Hemodialysis treatment provides progressive improvement in decreasing the risk of
mortality and mobility. However, insufficient hemodialysis treatment and
hemodialysis related complications tend to decrease patient’s nutritional status and
overall quality of life.
The objective of this cross-sectional study was to determine the nutritional status and
quality of life among hemodialysis patients. A total of 90 subjects were recruited
from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation
of Malaysia. Data on socioeconomics, demography, medical history, hemodialysis
treatment and nutritional status were collected. Anthropometry assessment included
weight, height, mid-arm circumference and mid-arm muscle circumference, skin fold
thicknesses at four sides (biceps, triceps, subscapular and suprailliac), calf
circumference and bioimpedance assessment. Subjective Global Assessment was conducted. Biochemical indices including renal function test, liver function test,
glucose test, electrolytes, lipid profile, hemoglobin and hematocrit were ascertained.
Information on dietary intake were collected using 24-hour diet recall and one-day
food record. Information on appetite level and eating habits were collected. Kidney
Disease Quality of Life Short Form was used to determine quality of life of the
subjects.
Subjects comprised 48.9% males and 51.1% females. The sample size predominately
Chinese (n=62, 68.9%), followed by Malays (n=19, 21.1%), Indians (n=7, 7.8%) and
others (n=2, 22.0%). The mean age of subjects was 49.7 ± 14.1. Approximately 30%
of the subjects achieved the recommended body mass index for hemodialysis patients.
Approximately 80% and 34% of the subjects had triceps skinfold and mid-arm
circumference less than 50th percentiles, respectively. Approximately 48% subjects
had serum albumin level lower than 4.0 mg/dL. About 58.6% had elevated serum
phosphate (> 1.6 mmol/L). For lipid profile, 28.8% subjects had elevated total
cholesterol (> 5.2 mmol/L), 71.1% had serum cholesterol of less than 5.2 mmol/L.
The mean total energy and protein intake was 26.8 ± 7.0 kcal/kg and 1.0 ± 0.3 g/kg,
respectively.
Results of the Kidney Disease Quality of Life Short Form analysis showed that the
highest score was for dialysis staff encouragement (75.28 ± 23.55). The lowest score
was for work status (27.78 ± 34.4). In the General Linear Model univariate analysis,
blood flow was found to contribute to complication of the kidney, while calf circumference and mid-arm muscle circumference were predictors for the support and
satisfaction of the treatment, blood flow, serum albumin, serum creatinine and protein
intake were predictors for the physical health composite. As for mental health
composite, diabetes was the only contributory factor. Multivariate regression showed
similar results were obtained with exception of treatment support and satisfaction.
In conclusion, low blood flow, diabetes, increased serum calcium and low serum
creatinine had an impact on quality of life of the subjects. Longitudinal study is
required to determine the cause and effect mechanism between the associated factors
and quality of life