Quality-of-life and mortality in hemodialysis patients

Roles of race and nutritional status

Usama Feroze, Nazanin Noori, Csaba P. Kovesdy, M. Molnár, David J. Martin, Astrid Reina-Patton, Debbie Benner, Rachelle Bross, Keith C. Norris, Joel D. Kopple, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Summary Background and objectives Maintenance hemodialysis (MHD) patients often have protein-energy wasting, poor health-related quality of life (QoL), and high premature death rates, whereas African-American MHD patients have greater survival than non-African-American patients. We hypothesized that poor QoL scores and their nutritional correlates have a bearing on racial survival disparities of MHD patients. Design, setting, participants, & measurements We examined associations between baseline self-administered SF36 questionnaire-derived QoL scores with nutritional markers by multivariate linear regression and with survival by Cox models and cubic splines in the 6-year cohort of 705 MHD patients, including 223 African Americans. Results Worse SF36 mental and physical health scores were associated with lower serum albumin and creatinine levels but higher total body fat percentage. Spline analyses confirmed mortality predictability of worse QoL, with an almost strictly linear association for mental health score in African Americans, although the race-QoL interaction was not statistically significant. In fully adjusted analyses, the mental health score showed a more robust and linear association with mortality than the physical health score in all MHD patients and both races: death hazard ratios for (95% confidence interval) each 10 unit lower mental health score were 1.12 (1.05-1.19) and 1.10 (1.03-1.18) for all and African American patients, respectively. Conclusions MHD patients with higher percentage body fat or lower serum albumin or creatinine concentration perceive a poorer QoL. Poor mental health in all and poor physical health in non-African American patients correlate with mortality. Improving QoL by interventions that can improve the nutritional status without increasing body fat warrants clinical trials.

Original languageEnglish
Pages (from-to)1100-1111
Number of pages12
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number5
DOIs
Publication statusPublished - May 1 2011

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Nutritional Status
Renal Dialysis
Quality of Life
Mortality
African Americans
Mental Health
Adipose Tissue
Serum Albumin
Survival
Creatinine
Mental Health Associations
Premature Mortality
Health
Proportional Hazards Models
Linear Models
Maintenance
Clinical Trials
Confidence Intervals

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Quality-of-life and mortality in hemodialysis patients : Roles of race and nutritional status. / Feroze, Usama; Noori, Nazanin; Kovesdy, Csaba P.; Molnár, M.; Martin, David J.; Reina-Patton, Astrid; Benner, Debbie; Bross, Rachelle; Norris, Keith C.; Kopple, Joel D.; Kalantar-Zadeh, Kamyar.

In: Clinical Journal of the American Society of Nephrology, Vol. 6, No. 5, 01.05.2011, p. 1100-1111.

Research output: Contribution to journalArticle

Feroze, U, Noori, N, Kovesdy, CP, Molnár, M, Martin, DJ, Reina-Patton, A, Benner, D, Bross, R, Norris, KC, Kopple, JD & Kalantar-Zadeh, K 2011, 'Quality-of-life and mortality in hemodialysis patients: Roles of race and nutritional status', Clinical Journal of the American Society of Nephrology, vol. 6, no. 5, pp. 1100-1111. https://doi.org/10.2215/CJN.07690910
Feroze, Usama ; Noori, Nazanin ; Kovesdy, Csaba P. ; Molnár, M. ; Martin, David J. ; Reina-Patton, Astrid ; Benner, Debbie ; Bross, Rachelle ; Norris, Keith C. ; Kopple, Joel D. ; Kalantar-Zadeh, Kamyar. / Quality-of-life and mortality in hemodialysis patients : Roles of race and nutritional status. In: Clinical Journal of the American Society of Nephrology. 2011 ; Vol. 6, No. 5. pp. 1100-1111.
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AU - Noori, Nazanin

AU - Kovesdy, Csaba P.

AU - Molnár, M.

AU - Martin, David J.

AU - Reina-Patton, Astrid

AU - Benner, Debbie

AU - Bross, Rachelle

AU - Norris, Keith C.

AU - Kopple, Joel D.

AU - Kalantar-Zadeh, Kamyar

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N2 - Summary Background and objectives Maintenance hemodialysis (MHD) patients often have protein-energy wasting, poor health-related quality of life (QoL), and high premature death rates, whereas African-American MHD patients have greater survival than non-African-American patients. We hypothesized that poor QoL scores and their nutritional correlates have a bearing on racial survival disparities of MHD patients. Design, setting, participants, & measurements We examined associations between baseline self-administered SF36 questionnaire-derived QoL scores with nutritional markers by multivariate linear regression and with survival by Cox models and cubic splines in the 6-year cohort of 705 MHD patients, including 223 African Americans. Results Worse SF36 mental and physical health scores were associated with lower serum albumin and creatinine levels but higher total body fat percentage. Spline analyses confirmed mortality predictability of worse QoL, with an almost strictly linear association for mental health score in African Americans, although the race-QoL interaction was not statistically significant. In fully adjusted analyses, the mental health score showed a more robust and linear association with mortality than the physical health score in all MHD patients and both races: death hazard ratios for (95% confidence interval) each 10 unit lower mental health score were 1.12 (1.05-1.19) and 1.10 (1.03-1.18) for all and African American patients, respectively. Conclusions MHD patients with higher percentage body fat or lower serum albumin or creatinine concentration perceive a poorer QoL. Poor mental health in all and poor physical health in non-African American patients correlate with mortality. Improving QoL by interventions that can improve the nutritional status without increasing body fat warrants clinical trials.

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