Introduction:
Patients on maintenance hemodialysis have significant impairments in health related quality of life and nutrition. This study was designed to investigate whether dialysis adequacy is associated with Quality of life and Nutritional status of the end-stage kidney disease patients on maintenance hemodialysis.
Methods:
This cross sectional study recruited 203 patients who were on maintenance hemodialysis for more than 3 months at Max Superspeciality Hospital, Vaishali from 01/02/2023 to 31/01/2024. Patients with malignancy, cognitive impairment, other organ failure like advanced liver failure or heart failure were excluded. Patients were grouped based on standard Kt/V (std Kt/V ≥2.1 and <2.1) and frequency of dialysis per week.
Demographic data and laboratory data were recorded. Patients were interviewed by Kidney Disease Quality Of Life Short Form Questionnaire (KDQOL-SF-36 version 1.3) for assessment of quality of life. Nutritional status was assessed using Modified Subjective Global Assessment- Dialysis Malnutrition score (SGA-DMS).
Results:
Mean age of patients was 58.8± 11.9 years. 70% patients were men. 96 patients were on twice a week hemodialysis and 107 on thrice a week. 80 patients had achieved std Kt/V ≥ 2.1 and 123 patients had std Kt/V <2.1. All the patients with std Kt/V≥2.1 were receiving hemodialysis thrice a week. Duration of dialysis in patients with std Kt/V ≥2.1 was longer compared to patients with std Kt/ V<2.1 (45 months vs 27.9 months, p < 0.001).Mean haemoglobin, serum albumin, ferritin, TSAT, PTH were not significantly different in two groups.
Quality of life as indicated by total SF36 score was similar in both the groups (58.17±0.07 vs 56.19±11.28, p=0.205). Patients who achieved std Kt/V≥ 2.1 fared better in terms of symptom problem list parameter, albeit not statistically significant (71.28± 14.2 vs 67.47 + 14.09 p=0.04). Quality of life score was not different in patients who were receiving dialysis twice a week as compared to thrice a week (50.02±15.03 vs 48.73±12.12 respectively, p=0.499).
Sixty patients (75 %) in the group with std Kt/V ≥ 2.1 were malnourished (mild 42 (52.5%); moderate 18 (22.5%)) as compared to ninety one (74 %) patient in std Kt/V < 2.1 (mild 53 (43.4%) ; moderate 38 (31.1%)). None of the patients had severe malnutrition (SGA-DMS=35). Moderate malnutrition was more common in the group with std Kt/V < 2.1 (31.1% vs 22.5%, p=0.341), and in patients receiving twice a week dialysis (35.8% vs 20.6%, p=0.046).
Conclusions:
This cross-sectional study demonstrates that small solute clearance or frequency of dialysis per week did not influence the quality of life as assessed by SF-36. Nutritional status was better in patients who were on thrice a week dialysis and in patient who could achieve std Kt/V≥ 2.1. Long-term prospective studies with larger group of patients are required to ascertain these observations.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.