Evaluation of Nutritional Status and Quality of Life in Hemodialysis Patients: Traditional Review

Abstract

The assessment of nutritional status in patients with Chronic Renal Failure (CRF) is crucial for the early diagnosis and management of malnutrition, a common complication arising from the dietary and fluid restrictions imposed by the hemodialysis (HD) process. Various measurement tools have been developed for clinical use to evaluate malnutrition, each differing in their target populations and applications. Among these, the Subjective Global Assessment – 7P (SGD-7P) and the Malnutrition Inflammation Score (MIS) are widely utilized in HD patients due to their comprehensive scope, ease of application without specialized equipment, and short administration time. These tools effectively assess nutritional status and detect malnutrition, making them essential components of patient evaluation. Beyond nutritional concerns, HD significantly impacts the physical, psychological, and socioeconomic well-being of individuals, often leading to a decline in overall quality of life. The advanced age of many HD patients further affects their ability to perform daily activities and maintain independence, contributing to poorer health outcomes and increased susceptibility to complications and mortality. In this context, the Kidney Disease Quality of Life Scale-36 (KDQOL-36) serves as a valuable tool for evaluating quality of life, providing critical insights into patients' well-being. The combined use of SGD-7P, MIS, and KDQOL-36 enhances the accuracy of patient assessments, enabling a more comprehensive evaluation of both nutritional status and quality of life. Regular monitoring of these parameters facilitates the early detection of malnutrition and allows for timely interventions, ultimately reducing the risk of mortality and improving clinical patient outcomes.

Keywords

• nutritional status
• dialysis
• malnutrition
• quality of life

Hemodiyaliz Hastalarında Beslenme Durumu ve Yaşam Kalitesinin Değerlendirilmesi: Geleneksel Derleme

Abstract

Kronik Böbrek Yetmezliği (KBY) hastalarının beslenme durumunun değerlendirilmesi özellikle hemodiyaliz (HD) sürecinin beraberinde getirdiği diyet ve sıvı kısıtlamaları nedeniyle sıklıkla karşılaşılan malnütrisyonun erken teşhisi ve tedavisinde önemlidir. Malnütrisyonun değerlendirilmesinde klinik kullanımı olan birçok ölçüm aracı geliştirilmiştir. Bu beslenme durumu değerlendirme araçları hitap ettiği kitle ve kullanım alanlarına göre farklılık göstermektedir. Geniş kapsamları, uygulanmasında özel bir ekipmana gereksinim duyulmaması ve kısa sürede gerçekleştirilebilmesi nedeniyle beslenme durumunun etkili bir şekilde değerlendirilmesine ve malnütrisyonun tespit edilmesine olanak sağlayan Subjektif Global Değerlendirme – 7P (SGD-7P) ve Malnütrisyon İnflamasyon Skoru (MIS), HD hastalarında en sık kullanılan öznel değerlendirme araçlarındandır. Ayrıca HD bireylerin fiziksel, psikolojik ve sosyoekonomik durumlarını etkileyerek yaşam kalitelerini değiştirebilmektedir ve bu değişim çoğunlukla negatif yönde bir eğilim göstermektedir. Bu popülasyondaki hastaların yaş ortalamasının yüksek olması günlük yaşam aktivitelerinin ve kendi başına iş yapabilme kapasitesinin de etkilenmesine sebep olmaktadır. HD hastalarının daha kötü yaşam kalitesine sahip olması komplikasyon risklerini ve mortaliteye yatkınlığı da beraberinde getirmektedir. Bireylerin yaşam kalitesinin değerlendirilmesinde Böbrek Hastalığı Yaşam Kalitesi Ölçeği-36 (KDQOL-36) ölçüm aracı etkili bir yöntem olarak karşımıza çıkarken bu ölçüm araçlarının kombine bir şekilde kullanılması hastaların genel durumunun gözlenmesi ve takibinde daha güçlü sonuçlar vermektedir. Malnütrisyonun erken teşhisi için beslenme durumunun düzenli aralıklarla değerlendirilmesi ve yaşam kalitesinin belirli aralıklarla değerlendirilerek hastalara gerekli desteklerin sağlanması hastaların klinik seyrinin iyileşmesi ve mortalite riskinin azaltılmasında önem arz etmektedir.

Keywords

• beslenme durumu
• diyaliz
• malnütrisyon
• yaşam kalitesi

References

1. 1. El Alami El Hassani N, Akrichi MA, Bajit H, Alem C. Investigation of accordance between nutritional assessment tools, and bio-electrical impedance-derived phase angle, with the global leadership initiative on malnutrition criteria in hemodialysis patients. Clin Nutr ESPEN. 2024;62:260-9.
2. 2. Fetter RL, Bigogno FG, de Oliveira FG, Avesani CM. Cross-cultural adaptation to Portuguese of tools for assessing the nutritional status of patients on dialysis. J Bras Nefrol. 2014;36(2):176-85.
3. 3. Avesani CM, Sabatino A, Guerra A, Rodrigues J, Carrero JJ, Rossi GM, et al. A Comparative Analysis of Nutritional Assessment Using Global Leadership Initiative on Malnutrition Versus Subjective Global Assessment and Malnutrition Inflammation Score in Maintenance Hemodialysis Patients. J Ren Nutr. 2022;32(4):476-82.
4. 4. Santin F, Rodrigues J, Brito FB, Avesani CM. Performance of subjective global assessment and malnutrition inflammation score for monitoring the nutritional status of older adults on hemodialysis. Clin Nutr. 2018;37(2):604-11.
5. 5. Galland R, Traeger J, Arkouche W, Cleaud C, Delawari E, Fouque D. Short daily hemodialysis rapidly improves nutritional status in hemodialysis patients. Kidney Int. 2001;60(4):1555-60.
6. 6. Visiedo L, Rey L, Rivas F, López F, Tortajada B, Giménez R, et al. The impact of nutritional status on health-related quality of life in hemodialysis patients. Sci Rep. 2022;12(1):3029. 7. Macedo C, Amaral TF, Rodrigues J, Santin F, Avesani CM. Malnutrition and Sarcopenia Combined Increases the Risk for Mortality in Older Adults on Hemodialysis. Front Nutr. 2021;8:721941.
7. 8. Marcelli D, Wabel P, Wieskotten S, Ciotola A, Grassmann A, Di Benedetto A, et al. Physical methods for evaluating the nutrition status of hemodialysis patients. J Nephrol. 2015;28(5):523-30.
8. 9. Schulman G. Nutrition in daily hemodialysis. Am J Kidney Dis. 2003;41(3 Suppl 1):S112-5.

9. 10. Cortes R, Yañez AM, Capitán-Moyano L, Millán-Pons A, Bennasar-Veny M. Evaluation of different screening tools for detection of malnutrition in hospitalised patients. J Clin Nurs. 2024;33(12):4759-71.
10. 11. Akmansu M, Kanyilmaz G. Malnütrisyon taramasındaki yöntemler: hangi yöntemi kullanalım? Turkish Journal of Oncology. 2020;35 12. Şahin DA, Erol Ö. Hemodiyaliz Hastalarının Yaşam Kalitesi ve Beslenme Durumlarının Değerlendirilmesi. Balkan Sağlık Bilimleri Dergisi. 2024;3(2):81-94.
11. 13. Desbrow B, Bauer J, Blum C, Kandasamy A, McDonald A, Montgomery K. Assessment of nutritional status in hemodialysis patients using patient-generated subjective global assessment. J Ren Nutr. 2005;15(2):211-6.
12. 14. Pompey CS, Ridwan MN, Zahra AN, Yona S. Illness acceptance and quality of life among end state renal disease patients undergoing hemodialysis. Enfermeria clinica. 2019;29:128-33.
13. 15. Detsky AS, Baker JP, Mendelson RA, Wolman SL, Wesson DE, Jeejeebhoy KN. Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. JPEN J Parenter Enteral Nutr. 1984;8(2):153-9.
14. 16. Eminsoy İO, Kızıltan G, Ok MA, Eminsoy MG, Oral EA, Sayın CB. “Yedi Puanlamalı Subjektif Global Değerlendirme’nin (SGD-7P)” Türkçe’ye Uyarlanması ve Hemodiyaliz Hastaları Üzerinde Pilot Çalışma ile SGD-3P Uyumunun Değerlendirilmesi. Beslenme ve Diyet Dergisi. 2019;47(3):34-45.
15. 17. Cepeda Marte JL, Javier A, Ruiz-Matuk C, Paulino-Ramirez R. Quality of Life and Nutritional Status in diabetic patients on hemodialysis. Diabetes Metab Syndr. 2019;13(1):576-80. 18. Lin TY, Hung SC. Association of subjective global assessment of nutritional status with gut microbiota in hemodialysis patients: a case-control study. Nephrol Dial Transplant. 2021;36(6):1104-11.
16. 19. Hafi E, Soradi R, Diab S, Samara AM, Shakhshir M, Alqub M, et al. Nutritional status and quality of life in diabetic patients on hemodialysis: a cross-sectional study from Palestine. J Health Popul Nutr. 2021;40(1):30.
17. 20. Colman S, Bross R, Benner D, Chow J, Braglia A, Arzaghi J, et al. The Nutritional and Inflammatory Evaluation in Dialysis patients (NIED) study: overview of the NIED study and the role of dietitians. J Ren Nutr. 2005;15(2):231-43.
18. 21. Yamada S, Yamada K, Nishida H. Comparison of nutrition screening tools in patients receiving maintenance hemodialysis. Ther Apher Dial. 2023;27(1):177-9.
19. 22. Kalantar-Zadeh K, Kleiner M, Dunne E, Lee GH, Luft FC. A modified quantitative subjective global assessment of nutrition for dialysis patients. Nephrol Dial Transplant. 1999;14(7):1732-8.
20. 23. Higuita-Gutiérrez LF, Velasco-Castaño JJ, Jiménez Quiceno JN. Health-Related Quality of Life in Patients with Chronic Kidney Disease in Hemodialysis in Medellín (Colombia). Patient Prefer Adherence. 2019;13:2061-70.
21. 24. Rusa SG, Peripato GI, Pavarini SC, Inouye K, Zazzetta MS, Orlandi Fde S. Quality of life/spirituality, religion and personal beliefs of adult and elderly chronic kidney patients under hemodialysis. Rev Lat Am Enfermagem. 2014;22(6):911-7.
22. 25. Cohen DE, Lee A, Sibbel S, Benner D, Brunelli SM, Tentori F. Use of the KDQOL-36™ for assessment of health-related quality of life among dialysis patients in the United States. BMC Nephrol. 2019;20(1):112.
23. 26. Toraman A, Ekmekci C, Çolak H, Kürşat S. Hemodiyaliz Hastalarında Yaşam Kalitesinin Malnutrisyon ve Ekokardiyografik Parametreler ile İlişkisi. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2016;3(3)
24. 27. Yang F, Wong CKH, Luo N, Piercy J, Moon R, Jackson J. Mapping the kidney disease quality of life 36-item short form survey (KDQOL-36) to the EQ-5D-3L and the EQ-5D-5L in patients undergoing dialysis. Eur J Health Econ. 2019;20(8):1195-206.
25. 28. Peipert JD, Bentler PM, Klicko K, Hays RD. Psychometric Properties of the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36) in the United States. Am J Kidney Dis. 2018;71(4):461-8.
26. 29. Suryantoro SD, Ardhany AR, Basoeki W, Thaha M, Mardiana N, Tjempakasari A, et al. Dietary management of haemodialysis patients with chronic kidney disease and malnourishment. Asia Pac J Clin Nutr. 2021;30(4):579-87.
27. 30. Rokhman MR, Wardhani Y, Partiningrum DL, Purwanto BD, Hidayati IR, Idha A, et al. Psychometric properties of kidney disease quality of life-36 (KDQOL-36) in dialysis patients in Indonesia. Qual Life Res. 2023;32(1):247-58.
28. 31. Hall R, Luciano A, Carl Pieper D, Colon-Emeric C. Psychometric evaluation of the kidney disease quality of life 36-item survey instrument (KDQOL-36): A comparison between older and younger adults receiving dialysis. The Journal of Nephrology Social Work. 2018;42(1):21-30.
29. 32. Ng HM, Khor BH, Sahathevan S, Sualeheen A, Chinna K, Gafor AHA, et al. Is malnutrition a determining factor of health-related quality of life in hemodialysis patients? A cross-sectional design examining relationships with a comprehensive assessment of nutritional status. Qual Life Res. 2022;31(5):1441-59.
30. 33. Nagy E, Mahmoud M, El-Kannishy G, Sayed-Ahmed N. Impact of malnutrition on health-related quality of life in patients on maintenance hemodialysis. Ther Apher Dial. 2021;25(4):467-74.
31. 34. Rifai A, Soelistyoningsih D, Fajar JK, Gunawan A. The association between MNA and PG-SGA malnutrition assessment and the quality of life among hemodialysis patients. Clinical Epidemiology and Global Health. 2022;16:101075.
32. 35. Collein I, Hafid F, Ismunandar I. The Relationship Between Nutritional Status and The Quality of Life of Chronic Kidney Disease Patients Undergoing Hemodialysis. Poltekita: Jurnal Ilmu Kesehatan. 2023;17(3):909-16.