemoglobin level were significantly associated with poor MCS. CONCLUSION The overall mean scores of PCS and MCS were low, below the standard level. Level of education, serum creatinine and smoking history were significantly associated with PCS, while the presence of comorbidity, complications and haemoglobin level were significantly associated with MCS. Stakeholders working on CKD management should design a relevant strategy targeting patients, patients' care providers and healthcare professionals to improve HRQoL of patients.
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Affiliation(s)
- Teshome Berhe
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gobezie T Tegegne
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Maeda SS, Peters BSE, Martini LA, Antunes HKM, Gonzalez MC, Arantes HP, Prado CM, Pinto CL, de Araújo IM, de Paula FJA, Borges JLC, Albergaria BH, Ushida M, de Souza GC, de Mendonça LMC, do Prado M, de Medeiros Pinheiro M. Official position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry: part I (technical aspects)—general concepts, indications, acquisition, and analysis. Adv Rheumatol 2022; 62:7. [DOI: 10.1186/s42358-022-00241-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To review the technical aspects of body composition assessment by dual-energy X-ray absorptiometry (DXA) and other methods based on the most recent scientific evidence.
Materials and methods
This Official Position is a result of efforts by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism (Associação Brasileira de Avaliação Óssea e Osteometabolismo, ABRASSO) and health care professionals with expertise in body composition assessment who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications. In this first part of the Official Position, the authors discuss the different methods and parameters used for body composition assessment, general principles of DXA, and aspects of the acquisition and analysis of DXA scans.
Conclusion
Considering aspects of accuracy, precision, cost, duration, and ability to evaluate all three compartments, DXA is considered the gold-standard method for body composition assessment, particularly for the evaluation of fat mass. In order to ensure reliable, adequate, and reproducible DXA reports, great attention is required regarding quality control procedures, preparation, removal of external artifacts, imaging acquisition, and data analysis and interpretation.
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Orozco-González CN, Márquez-Herrera RM, Cortés-Sanabria L, Cueto-Manzano AM, Gutiérrez-Medina M, Gómez-García EF, Rojas-Campos E, Paniagua-Sierra JR, Martín Del Campo F. Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients. Nefrologia 2022; 42:186-195. [PMID: 36153915 DOI: 10.1016/j.nefroe.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/05/2021] [Indexed: 06/16/2023] Open
Abstract
Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001). As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.
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Affiliation(s)
- Claudia N Orozco-González
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico; Universidad Internacional Iberoamericana, Campeche, Mexico
| | - Roxana M Márquez-Herrera
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Laura Cortés-Sanabria
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico.
| | - Alfonso M Cueto-Manzano
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | | | - Erika F Gómez-García
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Enrique Rojas-Campos
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - José R Paniagua-Sierra
- Unidad de Investigación en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, Mexico
| | - Fabiola Martín Del Campo
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
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Li X, Lang X, Peng S, Ding L, Li S, Li Y, Yin L, Liu X. Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches. J Nutr Health Aging 2022; 26:826-838. [PMID: 36156674 DOI: 10.1007/s12603-022-1838-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults 18 years and older via combining various analyses based on empirical dichotomic CC, continuous CC, and dose-response CC. METHODS We conducted a systematic search of relevant studies in PubMed, EMBASE, Cochrane Library, and Web of Science published through April 12, 2022. This systematic review includes longitudinal observational studies reporting the relationships of total mortality with CC. We calculated the pooled relative risk (RR) and 95% confidence interval (CI) of total mortality with CC per 1 cm for each study and combined the values using standard meta-analysis approaches. Newcastle-Ottawa scale (NOS), Grading of Recommendations, Assessment, Development and Evaluations approach (GRADE), and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) were assessed for meta-analyses. RESULTS Our analysis included a total of 37 cohort studies involving 62,736 participants, across which moderate heterogeneity was observed (I2=75.7%, P<0.001), but no publication bias was found. Study quality scores ranged from 6 to 9 (mean 7.7), with only three studies awarded a score of 6 (fair quality). We observed an inverse trend between total death risk and CC per 1 cm increase (RR, 0.95, 95% CI, 0.94-0.96; P<0.001; GRADE quality=high). Only a very slight difference was found among residents of nursing homes (6.9% mortality risk reduction per one cm CC increase), community-dwellers (5.4%), and those living in hospitals (4.8%), respectively (P for meta-regression=0.617). Low credible subgroup difference was found based on the ICEMAN tool. CONCLUSIONS Calf circumference is a valid anthropometric measure for mortality risk prediction in a community, nursing home, or hospital.
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Affiliation(s)
- X Li
- Lu Yin, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing 102300, China. E-mail: ; Xiaomei Liu, Department of Emergency, Zhongshan Hospital of Xiamen University, Xiamen, China. Tel:
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Is malnutrition a determining factor of health-related quality of life in hemodialysis patients? A cross-sectional design examining relationships with a comprehensive assessment of nutritional status. Qual Life Res 2021; 31:1441-1459. [PMID: 34748139 DOI: 10.1007/s11136-021-03018-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify relationships between health-related quality of life (HRQOL) and nutritional status in hemodialysis (HD) patients. METHOD Secondary data from a cross-sectional survey was utilized. HRQOL was assessed for 379 HD patients using the generic Short Form 36 (SF-36) and disease-specific Kidney-Disease Quality of Life-36 (KDQOL-36). Malnutrition was indicated by malnutrition inflammation score (MIS) ≥ 5, and presence of protein-energy wasting (PEW). The individual nutritional parameters included the domains of physical status, serum biomarkers, and dietary intake. Multivariate associations were assessed using the general linear model. RESULTS MIS ≥ 5 was negatively associated with SF-36 scores of physical functioning (MIS < 5 = 73.4 ± 8.0 SE vs MIS ≥ 5 = 64.6 ± 7.7 SE, P < 0.001), role-limitation-physical (MIS < 5 = 65.3 ± 14.3 SE vs MIS ≥ 5 = 52.9 ± 14.0 SE, P = 0.006), general health (MIS < 5 = 53.7 ± 7.5 SE vs MIS ≥ 5 = 47.0 ± 7.1 SE, P = 0.003), and PCS-36 (MIS < 5 = 40.5 ± 3.3 SE vs MIS ≥ 5 = 35.9 ± 3.1 SE, P < 0.001); and KDQOL-36 score of symptoms/problems (MIS < 5 = 78.9 ± 5.6 SE vs MIS ≥ 5 = 74.8 ± 5.4 SE, P = 0.022), but not with PEW by any tool. Of individual nutritional parameters, underweight (68.1 ± 5.4 SE, P = 0.031), normal weight (63.8 ± 2.8 SE, P = 0.023), and overweight (64.3 ± 2.9 SE, P = 0.003) patients had significantly higher physical functioning scores compared to obese patients (44.8 ± 5.5 SE). Serum albumin levels were positively associated with physical functioning (P = 0.041) score. HGS was also positively associated with physical functioning (P = 0.036), and vitality (P = 0.041) scores. Greater dietary phosphorus intakes were significantly associated with lower scores for role limitation-physical (P = 0.008), bodily pain (P = 0.043), and PCS-36 (P = 0.024). CONCLUSION Malnutrition diagnosis by MIS, but not PEW, indicated associations with HRQOL in HD patients. Individual nutritional parameters that related to higher HRQOL were BMI < 30 kg/m2, better dietary phosphorus control, greater muscle strength and higher visceral protein pool.
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Sobhiyeh S, Dunkel A, Dechenaud M, Mehrnezhad A, Kennedy S, Shepherd J, Wolenski P, Heymsfield SB. Digital anthropometric volumes: Toward the development and validation of a universal software. Med Phys 2021; 48:3654-3664. [PMID: 33694162 DOI: 10.1002/mp.14829] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Anthropometry is a method for quantifying body size and shape often used to derive body composition and health risk prediction models. Recent technology advancements led to development of three-dimensional (3D) optical scanners that can overcome most of the limitations associated with manual anthropometric data collection. However, each of the currently available devices offers proprietary measurements that do not match conventional anthropometric definitions. The aim of the current study was to develop and then evaluate the precision and accuracy of new "universal" 3D optical analysis software that calculates digital anthropometric volumes using identical standard landmarks across scanners. METHODS Dual-energy x-ray absorptiometry (DXA) and air displacement plethysmography (ADP) total body and regional volume and fat mass reference measurements and 3D optical scans from two proprietary devices were collected from 356 participants to evaluate the robustness of total body and regional volume and fat mass measurements calculated by the developed software. Linear regression modeling with threefold cross validation was used to evaluate total body and regional fat masses from 3D scans. RESULTS Total body and regional volumes measured by DXA and ADP had strong associations with corresponding estimates from the commercial 3D optical scanners coupled with the universal software (e.g., R2 = 0.98 for Styku and R2 = 1.00 for SS20, for both DXA and ADP comparisons). Regional body volumes also had strong correlation between DXA and the 3DO scanners (e.g., for arm, leg and trunk, respective R2 s of 0.75, 0.86, and 0.97 for Styku and 0.79, 0.89, and 0.98 for SS20). Similarly, there were strong associations between DXA- measured total body and regional fat mass and 3D optical estimates calculated by the universal software (e.g., for total body, arm, leg and trunk, respective R2 s of 0.86, 0.72, 0.77, and 0.88 for Styku and 0.84, 0.76, 0.78, and 0.85 for SS20). Absolute differences in volumes and fat mass between the reference methods and the universal software values revealed underlying proprietary scanner differences that can be improved when designing future devices. CONCLUSIONS The current study suggests that, when compared against values calculated using DXA and ADP, the universal software was able to measure total and regional body volumes reliably from scans obtained by two different scanners. The universal software, with future refinements, combined with potential optical scanner design improvements, creates new opportunities for developing large multicenter anthropometric databases with uniformly defined body dimensions that can be used for modeling health risks. CLINICAL TRIAL REGISTRATION ID Shape Up! Adults Study, NCT0363785.
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Affiliation(s)
- Sima Sobhiyeh
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | | | | | | | - Samantha Kennedy
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - John Shepherd
- University of Hawaii Cancer Center, Honolulu, HI, 9681, USA
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ALATAŞ H, YILDIRAN H, YALÇIN A. Hemodiyaliz tedavisi alan hastalarda besin alımı ile malnütrisyon inflamasyon skoru arasındaki ilişki. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.794910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Orozco-González CN, Márquez-Herrera RM, Cortés-Sanabria L, Cueto-Manzano AM, Gutiérrez-Medina M, Gómez-García EF, Rojas-Campos E, Paniagua-Sierra JR, Martín Del Campo F. Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients. Nefrologia 2021; 42:S0211-6995(21)00103-X. [PMID: 34154849 DOI: 10.1016/j.nefro.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 03/10/2021] [Accepted: 04/05/2021] [Indexed: 12/18/2022] Open
Abstract
Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001). As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.
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Affiliation(s)
- Claudia N Orozco-González
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico; Universidad Internacional Iberoamericana, Campeche, Mexico
| | - Roxana M Márquez-Herrera
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Laura Cortés-Sanabria
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico.
| | - Alfonso M Cueto-Manzano
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | | | - Erika F Gómez-García
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Enrique Rojas-Campos
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - José R Paniagua-Sierra
- Unidad de Investigación en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, Mexico
| | - Fabiola Martín Del Campo
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
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Dobronravov VA, Vasilieva IA. Health-related quality of life and long-term mortality in young and middle-aged hemodialysis patients. Int Urol Nephrol 2021; 53:2377-2384. [PMID: 34028642 DOI: 10.1007/s11255-021-02894-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The relationship of health-related quality of life (HRQoL) with mortality in young and middle-aged hemodialysis (HD) patients has scarcely been studied and remains unclear. The aim of the study was to examine whether physical and mental components of HRQoL are related to long-term risks of all-cause and cardiovascular (CV) death in this particular HD population. METHODS A long-term observational prospective study included 238 prevalent HD patients aged 18-64 years. The median follow-up was 50 (22, 96) months (maximum 13.9 years). HRQoL variables of the Short Form 36 Health Survey (SF-36), clinical, and demographic data were assessed at the time of inclusion. Associations of baseline HRQoL scores with all-cause and CV mortality were assessed using Kaplan-Meier survival plots and Cox regression analysis adjusted for clinical and demographic confounders. RESULTS The majority of HRQoL parameters were associated with outcomes in univariable analyses. In multivariable regression models adjusted for clinical and demographic confounders, Physical Functioning (PF) and Physical Component Summary Score (PCS) remained independently related to all-cause mortality [hazard ratio (HR) for a 1-point increase in PF and PCS were 0.981, 95% confidence interval (CI) 0.972-0.989 and 0.954, CI 0.929-0.980, respectively] and CV death (HR for a 1-point increase in PF and PCS were 0.975, CI 0.962-0.988 and 0.950, CI 0.915-0.985, respectively). CONCLUSION PF and PCS assessment seems to be relevant for refining the prognosis and clinical decision-making in young and middle-aged HD patients.
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Affiliation(s)
- Vladimir A Dobronravov
- Research Institute of Nephrology, Pavlov University, L'va Tolstogo str. 6-8, Saint Petersburg, 197022, Russian Federation
| | - Irina A Vasilieva
- Research Institute of Nephrology, Pavlov University, L'va Tolstogo str. 6-8, Saint Petersburg, 197022, Russian Federation.
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Physical Function in Kidney Transplantation: Current Knowledge and Future Directions. CURRENT TRANSPLANTATION REPORTS 2021; 7:46-55. [PMID: 33457184 DOI: 10.1007/s40472-020-00271-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose of review Low physical function (PF) is common among individuals with end-stage kidney disease. In this review, we explore data on the impacts of PF on access to kidney transplantation (KT) and KT outcomes. We also discuss the latest interventions to improve PF in pre- and post-KT settings. Recent Findings Many US KT programs measure PF or related constructs when assessing KT candidacy. Although carefully selected KT candidates with low PF can benefit from KT with respect to survival and quality of life, low PF decreases the likelihood of being listed for KT and increases the risk of adverse post-KT outcomes. Recent trials suggest that exercise is a promising strategy to improve PF among KT candidates and recipients. Summary PF is a potentially modifiable risk factor for adverse pre- and post-KT outcomes. Research is needed to determine the ideal PF metric for use in KT evaluations and interventions to improve PF.
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Holvoet E, Vanden Wyngaert K, Van Craenenbroeck AH, Van Biesen W, Eloot S. The screening score of Mini Nutritional Assessment (MNA) is a useful routine screening tool for malnutrition risk in patients on maintenance dialysis. PLoS One 2020; 15:e0229722. [PMID: 32130271 PMCID: PMC7055863 DOI: 10.1371/journal.pone.0229722] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/13/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Malnutrition is prevalent in patients on dialysis and is associated with morbidity and mortality. Nutritional status can be assessed by a variety of biochemical and physical parameters or nutritional assessment scores. Most of these methods are expensive or cumbersome to use and are not suitable for routine repetitive follow-up in dialysis patients. The Mini Nutritional Assessment (MNA) has a short form screening set (MNA-SF), which would be suitable as a screening tool, but has not been validated yet in dialysis patients. We aimed to assess whether the MNA is an appropriate tool for identifying nutritional problems in dialysis patients. METHOD MNA, routine biochemistry, physical parameters, comorbidities were assessed in cross-sectional multicentric cohorts of hemodialysis and peritoneal dialysis patients with a longitudinal follow up of 2 years for mortality. RESULTS In this cohort of 216 patients, mortality was 27.3% at a follow up of 750±350 days. The mean MNA-SF score was 9.9±1.8, with 30.1%, 59.3% and 10.6% of patients categorized as having normal nutritional status, at risk for malnutrition and malnourished, respectively. The screening score was associated with mortality (HR 0.86, 95% CI 0.75-0.98 per point). With normal nutrition as reference, adjusted mortality was 2.50 (95% CI 1.16-5.37) and 3.89 (95% CI 1.48-10.13) for patients at risk for malnutrition and with malnutrition, respectively. After recalibrating the MNA full score for the specificity of some of its domains for dialysis patients, the MNA-SF had a good sensitivity and specificity for not being well nourished (0.95 and 0.63 respectively) in the full score, and a high negative predictive value (0.91). CONCLUSION The MNA-SF is independently associated with 2 year mortality in dialysis patients. It has a high negative predictive value for excluding being at risk or having malnutrition in the full score. Therefore, it can be advocated as a screening tool for nutritional status in dialysis patients.
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Affiliation(s)
- Els Holvoet
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
- * E-mail:
| | - Karsten Vanden Wyngaert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Amaryllis H. Van Craenenbroeck
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Wim Van Biesen
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sunny Eloot
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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Rebollo Rubio A, Morales Asencio JM, Eugenia Pons Raventos M. Depression, anxiety and health-related quality of life amongst patients who are starting dialysis treatment. J Ren Care 2017; 43:73-82. [PMID: 28239953 DOI: 10.1111/jorc.12195] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) has a severe impact on patients' health-related quality of life (HRQL). The start of renal replacement therapy (RRT) significantly influences psychological, physical and social aspects of life. OBJECTIVES To analyse the HRQL and psychological status (anxiety and depression) at the start of RRT. METHODS We undertook an observational descriptive cross-sectional study. A total of 152 patients starting RRT were recruited for the study. HRQL was measured by the Kidney Disease and Quality of Life Short Form questionnaire. Levels of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale questionnaire. Comorbidities and sociodemographic and clinical factors were also evaluated. FINDINGS HRQL in patients with end-stage kidney disease (ESKD) is significantly affected by the initiation of RRT in all respects. States of anxiety and depression were present in 26.6% and 27% of patients, respectively. These states are significantly related to the emotional component of the quality of life. CONCLUSION The initiation of RRT has a strong impact on HRQL in comparison with a reference population and with other stages of CKD. The early detection of an altered psychological state is important, as this condition should be treated from the first stages of the disease, as it can significantly affect the subsequent development of RRT and the patient's quality of life.
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Affiliation(s)
- Ana Rebollo Rubio
- Department of Nephrology, Carlos Haya Regional University Hospital and University of Málaga, Málaga, Spain
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13
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Washington T, Zimmerman S, Browne T. Factors Associated with Chronic Kidney Disease Self-Management. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:58-69. [PMID: 26799496 DOI: 10.1080/19371918.2015.1087908] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Chronic kidney disease (CKD) affected 26 million U.S. adults. Many end-stage CKD patients undergoing hemodialysis experience self-management challenges. However, factors associated with CKD self-management are under-identified. This article describes a mixed-methods study to identify factors associated with self-management in end-stage CKD patients undergoing hemodialysis. A total of 107 patients age 50 and older were interviewed. Overall, participants had low mean scores for exercise (2.46), communication with physicians (2.50), and cognitive symptom management (0.89) and were adherent for greater than 11 days in a 2-week period with fluid (11.86) and diet (11.65) regimens. There were statistically significant age group differences in the self-management behavior of fluid adherence (p < .05) and communication with physicians (p = .05). None of the respondents discussed communicating with their physicians or cognitive symptom management, yet 90% and 77% of the respondents reported engaging in these behaviors, respectively. The findings from this study support the need for public health social work interventions aimed at increasing self-management behaviors in end-stage CKD patients.
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Affiliation(s)
| | - Sheryl Zimmerman
- b School of Social Work, University of North Carolina , Chapel Hill , North Carolina , USA
| | - Teri Browne
- c College of Social Work, University of South Carolina , Columbia , South Carolina , USA
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14
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de Roij van Zuijdewijn CLM, Grooteman MPC, Bots ML, Blankestijn PJ, van den Dorpel MA, Nubé MJ, ter Wee PM. Comparing Tests Assessing Protein-Energy Wasting: Relation With Quality of Life. J Ren Nutr 2015; 26:111-7. [PMID: 26584787 DOI: 10.1053/j.jrn.2015.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/02/2015] [Accepted: 09/13/2015] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Protein-energy wasting (PEW), a state of decreased bodily protein and energy fuels, is highly prevalent among hemodialysis patients. The best method to determine PEW, however, remains debated. As an independent, negative association between PEW and quality of life (QOL) has been demonstrated, establishing which nutrition-related test correlates best with QOL may help to identify how PEW should preferably be assessed. DESIGN AND METHODS Data were used from CONTRAST, a cohort of end-stage kidney disease patients. At baseline, Subjective Global Assessment (SGA), Malnutrition Inflammation Score (MIS), Geriatric Nutritional Risk Index, composite score on protein-energy nutritional status, normalized protein nitrogen appearance, body mass index, serum albumin, and serum creatinine were determined. QOL was assessed by the Kidney Disease Quality of Life Short Form 1.3. The present study reports on 2 general and 11 kidney disease-specific QOL scores. Spearman's rho (ρ) was calculated to determine correlations between nutrition-related tests and QOL domains. Twelve months after randomization, a sensitivity analysis was performed to test the robustness of the results. RESULTS Of 714 patients, 489 representative subjects were available for analysis. All tests correlated with the Physical Component Score, except body mass index. Only SGA and MIS correlated significantly with the Mental Component Score. SGA correlated significantly with 10 of 11 kidney disease-specific QOL domains. The MIS not only correlated significantly with all (11) kidney disease-specific QOL domains but also with higher correlation coefficients. CONCLUSION Of the 8 investigated nutrition-related tests, only MIS correlates with all QOL domains (13 of 13) with the strongest associations.
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Affiliation(s)
- Camiel L M de Roij van Zuijdewijn
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands.
| | - Muriel P C Grooteman
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Menso J Nubé
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Piet M ter Wee
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
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Broers NJH, Usvyat LA, Kooman JP, van der Sande FM, Lacson E, Kotanko P, Maddux FW. Quality of Life in Dialysis Patients: A Retrospective Cohort Study. Nephron Clin Pract 2015; 130:105-12. [PMID: 26044799 DOI: 10.1159/000430814] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Physical component summary (PCS) and mental component summary (MCS) scores are associated with hospitalization and mortality in patients with end-stage renal disease. Most studies in these patients are cross-sectional in nature. This study aimed to assess the dynamics of health-related quality of life (HRQOL) over time, as well as determinants of changes in HRQOL. Also, the relation between changes in HRQOL with respect to both hospitalization and mortality was assessed. METHODS A cross-sectional analysis was performed in 77,848 hemodialysis (HD) patients whereas changes in HRQOL were assessed in 8,339 patients over a 1-year time period. HRQOL measurements were assessed with Kidney Disease Quality of Life-36 questionnaires. Also, relevant biomarkers (albumin, creatinine, hemoglobin, sodium) and equilibrated normalized protein catabolic rate (enPCR) were measured. RESULTS HRQOL were found to be decreased in HD patients. Nutritional indices like creatinine (r = 0.23; p < 0.0001) and serum albumin (r = 0.21; p < 0.0001) positively correlated with PCS scores. An increase in levels of albumin, creatinine, hemoglobin, enPCR and serum sodium over time are significantly (p < 0.0001) associated with positive changes in PCS scores. Changes in PCS scores were found to be predictive for hospitalization and mortality. The correlates of predictors for MCS scores were less strong compared to that of PCS scores. The strongest positive predictors of MCS scores were age (r = 0.08; p < 0.0001), albumin (r = 0.05; p < 0.0001) and sodium (r = 0.05; p < 0.0001). CONCLUSIONS Nutritional factors are strongly associated with changes in HRQOL, especially with regard to PCS scores (change over time in HRQOL was an independent predictor of hospitalization and mortality). Increased scores of HRQOL over time are positively associated with survival.
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Affiliation(s)
- Natascha J H Broers
- Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
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16
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Vishnevsky KA, Zemchenkov AY, Korosteleva NY, Smirnov AV. Use of the Charlson comorbidity index and the Barthel disability index in the integrated assessment of the sociomedical status of patients receiving continuous renal replacement therapy with hemodialysis. TERAPEVT ARKH 2015; 87:62-67. [DOI: 10.17116/terarkh201587662-67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Madden AM, Smith S. Body composition and morphological assessment of nutritional status in adults: a review of anthropometric variables. J Hum Nutr Diet 2014; 29:7-25. [PMID: 25420774 DOI: 10.1111/jhn.12278] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Evaluation of body composition is an important part of assessing nutritional status and provides prognostically useful data and an opportunity to monitor the effects of nutrition-related disease progression and nutritional intervention. The aim of this narrative review is to critically evaluate body composition methodology in adults, focusing on anthropometric variables. The variables considered include height, weight, body mass index and alternative indices, trunk measurements (waist and hip circumferences and sagittal abdominal diameter) and limb measurements (mid-upper arm and calf circumferences) and skinfold thickness. The importance of adhering to a defined measurement protocol, checking measurement error and the need to interpret measurements using appropriate population-specific cut-off values to identify health risks were highlighted. Selecting the optimum method for assessing body composition using anthropometry depends on the purpose (i.e. evaluating obesity or undernutrition) and requires practitioners to have a good understanding of both practical and theoretical limitations and to be able to interpret the results wisely.
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Affiliation(s)
- A M Madden
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - S Smith
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
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Delgado C, Ward P, Chertow GM, Storer L, Dalrymple L, Block T, Kaysen GA, Kornak J, Grimes B, Kutner NG, Johansen KL. Calibration of the brief food frequency questionnaire among patients on dialysis. J Ren Nutr 2014; 24:151-156.e1. [PMID: 24613023 PMCID: PMC4145671 DOI: 10.1053/j.jrn.2013.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 10/04/2013] [Accepted: 12/03/2013] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Estimating dietary intake is challenging in patients with chronic diseases. The aim of this study was to calibrate the Block Brief 2000 food frequency questionnaire (BFFQ) using 3-day food diary records among patients on dialysis. METHODS Data from 3-day food diary records from 146 patients new to dialysis were reviewed and entered into National Cancer Institute self-administered 24-hour dietary recall (ASA24), a web-based dietary interview system. The information was then re-entered omitting foods reported in the diaries that were not in the BFFQ to generate a "BFFQ-restricted" set of intakes. We modeled each major dietary component (i.e., energy [total calories], protein, carbohydrate, fat) separately using linear regression. The main independent variables were BFFQ-restricted food diary estimates computed as the average of the 3 days of diaries, restricted to items included in the BFFQ, with the unrestricted 3-day food diary averages as dependent variables. RESULTS The BFFQ-restricted diary energy estimate of 1,325 ± 545 kcal was 87% of the energy intake in the full food diary (1,510.3 ± 510.4, P < .0001). The BFFQ-restricted diary carbohydrate intake was 83% of the full food diary (156.7 ± 78.7 g vs. 190.4 ± 72.7, P < .0001). The BFFQ-restricted fat intake was 90% of the full-diary-reported fat intake (50.1 ± 24.1 g vs. 56.4 ± 21.6 g, P < .0001). Daily protein intake assessments were not statistically different by BFFQ-restricted diary and full diary assessment (63.1 ± 28.5 vs. 64.1 ± 21.4 g, P = .60). The associations between BFFQ-restricted diary intake and unrestricted intake were linear. Three-day diary-reported intake could be estimated from BFFQ-restricted intake with r2 ranging from 0.36 to 0.56 (P < .0001 for energy [total calories], protein, carbohydrate, and fat). Final equations did not include adjustments for age, sex, or race because the patterns of associations were not significantly different. CONCLUSION Energy and macronutrient estimates by BFFQ are lower than estimates from 3-day food diaries, but simple calibration equations can be used to approximate total intake from BFFQ responses.
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Affiliation(s)
- Cynthia Delgado
- Division of Nephrology, University of California-San Francisco, San Francisco, California; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Patricia Ward
- Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
- United States Renal Data System Nutrition Special Studies Center, San Francisco, California
| | - Lindsey Storer
- Division of Nephrology, University of California-San Francisco, San Francisco, California; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Lorien Dalrymple
- Division of Nephrology, University of California-Davis, Davis, California
| | | | - George A. Kaysen
- United States Renal Data System Nutrition Special Studies Center, San Francisco, California
- Division of Nephrology, University of California-Davis, Davis, California
| | - John Kornak
- United States Renal Data System Nutrition Special Studies Center, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, California
| | - Barbara Grimes
- United States Renal Data System Nutrition Special Studies Center, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, California
| | - Nancy G. Kutner
- Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia
| | - Kirsten L. Johansen
- Division of Nephrology, University of California-San Francisco, San Francisco, California; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California
- United States Renal Data System Nutrition Special Studies Center, San Francisco, California
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Md. Yusop NB, Yoke Mun C, Shariff ZM, Beng Huat C. Factors associated with quality of life among hemodialysis patients in Malaysia. PLoS One 2013; 8:e84152. [PMID: 24358336 PMCID: PMC3865310 DOI: 10.1371/journal.pone.0084152] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 11/17/2013] [Indexed: 01/26/2023] Open
Abstract
Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90) were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data obtained included socio-demography, medical history, hemodialysis treatment and nutritional status. Mental and physical quality of life were measured using the Mental Composite Summary (MCS) and Physical Composite Summary (PCS) of the Short-Form Health Survey 36-items, a generic core of the Kidney Disease Quality of Life Short Form. Two summary measures and total SF-36 was scored as 0–100, with a higher score indicating better quality of life. Approximately 26 (30%) of respondents achieved the body mass index (24 kg/m2) and more than 80% (n=77) achieved serum albumin level (>35.0 mg/dL) recommended for hemodialysis patients. The majority of respondents did not meet the energy (n=72, 80%) and protein (n=68,75%) recommendations. The total score of SF-36 was 54.1±19.2, while the score for the mental and physical components were 45.0±8.6 and 39.6±8.6, respectively. Factors associated with a higher MCS score were absence of diabetes mellitus (p=0.000) and lower serum calcium (p=0.004), while higher blood flow (p=0.000), higher serum creatinine (p=0.000) and lower protein intake (p=0.006) were associated with a higher PCS score. To improve the overall quality of life of hemodialysis patients, a multidisciplinary intervention that includes medical, dietetic and psychosocial strategies that address factors associated with mental and physical quality of life are warranted to reduce further health complications and to improve quality of life.
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Affiliation(s)
- Nor Baizura Md. Yusop
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Chan Yoke Mun
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zalilah Mohd Shariff
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
| | - Choo Beng Huat
- Department of Medicine, Manipal Medical Collage, Melaka, Malaysia
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Lægreid IK, Aasarød K, Bye A, Leivestad T, Jordhøy M. The impact of nutritional status, physical function, comorbidity and early versus late start in dialysis on quality of life in older dialysis patients. Ren Fail 2013; 36:9-16. [PMID: 24028283 DOI: 10.3109/0886022x.2013.830206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For the majority of the older patients in dialysis, the treatment will be lifelong. Thus, quality of life (QoL) is a crucial outcome. Our aim was to assess the QoL of older Norwegian dialysis patients and to investigate the impact of early (estimated glomerular filtration rate, eGFR ≥10 mL/min) versus late (eGFR <10 mL/min) start in dialysis, comorbidity, nutritional status and physical capacity. METHODS A self-report questionnaire including SF-36 (QoL) and the Subjective Global Assessment (SGA; nutritional status) was mailed to all patients (n = 320) ≥75 years registered in the Norwegian Renal Registry (NRR) as being in dialysis by September 2009. Reply was received from 233 patients (73%). Medical data including comorbidities and eGFR at dialysis start (obtained for 194 patients) were retrieved from the NRR. Functional capacity was determined from the SGA. RESULTS Compared to reports from younger dialysis patients, our patients scored poorer on all SF-36 subscales. Early start in dialysis was registered for 52 patients, 142 patients started late, 51.4% were well nourished (SGA A), 32.3% moderately malnourished (SGA B) and 16.4% were severely malnourished (SGA C). No significant association between any SF-36 scores and early versus late start, nutritional status or comorbidity was found. Better physical function was significantly associated with better scores on all SF-36 scales. CONCLUSIONS Our results indicate that physical function is important to all QoL aspects. Increased focus on physical rehabilitation seems pertinent. Early start of dialysis treatment was not associated with better long term QoL scores.
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Affiliation(s)
- Inger Karin Lægreid
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU , Trondheim , Norway
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Lee J, Kim JM, Kim Y. Association of diet-related quality of life with dietary regimen practice, health-related quality of life, and gastrointestinal symptoms in end-stage renal disease patients with hemodialysis. ACTA ACUST UNITED AC 2013. [DOI: 10.4163/kjn.2013.46.2.137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- JinJu Lee
- The Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul 120-750, Korea
| | - Ji-Myung Kim
- Department of Food and Nutritional Sciences, Hanbuk University, Dongducheon 483-777, Korea
| | - Yuri Kim
- The Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul 120-750, Korea
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 120-750, Korea
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Mazairac AHA, de Wit GA, Grooteman MPC, Penne EL, van der Weerd NC, den Hoedt CH, Lévesque R, van den Dorpel MA, Nubé MJ, ter Wee PM, Bots ML, Blankestijn PJ. Effect of hemodiafiltration on quality of life over time. Clin J Am Soc Nephrol 2012; 8:82-9. [PMID: 23124783 DOI: 10.2215/cjn.00010112] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES It is unclear if hemodiafiltration leads to a better quality of life compared with hemodialysis. It was, therefore, the aim of this study to assess the effect of hemodiafiltration on quality of life compared with hemodialysis in patients with ESRD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study analyzed the data of 714 patients with a median follow-up of 2 years from the Convective Transport Study. The patients were enrolled between June of 2004 and December of 2009. The Convective Transport Study is a randomized controlled trial on the effect of online hemodiafiltration versus low-flux hemodialysis on all-cause mortality. Quality of life was assessed with the Kidney Disease Quality of Life-Short Form. This questionnaire provides data for a physical and mental composite score and describes kidney disease-specific quality of life in 12 domains. The domains have scales from 0 to 100. RESULTS There were no significant differences in changes in health-related quality of life over time between patients treated with hemodialysis (n=358) or hemodiafiltration (n=356). The quality of life domain patient satisfaction declined over time in both dialysis modalities (hemodialysis: -2.5/yr, -3.4 to -1.5, P<0.001; hemodiafiltration: -1.4/yr, -2.4 to -0.5, P=0.004). CONCLUSIONS Compared with hemodialysis, hemodiafiltration had no significant effect on quality of life over time.
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Affiliation(s)
- Albert H A Mazairac
- Department of Nephrology and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Han H, Burrowes JD, Houser R, Chung MC, Dwyer JT. What is the Impact of Nutritional Status on Health-Related Quality of Life in Hemodialysis Patients? J Ren Nutr 2012; 22:237-243. [DOI: 10.1053/j.jrn.2011.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/22/2011] [Accepted: 05/05/2011] [Indexed: 11/11/2022] Open
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Afsar B, Elsurer R, Kanbay M. The relationship between breakfast, lunch and dinner eating pattern and hemodialysis sessions, quality of life, depression and appetite in hemodialysis patients. Int Urol Nephrol 2011; 44:1507-14. [DOI: 10.1007/s11255-011-0061-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 09/14/2011] [Indexed: 11/24/2022]
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Mazairac AH, de Wit GA, Penne EL, van der Weerd NC, Grooteman MP, van den Dorpel MA, Nubé MJ, Buskens E, Lévesque R, ter Wee PM, Bots ML, Blankestijn PJ. Protein-Energy Nutritional Status and Kidney Disease-specific Quality of Life in Hemodialysis Patients. J Ren Nutr 2011; 21:376-386.e1. [DOI: 10.1053/j.jrn.2010.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 07/30/2010] [Accepted: 08/04/2010] [Indexed: 11/11/2022] Open
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Bolasco P, Caria S, Cupisti A, Secci R, Saverio Dioguardi F. A Novel Amino Acids Oral Supplementation in Hemodialysis Patients: a Pilot Study. Ren Fail 2011; 33:1-5. [DOI: 10.3109/0886022x.2010.536289] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Protein-energy wasting (PEW) is one of the strongest risk factors of adverse outcomes in patients with chronic kidney disease including those with end-stage renal disease (ESRD) who undergo maintenance dialysis treatment. One important determinant of PEW in this patient population is an inadequate amount of protein and energy intake. Compounding the problem are the many qualitative nutritional deficiencies that arise because of the altered dietary habits of dialysis patients. Many of these alterations are iatrogenically induced, and albeit well intentioned, they could induce unintended harmful effects. In order to determine the best possible diet in ESRD patients, one must first understand the complex interplay between the quantity and quality of nutrient intake in these patients, and their impact on relevant clinical outcomes. We review available studies examining the association of nutritional intake with clinical outcomes in ESRD, stressing the complicated and often difficult-to-study inter-relationship between quantitative and qualitative aspects of nutrient intake in nutritional epidemiology. The currently recommended higher protein intake of 1.2 g/kg/day may be associated with a higher phosphorus and potassium burden and with worsening hyperphosphatemia and hyperkalemia, whereas dietary control of phosphorus and potassium by restricting protein intake may increase the risk of PEW. We assess the relevance of associative studies by examining the biologic plausibility of underlying mechanisms of action and emphasize areas in need of further research.
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Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Salem Veterans Affairs Medical Center, Salem, Virginia 24153, USA.
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Cupisti A, D'Alessandro C, Valeri A, Capitanini A, Meola M, Betti G, Barsotti G. Food Intake and Nutritional Status in Stable Hemodialysis Patients. Ren Fail 2010; 32:47-54. [DOI: 10.3109/08860220903391234] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A. Cupisti
- Department of Internal Medicine, Nephrology Section, University of Pisa, Pisa, Italy
| | - C. D'Alessandro
- Department of Internal Medicine, Nephrology Section, University of Pisa, Pisa, Italy
| | - A. Valeri
- Department of Internal Medicine, Nephrology Section, University of Pisa, Pisa, Italy
| | - A. Capitanini
- Division of Nephrology, Pescia Hospital, Pescia, Italy
| | - M. Meola
- Department of Internal Medicine, Nephrology Section, University of Pisa, Pisa, Italy
| | - G. Betti
- Division of Nephrology, Massa-Carrara Hospital, Massa Carrara, Italy
| | - G. Barsotti
- Department of Internal Medicine, Nephrology Section, University of Pisa, Pisa, Italy
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Argyropoulos C, Chang CCH, Plantinga L, Fink N, Powe N, Unruh M. Considerations in the statistical analysis of hemodialysis patient survival. J Am Soc Nephrol 2009; 20:2034-43. [PMID: 19643932 PMCID: PMC2736780 DOI: 10.1681/asn.2008050551] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 05/05/2009] [Indexed: 11/03/2022] Open
Abstract
The association of hemodialysis dosage with patient survival is controversial. Here, we tested the hypothesis that methods for survival analysis may influence conclusions regarding dialysis dosage and mortality. We analyzed all-cause mortality by proportional hazards and accelerated failure time regression models in a cohort of incident hemodialysis patients who were followed for 9 yr. Both models identified age, race, heart failure, physical functioning, and comorbidity scores as important predictors of patient survival. Using proportional hazards, there was no statistically significant association between mortality and Kt/V (hazard ratio 0.72; 95% confidence interval 0.45 to 1.14). In contrast, using accelerated failure time models, each 0.1-U increment of Kt/V improved adjusted median patient survival by 3.50% (95% confidence interval 0.20 to 7.08%). Proportional hazard models also yielded less accurate estimates for median survival. These findings are consistent with an additive damage model for the survival of patients who are on hemodialysis. In this conceptual model, the assumptions of the proportional hazard model are violated, leading to underestimation of the importance of dialysis dosage. These results suggest that future studies of dialysis adequacy should consider this additive damage model when selecting methods for survival analysis. Accelerated failure time models may be useful adjuncts to the Cox model when studying outcomes of dialysis patients.
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Affiliation(s)
- Christos Argyropoulos
- Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
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Scott MK, Shah NA, Vilay AM, Thomas J, Kraus MA, Mueller BA. Effects of peridialytic oral supplements on nutritional status and quality of life in chronic hemodialysis patients. J Ren Nutr 2009; 19:145-52. [PMID: 19218041 DOI: 10.1053/j.jrn.2008.08.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Our objective was to determine the effects of peridialytic oral supplements on nutritional markers and quality of life (QOL) in patients receiving maintenance hemodialysis. DESIGN This trial was open, prospective, nonrandomized, and comparative. SETTING This study was performed at an outpatient hemodialysis unit in a teaching hospital. PATIENTS This study included 88 adults with chronic kidney disease at stage 5. INTERVENTION This study involved directly observed nutrition therapy with >or=1 can of enteral nutrition (Nepro) with each hemodialysis session thrice weekly for 3 months, or standard care. MAIN OUTCOME MEASURE Changes in biochemical markers of nutritional status and QOL, as measured by the Kidney Disease Quality of Life-Short Form, were determined. RESULTS Peridialytic oral nutrition resulted in a significant difference between the nutrition and comparison groups in serum albumin change over time (P = .03; repeated-measures analysis of variance with covariates). Mean (+/-SD) serum albumin concentration did not differ between baseline and month 3 in the nutrition group (3.68 +/- 0.33 g/dL vs. 3.75 +/- 0.40 g/dL; P = .12), but in the comparison group, serum albumin levels declined significantly (3.93 +/- 0.34 g/dL at baseline versus 3.81 +/- 0.37 g/dL at month 3; P = .04). The "role-physical" domain score of the Kidney Disease Quality of Life-Short Form significantly changed over time in the nutrition group versus the comparison group (P = .02; repeated-measures analysis of variance with covariates). Nepro was well-tolerated, and greater than 80% of the prescribed therapy was consumed. CONCLUSION Oral nutrition, as part of structured, directly observed peridialytic therapy in chronic hemodialysis patients, was well-accepted, and resulted in the maintenance of serum albumin levels and QOL with respect to impact of physical health on daily activities. These findings need to be confirmed in a randomized, controlled trial.
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Affiliation(s)
- Meri Kay Scott
- Clinical Development Organization, Eli Lilly and Co, Indianapolis, Indiana
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Spiegel BMR, Melmed G, Robbins S, Esrailian E. Biomarkers and health-related quality of life in end-stage renal disease: a systematic review. Clin J Am Soc Nephrol 2008; 3:1759-68. [PMID: 18832106 DOI: 10.2215/cjn.00820208] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Health-related quality of life (HRQOL) predicts mortality in ESRD, yet adoption of HRQOL monitoring is not widespread, and regulatory authorities remain predominantly concerned with monitoring traditional biologic parameters. To assist with future efforts to adopt HRQOL monitoring while acknowledging the importance of biomarkers, this study sought to establish which domains of HRQOL are most affected by ESRD and to measure the strength of evidence linking common biomarkers to HRQOL in ESRD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A systematic review was performed to identify studies that measured HRQOL in ESRD. Data were abstracted according to a conceptual model regarding the measurement of HRQOL differences, and HRQOL data were converted to weighted mean effect sizes and correlation coefficients. RESULTS The impact of ESRD was largest in the Short Form 36 domains of physical functioning (e.g., role-physical, vitality) and smallest in mental functioning (e.g., mental health, role-emotional). Dialysis adequacy, as measured by Kt/V, was a poor correlate for Short Form 36 scores. Similarly, mineral metabolism (e.g., calcium x phosphorous, parathyroid hormone) and inflammatory (e.g., C-reactive protein, TNF) biomarkers had small effect sizes and correlations with HRQOL. In contrast, hematocrit demonstrated small to moderate relationships with mental and physical HRQOL, and nutritional biomarkers (e.g., albumin, creatinine, body mass index) demonstrated moderate to large relationships. CONCLUSIONS HRQOL in ESRD is most affected in the physical domains, and nutritional biomarkers are most closely associated with these domains. In contrast, Kt/V, mineral metabolism indices, and inflammatory markers are poor HRQOL correlates.
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Affiliation(s)
- Brennan M R Spiegel
- Department of Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA.
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Mau LW, Chiu HC, Chang PY, Hwang SC, Hwang SJ. Health-related Quality of Life Taiwanese Dialysis Patients: Effects of Dialysis Modality. Kaohsiung J Med Sci 2008; 24:453-60. [DOI: 10.1016/s1607-551x(09)70002-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Unruh ML, Newman AB, Larive B, Dew MA, Miskulin DC, Greene T, Beddhu S, Rocco MV, Kusek JW, Meyer KB. The influence of age on changes in health-related quality of life over three years in a cohort undergoing hemodialysis. J Am Geriatr Soc 2008; 56:1608-17. [PMID: 18721224 DOI: 10.1111/j.1532-5415.2008.01849.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the extent to which persons aged 70 and older undergoing hemodialysis (HD) had greater changes in health-related quality of life (HRQOL) over 3 years than younger patients undergoing HD. DESIGN Longitudinal. SETTING The Hemodialysis Study (HEMO Study) was a randomized, clinical trial of the effects of HD dose and membrane flux on mortality and morbidity in patients undergoing chronic dialysis. PARTICIPANTS Secondary analysis of the HEMO Study. MEASUREMENTS Participants completed the Index of Well-Being (IWB) and the Kidney Disease Quality of Life-Long Form (KDQOL-LF), which also includes the Medical Outcomes Study 36-item Short Form Questionnaire (SF-36) annually. Changes in subjects those aged 70 and older were compared with changes in subjects aged 55 to 69 and 18 to 54. RESULTS At baseline, 1,813 (98%) of HEMO participants completed HRQOL surveys. Their mean age was 58, 56% were female, 64% were black, and mean duration of dialysis was 3.8 years. In subjects with HRQOL data at the first three annual assessments, there were no substantial mean declines in the SF-36 Physical or Mental Component Summary scales over 3 years. In models incorporating effects of attrition, the differences in average change over 3 years between patients undergoing HD aged 70 and older and the younger cohorts were small in magnitude. There were high rates of adverse HRQOL events in all age groups and significantly higher composite event rates of death or clinically significant decline in HRQOL over 3 years was found in subjects aged 70 and older. CONCLUSION Although HRQOL was impaired in the population undergoing HD, HRQOL scores at baseline reflect a better-preserved multidimensional quality of life in respondents in the HEMO Study aged 70 and older than in younger patients undergoing HD. There was no substantial relationship between age and average decline in HRQOL score over 3 years in participants in the HEMO Study.
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Affiliation(s)
- Mark L Unruh
- Department of Medicine, University of Pittsburgh, Pennsylvania, USA.
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Genton L, van Gemert W, Pichard C, Soeters P. Physiological functions should be considered as true end points of nutritional intervention studies. Proc Nutr Soc 2007; 64:285-96. [PMID: 16048659 DOI: 10.1079/pns2005434] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
With the beginning of this millennium it has become fashionable to only follow ‘evidence-based’ practices. This generally-accepted approach cruelly negates experience or intelligent interpretation of pathophysiology. Another problem is that the great ‘meta-analysts’ of the present era only accept end points that they consider ‘hard’. In the metabolic and nutritional field these end points are infection-related morbidity and mortality, and all other end points are considered ‘surrogate’. The aim of this presentation is to prove that this claim greatly negates the contribution of more-fundamentally-oriented research, the fact that mortality has multifactorial causes, and that infection is a crude measure of immune function. The following problems should be considered: many populations undergoing intervention have low mortality, requiring studies with thousands of patients to demonstrate effects of intervention on mortality; nutrition is only in rare cases primary treatment, and in many populations is a prerequisite for survival rather than a therapeutic modality; once the effect of nutritional support is achieved, the extra benefit of modulation of the nutritional support regimen can only be modest; cost–benefit is not a valid end point, because the better it is done the more it will cost; morbidity and mortality are crude end points for the effect of nutritional intervention, and are influenced by many factors. In fact, it is a yes or no factor. In the literature the most important contributions include new insights into the pathogenesis of disease, the diminution of disease-related adverse events and/or functional improvement after therapy. In nutrition research the negligence of these end points has precluded the development and validation of functional end points, such as muscle, immune and cognitive functions. Disability, quality of life, morbidity and mortality are directly related to these functional variables. It is, therefore, of paramount importance to validate functional end points and to consider them as primary rather than surrogate end points.
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Affiliation(s)
- L Genton
- Department of Surgery, University Hospital, Maastricht, The Netherlands
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Fukuhara S, Yamazaki S, Marumo F, Akiba T, Akizawa T, Fujimi S, Haruki S, Kawaguchi Y, Nihei H, Shoji T, Maeda T. Health-Related Quality of Life of Predialysis Patients with Chronic Renal Failure. ACTA ACUST UNITED AC 2006; 105:c1-8. [PMID: 17106210 DOI: 10.1159/000096802] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Accepted: 07/29/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Health-related quality of life (HQOL) of predialysis patients with chronic renal failure (CRF) has received less attention than that of dialysis patients. We investigated changes in SF-36 over 1 year and examined associations between clinical parameters and SF-36 in predialysis CRF patients. METHODS Subjects were 471 predialysis CRF patients. SF-36 and clinical parameters were measured every 8 weeks for 48 weeks. Of the 471 subjects, 294 underwent one or more follow-ups. We analyzed the pooled dataset of the 294 CRF patients and 2002 subjects from Japanese general population using analysis of covariance. RESULTS After adjustment for age and sex, the 1-year declines in SF-36 domains were significantly greater in the predialysis patients than in the general population. For a 10% decline in hematocrit from the baseline survey value, the decline in vitality of SF-36 was 4.5 points (p = 0.003), while for a 10% increase in serum creatinine from the baseline survey value, respective declines in physical functioning, role-physical and mental health were 1.2 (p = 0.004), 1.9 (p = 0.035), and 1.0 points (p = 0.008). CONCLUSION Among these predialysis CRF patients, the decline in HQOL was faster than that in the general population, and was associated with an increase in serum creatinine and decline in hematocrit.
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Affiliation(s)
- Shunichi Fukuhara
- Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Unruh M, Miskulin D, Yan G, Hays RD, Benz R, Kusek JW, Meyer KB. Racial differences in health-related quality of life among hemodialysis patients. Kidney Int 2004; 65:1482-91. [PMID: 15086492 DOI: 10.1111/j.1523-1755.2004.00529.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED BACKGROUND; Despite technical progress in therapy, hemodialysis patients continue to report health-related quality of life (HRQOL) substantially lower than that of the general population. While African Americans with end-stage renal disease (ESRD) survive longer than members of other races, few studies have compared the HRQOL of African Americans with that of non-African Americans. METHODS We examined differences in sociodemographic, clinical, and HRQOL variables by race. A multiple regression model assessed the extent to which race was associated with differences in HRQOL scores after adjustment for sociodemographic and clinical variables. Racial differences in the relationship between comorbid disease severity and HRQOL were explored. RESULTS; In adjusted models, African Americans had higher scores in the Index of Well-Being and burden of kidney disease, but lower scores in cognitive function (all P < 0.05). For scales reflecting symptoms and effects of kidney disease, sleep quality, and the Physical Component Summary, the fall in HRQOL with increasing comorbidity was significantly greater in non-African Americans (all P < 0.05). After adjustment, there were no racial differences in scores on the Mental Component Summary, social support, dialysis staff encouragement, or patient satisfaction. CONCLUSION To our knowledge, ESRD is the only chronic illness for which African Americans report significantly better psychologic well being and a lower burden of disease than non-African Americans. Further research is needed to understand whether these experiences affect health care utilization, medical decision making, and patient survival. Clarification of the reasons for race differences may suggest measures to improve HRQOL for all patients with ESRD.
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Affiliation(s)
- Mark Unruh
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15261, USA.
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