Survival and Quality of Life on Maintenance Hemodialysis: Results from a Multicenter Study

The Malnutrition-Inflammation Score: A Valid Nutritional Tool to Assess Mortality Risk in Kidney Transplant Patients

Objectives: To assess the quality of life (QOL) and factors affecting QOL in hemodialysis patients so as to improve QOL of dialysis patients and provide the basis for better clinical care.Methods: A retrospective study was performed to assess the QOL and factors affecting QOL in hemodialysis patients. We recruited 125 patients who had been receiving hemodialysis for at least 2 years in the dialysis units of nine hospitals in Shanxi Province, China, and conducted a multi-center questionnaire survey between 1 May 2015 and 1 July 2016. We investigated the patients’ general condition and clinical data and used the Short Form-36 (SF-36) scale to measure QOL in these patients.Results: The overall SF-36 score was 107.55 ± 14.50 in patients who had received hemodialysis for more than 2 years. Age (p < .05, F = 4.972) and gender (p < .01, t = 3.993) significantly affected the overall QOL score in these patients. Education level was also an influencing factor (p < .05, Z= −0.838), especially on the mental health of these patients. In addition, residual urine volume (p < .05, Z= −2.465) and diabetic nephropathy (p < .05, Z= −2.062) were important factors that affected the physical strength and QOL score in these patients. However, sources of medical expenses, marital status and different methods of dialysis, had no effect on the QOL score.Conclusion: The overall score of QOL in patients who have received maintenance hemodialysis for more than 2 years is higher in Shanxi Province than that in other provinces of China. Only a few factors influenced the QOL of these patients.

Objective To investigate the quality of life (QOL) of maintenance hemodialysis (MHD) patients and its influencing factors. Methods A total of 257 MHD patients in our hospital were recruited in this study. Clinical data of the patients were collected, and the QOL was assessed by MOS 36 item short form health survey(SF-36). Nutritional status of patients was evaluated by modified quantitative subjective global assessment (MQSGA). Univariate analysis of variance, pearson correlation analysis and multiple linear stepwise regression analysis were performed to determine the effect of related factors on QOL scores. Results The scores of all scales of SF-36 evaluation in MHD patients were relatively lower than that of general population as reported before. Their physiological component summary (PCS) score decreased gradually as age grew, nevertheless, the mental component summary (MCS) score was highest in the group aged 41-60. The score was lower in patients with moderate to severe malnutrition or diabetic nephropathy when compared with other patients. Univariate analysis of variance also revealed that high SF-36 scores associated with higher education or income. Multivariate analysis indicated that PCS score and total SF-36 score of MHD patients were positively correlated with body mass index (BMI) and cholesterol, but negatively correlated with diabetic nephropathy, pulmonary artery systolic pressure and MQSGA score (all P<0.05). There was positive correlation between MCS score and income, yet negative correlation between MCS score and MQSGA score (all P<0.05). Conclusion MHD patients had relatively poor QOL. Primary diseases and nutritional status were probably the main influencing factors. Age, educated level, family income and pulmonary artery systolic pressure might also have effects on their QOL. Key words: Hemodialysis; Quality of life; SF-36 scales; Modified quantitative subjective global assessment

Background and Aims Uremic pruritus (UP) is a frequent problem in hemodialysis patients. Despite the strong impact in the quality of life, its pathogenesis is not completely understood. Multiple factors are found associated with UP in several studies. The aim of this study was to evaluate the frequency and severity of pruritus in maintenance hemodialysis (MHD) patients, associated factors and outcome. Method This observational study was performed between January 2016 and December 2019. A total of 85 adult (age &amp;gt;18 years) MHD patients were included in this study. Data were collected using a questionnaire. The severity of pruritus was scored according to the localization and the disturbance in usual work and sleep during the previous month. Mild: Episodic and localized pruritus without disturbance in usual work and sleep; Moderate: Generalized and continuous pruritus without sleep disturbance; Severe: Generalized and continuous pruritus with sleep disturbance. Some relevant demographic, clinical and laboratory parameters were evaluated. During follow up 2 patients underwent transplantation and 3 patients lost follow up. Mortality was the recorded outcome. We investigated whether demographic, clinical, biochemical parameters and outcome were correlated to UP. Results Pruritus was present in 61 % of the hemodialysis patients. Pruritic patients were older: median years 57.5(48.5-66.5) vs. 52(45-59) non pruritic; p=0.046 and male patients were significantly more affected (76.9% male vs. 23.1% female; p=0.015). Pruritic patients had shorter time on HD (mean years 5.2±3.4 vs. 7.8±4.2 non pruritic; p=0.003). The intensity of itching was mild, moderate and severe, in 35.3%, 20% and 5.9% of patients, respectively and severe pruritic patients had a significantly shorter time on HD (3.3±1.7 years; p=0.17). Xerosis was present in 84.6% of pruritic patients vs. 66.7% of non-pruritic; p=0.053. We didn’t find association with marital status, level of education, employment, presence of neuropathy, history of atopy, Diabetes Mellitus (DM). Urea redaction ratio (URR) was significantly lower in our pruritic patients: median 67(63-71) vs. 72(66-74) non-pruritic; p=049. Among biochemical parameters phosphorus (mg/dl) was significantly higher between pruritic patients: median 5.6(5.0-6.6) vs. 5.0(3.9-6.0) non-pruritic; p=0.051. Univariate logistic regression analysis showed significant factors associated with UP: male gender OR=3.1, 95% CI: 1.2-8.0, p=0.017; time on HD OR=0.8, 95% CI: 0.73-0.95, p=0.006; phosphorus level OR=1.4, 95% CI: 1.0-2.0, p=0.034. Multivariate logistic regression analysis adjusted for confounders (age, DM) identified as independent factor associated with UP: male gender OR=3.9, 95% CI: 1.3-11.7, p=0.017 During 4 years follow up 29 (36.3%) patients died. Cox Regression analysis showed moderate pruritus as independent factor for mortality (64.7% dead vs. 35.3% survived within moderate pruritic patients) OR=3.2, 95% CI: 1.4-9.0, p=0.027 (fig. 1). Conclusion UP was a frequent complication in the first years of MHD patients and associated with a worse outcome. A multidimensional approach should be adapted for pruritic MHD patients. Data regarding the possible risk factors of male pruritic MHD patients must be followed closely.

Cognitive Impairment in Dialysis Patients: Focus on the Blood Vessels?

Objective To evaluated the quality of life of maintenance hemodialysis (MHD) and CAPD patients and to discuss the influence factors of quality of life of MHD and CAPD patients. Methods The objects' clinical and questionnaire data were obtained from the Department of Nephrology and Blood Purification Center, the First Affiliated Hospital of Zhengzhou University, from July to September 2016, which inclued 118 MHD patients and 76 CAPD patients.The quality of life of MHD and CAPD patients was evaluated through the application of KDQOL-SFTM 1.3 version. At the meantime, related indexes reflecting nutrition and the adequecy of hemodialysis of MHD and CAPD patients were screened. Results The KDTA score of MHD patients was (62.4±11.3), SF-36 score was (58.3±17.9), significantly lower than the general population(P<0.05). In KDTA and SF-36, the score of 11 fractal dimensions was slightly higher than the United States, and the scores of 6 fractal dimensions was slightly higher than Spain.Compared with the survey data in Guangzhou, scores of all fractal dimensions were obviously improved and the same as survey data of Shenyang and Hefei.The KDTA score of CAPD patients was (71.4±8.9), SF-36 score was (61.6±16.3), significantly lower than the general population(P<0.05). In KDTA and SF-36, the score of 7 fractal dimensions was significantly higher than Hongkong, and the rest of which were all relatively low than Hongkong.Compared with the survey data in Guangzhou, scores of all fractal dimensions were obviously improved and the same as survey data of Shenyang and Hefei.The KDTA and SF-36 overall scores of MHD patients were significantly lower than the CAPD patients(P<0.05). In 11 fractal dimensions, the scores of all fractal dimensions of CAPD patients were higher than MHD patients and showed significant differences in EKD, BKD, WS, CF, QSI, SexF, SoS and PS(P<0.05). In 8 fractal dimensions’ scores of SF-36, besides PF, SF and Energy, the other fractal dimensions’ scores of CAPD patients were all higher than MHD patients and showed significant differences in PF, RP, BP, EWB, RE and SF(P<0.05). The general data for the MHD patients showed that the quality of life existed differences (P<0.05) among the sex, literacy, annual household income, the conditions of health insurance, the primary diseases and the dialysis age, and also had a correlation (P<0.05) with the scores of SAG, ALB, HB, Kt/V, iPTH, Ca×P. Multiple-factor analysis showed that dialysis age, sex (female), the primary disease (DN), iPTH, Kt/V, the score of SGA was the independent risk factors for the quality of life of the MHD patients, of which dialysis age was a long-time effect factor. The general data for the CAPD patients showed that professional conditions, the conditions of health insurance, the causes of primary diseased and the dialysis age existed differences (P<0.05), and also had a correlation (P<0.05) with the score of SAG, ALB, HB, Kt/V, multiple-factor analysis showed that the primary disease(DN), Kt/V, ALB, the score of SGA were the independent risk factors for the quality of life of the CAPD patients. Conclusions MHD and CAPD patients have a low quality of life, there are differences between developing and developed country.Diabetic Nephropathy, Kt/V, SGA are the common independent risk factors for the quality of life of the MHD and CAPD patients. Key words: Maintenance hemodialysis; CAPD; Quality of life

Introduction: Chronic kidney disease (CKD) is a global public health concern that has a significant financial impact on health-care systems. Protein energy malnutrition (PEM) in MHD patients is associated with increased in mortality, reduced quality of life and increases morbidity, hospitalization, and mortality. According to a global meta-analysis of 65 studies from 10 geographical regions, malnutrition is highly prevalent in maintenance hemodialysis (MHD) patients. The gold standard for evaluating the nutritional state of patients with ESKD is total body nitrogen. SGA tool, MIS, mini nutritional assessment (MNA) tool, Health-Related Quality of Life Short Form 36-Index (WHO HRQOL SF 36), and subjective global nutritional assessment are some of the tools that are practical, validated, and affordable questionnaires that can be utilized in the public domain. A combination of anthropometric measurements and nutritional assessment tools is the most effective way to determine nutritional status. Aim: To assess the nutritional status of maintenance hemodialysis patients in a tertiary care centre using the 7 point SGA method. Type of Study: observational study. Study Setting: Tertiary care hospital in south India. Study Population: Patients undergoing maintenance Hemodialysis in our hospital. Results: Total Number of patients included in the study is 68. Mean age is 46.78years with a standard deviation of 11.181years. Male predominance was seen in the study group 72.1% to female patients 27.9%. Hypertension is the most common associated comorbidity 67.6%, followed by Diabetes mellitus 39.7%. Majority of the study group are in the Dialysis vintage group 1-2 years. Male patients have significant association with Malnutrition (P =0.006*). There is no significant correlation with kuppuswamy socio-economic class(P=0.123). There is no significant correlation between dialysis vintage and malnutrition (P=0.35). There was significant association with serum albumin(P&lt;0.001), Body Mass Index (P&lt;0.001), Mid Arm Circumference (P&lt;0.001), Mid Arm Muscle Circumference (P&lt;0.001), Skin Fold Thickness-Triceps (P&lt;0.001). Conclusion: Moderate malnutrition was present in majority of patients 62%. Severe malnutrition was seen in only 0.8% patients. Statistically significant association was noted between anthropometric measurements-BMI, MAMC, MAC, Skin fold thickness and malnourishment. Serum albumin has significant association. Limitations: Small sample size. SGA is subjective assessment, has inter observer variations.

Chronic kidney disease (CKD) is a life-threatening illness that causes significant pain to patients, this serious impact on patient's physical fitness and quality of life. Previous studies have found that exercise training has a positive impact on improving CKD patients' symptoms. In order to improve patients' physical function and quality of life, this meta-analysis aimed to evaluate the application value of aerobic exercise combined with resistance training in maintenance hemodialysis (MHD) patients. A computer search was conducted of PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases. The search keywords were: "chronic kidney disease", "end-stage renal disease", "hemodialysis", "maintenance hemodialysis", "exercise", "aerobic exercise", "resistance exercise", "combined exercise", and "physical exercise". Included studies should meet the following criteria, the study population is MHD patients, the intervention is aerobic exercise combined with resistance training, and a randomized controlled study with clearly documented outcome indicators. The Cochrane risk-of-bias tool was used to evaluate the quality of the included studies, and the meta-analysis was performed by RevMan 5.20 software (Cochrane Collaboration). A total of seven articles met the inclusion criteria. The included studies were assessed for risk of bias and met the inclusion criteria. The results of the meta-analysis showed significant differences between patients who received aerobic exercise combined with resistance training and control patients (the rest treatment was same as the study group) in the urea clearance index [mean difference (MD) =0.16, 95% confidence interval (CI): 0.10, 0.21], mental health (MD =7.54, 95% CI: 2.74, 12.35) and social functioning (MD =9.98, 95% CI: 1.52, 18.44). However, there was no significant difference in physical functioning between the two groups (MD =1.26, 95% CI: -1.20, 3.71). Although aerobic exercise combined with resistance training did not improve the physical functioning of MHD patients, it improved their urea clearance, mental health, and social functioning and positively affected their quality of life, risk of bias should also be considered. In the future, multi-center studies with larger samples should be used to explore the effects of aerobic exercise combined with resistance training on MHD patients.

Objective To analyze the influencing factors of serum fibroblast growth factor 23 (FGF23) level in maintenance hemodialysis (MHD) patients, and to explore its relationship with mineral bone metabolism disorders and vascular calcification. Methods From January to February of 2018, a total of 380 patients who had undergone MHD for more than 3 months in our hospital were enrolled for this study. Clinical parameters were recorded, including gender, age, dialysis age, dialysis adequacy, and use of phosphorus-reducing drugs. Before dialysis, blood was drawn for detection of serum calcium, phosphorus, intact parathyroid hormone (iPTH), and alkaline phosphatase as mineral bone metabolism indicators, as well as hemoglobin, albumin, blood glucose, blood lipids, high-sensitivity C-reactive protein (hs-CRP), and β2 microglobulin, etc. The serum level of FGF23 was determined with enzyme-linked immunosorbent assay (ELISA), while multislice spiral CT (MSCT) was used to evaluate coronary artery calcification scores. The t-test and chi-square test were applied to analyze the influencing factors of FGF23 in the MHD patients. Multivariate linear regression analysis was performed for multivariate analysis. The chi-square test was also used to analyze the correlation between parathyroid hormone and coronary artery calcification scores in the MHD patients with different FGF23 levels. Results The median level of serum FGF23 in the MHD was 8 905.3 pg/ml. According to 50% of the FGF23 median level, the patients were divided into high-level group and low-level group. Univariate analysis showed that dialysis age, dialysis duration, dialysis ultrafiltration volume, and dialysis frequency were the influencing factors of serum FGF23 level. The level of FGF23 was higher in patients with larger age, longer duration of dialysis, more frequent dialysis, and greater volume of dialysis ultrafiltration (P<0.05). In the FGF23 high-level group, blood urea nitrogen, serum creatinine, and serum β2 microglobulin levels were higher than in the FGF23 low-level group (P<0.05). Multivariate linear regression analysis showed that dialysis age and serum creatinine were risk factors for the increase of FGF23 (P<0.001). And high FGF23 level was associated with the levels of serum calcium, serum phosphorus, iPTH, and high coronary artery calcification scores. Conclusions Dialysis age, dialysis duration, dialysis ultrafiltration volume, dialysis frequency, blood urea nitrogen, serum creatinine, serum β2 microglobulin, were related to the maintenance of FGF23 elevation in MHD patients. Dialysis AGE and serum creatinine were risk factors for FGF23 elevation. FGF23 was significantly associated with mineral-bone metabolism and coronary artery calcification in MHD patients. Key words: Hemodialysis; Fibroblast growth factor 23; Vascular calcification; Mineral-bone metabolism disorder; Cardiovascular disease

Objective To investigate the psychological status and related factors in patients with maintenance hemodialysis in Huzhou city. Methods 376 cases of maintenance hemodialysis were selected as the research subjects in Huzhou First People's Hospital.The anxiety and depression status in maintenance hemodialysis patients were investigated by issuing questionnaires.To study the relationship between anxiety and depression, gender, age, social support, nutritional status, complications, and in maintenance hemodialysis patients.At the same time, the quality of life was evaluated by SF-36 scale. Results Issuing 376 questionnaires, a total of 373 points, the effective recovery rate was 99.20%.In 373 patients, there were 182 patients (48.79%) with no depression, mild depression in 78 cases (20.91%), moderate depression in 59 cases (15.82%), severe depression in 54 cases (14.48%).51.21% patients had different degree of depression.Of the 373 patients, there were 123 patients (32.97%) with no anxiety, mild anxiety in 141 cases (37.80%), mild and moderate anxiety in 55 cases (14.75%), moderate anxiety in 33 cases (8.85%), severe anxiety in 21 cases (5.63%). A total of 67.03% patients had different degrees of anxiety.Huzhou city maintenance hemodialysis, female patients had depression rate of 80.70%, anxiety rate of 65.50%, which were significantly higher than the rate of depression 55.45%, anxiety rate 39.11% in male patients, the differences were statistically significant (P<0.01-0.05). In maintenance hemodialysis patients, the anxiety and depression status gradually increased with age.Severe malnutrition in maintenance hemodialysis patients, the rate of depression, anxiety rates were 80.65%, 90.32%, the rates of depression, anxiety were 44.49%, 61.81% in normal and mild malnutrition patients, the differences were statistically significant (all P<0.01). SF-36 scale showed that most of the patients with maintenance hemodialysis patients had poor quality of life, and the function was limited. Conclusion Maintenance hemodialysis patients, the general existence of anxiety and depression in the mental state in Huzhou city.Moreover, the psychological state of the patients is influenced by sex, age, nutrition status, and other factors.In clinical, it is needed to provide effective psychological intervention for patients to improve the quality of life, according to the psychological status and related factors of maintenance hemodialysis patients. Key words: Rend dialysis; Psychology, medical; Quality of life; Influence factors

The Nutritional and Inflammatory Evaluation in Dialysis patients (NIED) study: Overview of the NIED study and the role of dietitians

Objective To determine the influencing factors of life quality of patients undergoing maintenance hemodialysis(MHD). Methods SF-36 was used in 352 patients undergoing maintenance hemodialysis from the First People's Hospital of Luoyang, Luoyang Center Hospital Affilifated to Zhengzhou University, the First Affiliated Hospital of Henan University of Science and Technology, the Third Affiliated Hospital of Henan University of Science and Technology, the First Hospital of Traditional Chinese Medicine, the Second Hospital of Traditional Chinese Medicine, the 150th Hospital of Chinese People's Liberation Army. Hemodialysis patients' quality of life scores were calculated. The factors influencing the quality of life of MHD patients were analyzed and compared with healthy norm. Results The quality of life of the patients with hemodialysis was related to gender, age, dialysis age, haemoglobin and Kt/V. Conclusion MHD patients quality of life is significantly lower than healthy people. Age, gender, dialysis age, hemoglobin, Kt/V are the important factors influencing the MHD patients' quality of life. Improviythese factors may be expected to improve the quality of life of MHD patients. Key words: Hemodialysis; Quality of life; Dialysis adequacy; Short-form 36 health survey questionnaire

Background: Anemia is common in patients with end stage renal disease (ESRD) and is associated with impaired quality of life (QOL). This study was done to evaluate the QOL of ESRD patients on maintenance hemodialysis (MHD) with different levels of hemoglobin (Hb).Methods: This cross-sectional study was conducted from January to December 2013 on 135 adult ESRD patients on MHD for ?4 months, at hemodialysis units of three tertiary care hospitals in Dhaka, Bangladesh. The patients were divided into three groups based on Hb levels (Group 1: Hb &lt;9 gm/dl, n=45, 33%; Group 2: Hb 9-11 gm/dl, n=53, 39% and Group 3: Hb &gt;11 gm/dl, n=37, 28%), provided their Hb levels were stable [ie. maintained with erythropoietin (EPO) or blood transfusion (BT) or both] over the previous four months. Subjects were interviewed by principal investigator using Kidney Disease Quality of Life Short Form Tool (KDQOL-SF-36 version 1.3) consisting of two domains with 38 questions with each item put on a 0 to 100 range, higher scores indicating better QOL.Results: The mean age was 50+12 years with male predominance (male:female = 1.5:1). Mean duration of hemodialysis was 12±11.8 months (range 9 to 66 months). The average QOL score was 50. Comparison of QOL parameters between the three groups showed that symptoms/problems, effects of kidney disease, burden of kidney disease, cognitive function, quality of social interaction and sleep in the kidney disease specific domain as well as pain, emotional well-being, social function and energy/fatigue scale scores in the general health related domain were significantly higher in the group 2 and group 3 than group 1 patients (each with p&lt;0.001). Comparison of QOL parameters between anemia correction measures like EPO (n=65, 48.2%), BT (n=42, 31.1%) or both (n=28, 20.7%) showed that the group receiving EPO alone had better QOL [symptom/ problem (p 0.043), burden of kidney disease (p 0.000), sexual function (p 0.000), pain (p 0.008) and energy/ fatigue (p 0.036)] compared to those getting BT or even BT plus EPO.Conclusion: Patients were found to have better QOL with higher Hb levels. The overall QOL can be improved significantly by correction of anemia.Birdem Med J 2017; 7(3): 198-204

It is well documented that pulmonary congestion is common among patients undergoing treatment with hemodialysis, and recent evidence suggests a strong association with mortality ([1][1]–[4][2]). The cyclical, and very predictable, nature of each hemodialysis session carries several major risks

Mortality among hemodialysis patients in Europe, Japan, and the United States: Case-mix effects