Research reportRelationships between appetite and quality of life in hemodialysis patients☆
Highlights
► Hemodialysis patients with a reduced appetite scored lower in nine domains of Quality of Life (QoL). ► Nutritional status and appetite were important components of the physical health domain of QoL. ► Appetite was less important for the SF12 mental health and kidney disease summary domains. ► Monitoring nutritional status and appetite is an important component of care.
Introduction
While maintenance hemodialysis can prolong the lives of patients with chronic kidney disease, maintaining quality of life (QoL) is an important consideration and is one indicator of the effectiveness of the medical care that patients receive (Valderrábano, Jofre, et al., 2001). QoL decreases with the progression of kidney disease and is significantly lower in hemodialysis patients than healthy controls (Neto et al., 2000, Gorodetskaya et al., 2005, Loos-Ayav et al., 2008).
The Kidney Disease Quality of Life (KDQOL) survey has been widely used in this population (including in the international Dialysis Outcomes and Practice Patterns Study (Mapes, Lopes, et al., 2003) and is a valid method of measuring QoL in hemodialysis patients (Hays, Kallich, et al., 1994). It includes the SF-36 as the generic core, supplemented with additional items targeted at the specific concerns of dialysis patients. These include symptoms/problems, effects of kidney disease on daily life, burden of kidney disease, cognitive function, work status, quality of social interaction and sleep. No studies have reported the QoL of Australian hemodialysis patients using this kidney-disease specific approach.
A reduction in self-reported appetite has been closely linked with QoL in hemodialysis patients (Carrero et al., 2007, Kalantar-Zadeh et al., 2001) although it is unknown whether this is related to the kidney-disease specific components of QoL. Visual Analog Scales (VAS) provide a more useful method of assessing appetite in research compared to categorical methods, as more moderate sample sizes are needed to show clinically meaningful and statistically significant effects. We have previously demonstrated that VAS are sensitive to detect associations between subjective appetite ratings and a range of nutritional and inflammatory markers in hemodialysis patients (Zabel, Ash, et al., 2009).
A strong relationship has been demonstrated between nutritional status and QoL in pre-dialysis patients and other populations (Gleason et al., 2002, Kuehneman et al., 2002, Davidson et al., 2004, Hickman et al., 2004, Isenring et al., 2004, Wolf et al., 2004). Improvements in nutritional status correlate with improvements in quality of life, both in pre-dialysis chronic kidney disease (Campbell, Ash, et al., 2008) and other populations (Hickman et al., 2004, Davidson et al., 2004, Isenring et al., 2004). Subjective Global Assessment (SGA) and the scored Patient-Generated Subjective Global Assessment (PGSGA) are widely used methods of measuring nutritional status in CKD in Australia (Campbell, Ash, et al., 2009) as recommended in the Australian Evidence Based Practice Guidelines for the Nutritional Management of Chronic Kidney Disease (Ash and Campbell, 2006), but there is minimal evidence from Australian hemodialysis patients on the relationship between nutritional status and QoL.
The aim of this study was to explore the association between appetite and kidney disease specific QoL in a sample of maintenance hemodialysis patients.
Section snippets
Methods
This study was granted approval by the hospital (approval numbers 200643 and 2008093) and university (approval number 0800000367) ethics committees and informed consent was obtained from all participants. This was a cross-sectional design where QoL was measured in combination with appetite and a range of other nutritional parameters. Figure 1 details the study design. Data collection occurred in the dialysis unit of two hospitals in Brisbane, Australia. Exclusion criteria were having been on
Results
Most of this sample were well nourished (97% SGA A; PGSGA score 2(0–9)) and the average rating of subjective hunger was in the middle of the VAS at 49 mm (scale 0–100 mm) (Table 1).
18 patients (29%) self-reported their appetite as very good, 29 patients (47%) as good and 15 patients (24%) as poor or very poor (Table 2). Patients who self-reported a poor or very poor appetite had significantly lower scores in nine domains of QoL including seven in the SF36 component and two in the kidney-disease
Discussion
This study investigated the link between kidney disease-specific QoL, appetite and other nutritional parameters in a sample of Australian hemodialysis patients. Patients who self-reported a poor or very poor appetite had significantly lower scores in nine domains of QoL and seven of these were in the generic SF36 component of the tool. PGSGA score, BMI and hunger ratings were significantly associated with the SF12 physical health domain of QoL.
Self-reported appetite had a relationship with a
Statement of authorship
RZ designed the study, collected and analysed the data and wrote the manuscript. SA, NK, PJ and JB also designed the study and provided critical review of the data and manuscript. All authors read and approved the final manuscript.
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Acknowledgements: An Australian Postgraduate Award and top-up scholarship from the Institute of Health and Biomedical Innovation funded the lead author to conduct this research. Conflict of interest statement: The funding bodies had no involvement in the study design, collection, analysis and interpretation of data, writing of the manuscript or decision to submit the manuscript for publication. There are no conflicts of interest to declare.