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Quality of life and protein-energy wasting in kidney transplant recipients

  • Nephrology – Original Paper
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Abstract

Purpose

Chronic kidney disease has profound effects on the health-related quality of life (HRQoL) of patients, with serious physiological, psychological and socio-economic implications. The co-occurrence of protein-energy wasting and inflammation in end-stage renal disease patients is associated with worse HRQoL and increased mortality. We designed this study to examine the relationship between nutritional and inflammatory status and HRQoL in kidney transplant recipients.

Methods

Data from 100 randomly selected kidney transplant patients were analyzed in a cross-sectional survey. Socio-demographic parameters, laboratory results, transplantation-related data, comorbidities, medication and malnutrition-inflammation score (MIS) (Kalantar Score) were tabulated at baseline. Patients completed the Kidney Disease Quality of Life-SF (KDQoL-SF™) self-administered questionnaire.

Results

Mean age was 51 ± 13 years, median (interquartile range, IQR) time since transplantation 66 (83) months, 57% were men, and 19% had diabetes. The median (IQR) MIS was 3 (3). The MIS significantly and negatively correlated with almost all HRQoL domains analyzed, and this association remained significant in multivariate linear regression analysis for the log-transformed scores on energy/fatigue (β = −0.059 P < 0.001), bodily pain (β = −0.056 P = 0.004), physical functioning (β = −0.029, P = 0.022) and symptoms/problems (β = −0.023 P = 0.005) domains after statistical correction for age, gender, eGFR, dialysis vintage, Charlson Comorbidity Index and occupational status. Additionally, cubic spline analyses revealed linearly increasing, “dose–response” relationship between almost all domains of KDQoL-SF™ and the MIS.

Conclusions

Malnutrition-inflammation score is independently associated with different dimensions of HRQoL in kidney transplant recipients.

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References

  1. Kaizu Y, Ohkawa S, Odamaki M et al (2003) Association between inflammatory mediators and muscle mass in long-term hemodialysis patients. Am J Kidney Dis 42:295–302

    Article  PubMed  CAS  Google Scholar 

  2. Kalantar-Zadeh K, Ikizler TA, Block G et al (2003) Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis 42:864–881

    Article  PubMed  Google Scholar 

  3. Kalantar-Zadeh K, Kopple JD, Block G et al (2001) A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 38:1251–1263

    Article  PubMed  CAS  Google Scholar 

  4. Maruyama Y, Nordfors L, Stenvinkel P et al (2005) Interleukin-1 gene cluster polymorphisms are associated with nutritional status and inflammation in patients with end-stage renal disease. Blood Purif 23:384–393

    Article  PubMed  CAS  Google Scholar 

  5. Balakrishnan VS, Guo D, Rao M et al (2004) Cytokine gene polymorphisms in hemodialysis patients: association with comorbidity, functionality, and serum albumin. Kidney Int 65:1449–1460

    Article  PubMed  CAS  Google Scholar 

  6. Raj DS, Dominic EA, Pai A et al (2005) Skeletal muscle, cytokines, and oxidative stress in end-stage renal disease. Kidney Int 68:2338–2344

    Article  PubMed  CAS  Google Scholar 

  7. Caglar K, Peng Y, Pupim LB et al (2002) Inflammatory signals associated with hemodialysis. Kidney Int 62:1408–1416

    Article  PubMed  CAS  Google Scholar 

  8. Fujino Y, Ishimura E, Okuno S et al (2005) C-reactive protein is a significant predictor of decrease in fat mass in hemodialysis patients. Biomed Pharmacother 59:264–268

    Article  PubMed  CAS  Google Scholar 

  9. Carriere I, Dupuy AM, Lacroux A et al (2008) Biomarkers of inflammation and malnutrition associated with early death in healthy elderly people. J Am Geriatr Soc 56:840–846

    Article  PubMed  Google Scholar 

  10. Karadag F, Kirdar S, Karul AB et al (2008) The value of C-reactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease. Eur J Intern Med 19:104–108

    Article  PubMed  CAS  Google Scholar 

  11. Nakamura K, Moriyama Y, Kariyazono H et al (1999) Influence of preoperative nutritional state on inflammatory response after surgery. Nutrition 15:834–841

    Article  PubMed  CAS  Google Scholar 

  12. Stenvinkel P, Heimburger O, Paultre F et al (1999) Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 55:1899–1911

    Article  PubMed  CAS  Google Scholar 

  13. Prakash J, Raja R, Mishra RN et al (2007) High prevalence of malnutrition and inflammation in undialyzed patients with chronic renal failure in developing countries: a single center experience from eastern India. Ren Fail 29:811–816

    Article  PubMed  Google Scholar 

  14. Kalantar-Zadeh K, Kopple JD (2001) Relative contributions of nutrition and inflammation to clinical outcome in dialysis patients. Am J Kidney Dis 38:1343–1350

    Article  PubMed  CAS  Google Scholar 

  15. Stenvinkel P, Heimburger O, Lindholm B et al (2000) Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 15:953–960

    Article  PubMed  CAS  Google Scholar 

  16. Wang AY, Woo J, Lam CW et al (2005) Associations of serum fetuin-A with malnutrition, inflammation, atherosclerosis and valvular calcification syndrome and outcome in peritoneal dialysis patients. Nephrol Dial Transplant 20:1676–1685

    Article  PubMed  CAS  Google Scholar 

  17. Morena M, Delbosc S, Dupuy AM et al (2005) Overproduction of reactive oxygen species in end-stage renal disease patients: a potential component of hemodialysis-associated inflammation. Hemodial Int 9:37–46

    Article  PubMed  Google Scholar 

  18. Kalantar-Zadeh K, McAllister CJ, Lehn RS et al (2003) Effect of malnutrition-inflammation complex syndrome on EPO hyporesponsiveness in maintenance hemodialysis patients. Am J Kidney Dis 42:761–773

    Article  PubMed  Google Scholar 

  19. Locatelli F, Andrulli S, Memoli B et al (2006) Nutritional-inflammation status and resistance to erythropoietin therapy in haemodialysis patients. Nephrol Dial Transplant 21:991–998

    Article  PubMed  CAS  Google Scholar 

  20. Lopes AA, Elder SJ, Ginsberg N et al (2007) Lack of appetite in haemodialysis patients associations with patient characteristics, indicators of nutritional status and outcomes in the international DOPPS. Nephrol Dial Transplant 22:3538–3546

    Article  PubMed  Google Scholar 

  21. Czira ME, Lindner AV, Szeifert L et al (2011) Association between the malnutrition-inflammation score and depressive symptoms in kidney transplanted patients. Gen Hosp Psychiatry 33:157–165

    Article  PubMed  Google Scholar 

  22. Molnar MZ, Keszei A, Czira ME et al (2010) Evaluation of the malnutrition-inflammation score in kidney transplant recipients. Am J Kidney Dis 56:102–111

    Article  PubMed  Google Scholar 

  23. Molnar MZ, Czira ME, Rudas A et al (2011) Association between the malnutrition-inflammation score and post-transplant anaemia. Nephrol Dial Transplant 26:2000–2006

    Article  PubMed  CAS  Google Scholar 

  24. Molnar MZ, Czira ME, Rudas A et al (2011) Association of the malnutrition-inflammation score with clinical outcomes in kidney transplant recipients. Am J Kidney Dis 58:101–108

    Article  PubMed  Google Scholar 

  25. Talas MS, Bayraktar N (2004) Kidney transplantation: determination of the problems encountered by Turkish patients and their knowledge and practices on healthy living. J Clin Nurs 13:580–588

    Article  PubMed  Google Scholar 

  26. Lew SQ, Piraino B (2005) Quality of life and psychological issues in peritoneal dialysis patients. Semin Dialysis 18:119–123

    Article  Google Scholar 

  27. Sayin A, Mutluay R, Sindel S (2007) Quality of life in hemodialysis, peritoneal dialysis, and transplantation patients. Transplant Proc 39:3047–3053

    Article  PubMed  CAS  Google Scholar 

  28. Mingardi G, Cornalba L, Cortinovis E et al (1999) Health-related quality of life in dialysis patients. A report from an Italian study using the SF-36 health survey. DIA-QOL Group. Nephrol Dial Transplant 14:1503–1510

    Article  PubMed  CAS  Google Scholar 

  29. Kimmel PL, Peterson RA, Weihs KL et al (1995) Aspects of quality of life in hemodialysis patients. J Am Soc Nephrol 6:1418–1426

    PubMed  CAS  Google Scholar 

  30. Kimmel PL, Peterson RA, Weihs KL et al (1996) Psychologic functioning, quality of life, and behavioral compliance in patients beginning hemodialysis. J Am Soc Nephrol 7:2152–2159

    PubMed  CAS  Google Scholar 

  31. Mazairac AH, de Wit GA, Penne LE et al (2011) Protein-energy nutritional status and kidney disease-specific quality of life in hemodialysis patients. J Ren Nutr 21:376–386

    Article  PubMed  Google Scholar 

  32. Jassal SV, Schaubel DE, Fenton SS (2005) Baseline comorbidity in kidney transplant recipients: a comparison of comorbidity indices. Am J Kidney Dis 46:136–142

    Article  PubMed  Google Scholar 

  33. Levey A, Greene T, Kusek J et al (2000) A simplified equation to predict glomerular filtration rate from serum creatinine {Abstract}. J Am Soc Nephrol 11:155A

    Google Scholar 

  34. Kalantar-Zadeh K, Kleiner M, Dunne E et al (1998) Total iron-binding capacity-estimated transferrin correlates with the nutritional subjective global assessment in hemodialysis patients. Am J Kidney Dis 31:263–272

    Article  PubMed  CAS  Google Scholar 

  35. Enia G, Sicuso C, Alati G et al (1993) Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transplant 8:1094–1098

    PubMed  CAS  Google Scholar 

  36. Hays RD, Kallich JD, Mapes DL et al (1994) Development of the kidney disease quality of life (KDQOL) instrument. Qual Life Res 3:329–338

    Article  PubMed  CAS  Google Scholar 

  37. Hays R, Kallich J, Mapes D et al. (1997) Kidney disease quality of life short form (KDQOL-SFTM), Version 1.3: a manual for use and scoring. Santa Monica, CA

  38. Korevaar JC, Merkus MP, Jansen MA et al (2002) Validation of the KDQOL-SF: a dialysis-targeted health measure. Qual Life Res 11:437–447

    Article  PubMed  CAS  Google Scholar 

  39. Duarte PS, Miyazaki MC, Ciconelli RM et al (2003) Translation and cultural adaptation of the quality of life assessment instrument for chronic renal patients (KDQOL-SF). Rev Assoc Med Bras 49:375–381

    Article  PubMed  Google Scholar 

  40. Green J, Fukuhara S, Shinzato T et al (2001) Translation, cultural adaptation, and initial reliability and multitrait testing of the Kidney Disease Quality of Life instrument for use in Japan. Qual Life Res 10:93–100

    Article  PubMed  CAS  Google Scholar 

  41. Barotfi S, Molnar MZ, Almasi C et al (2006) Validation of the Kidney Disease Quality of Life-Short Form questionnaire in kidney transplant patients. J Psychosom Res 60:495–504

    Article  PubMed  Google Scholar 

  42. Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  43. Novak M, Molnar MZ, Szeifert L et al (2010) Depressive symptoms and mortality in patients after kidney transplantation: a prospective prevalent cohort study. Psychosom Med 72:527–534

    Article  PubMed  Google Scholar 

  44. Szeifert L, Molnar MZ, Ambrus C et al (2010) Symptoms of depression in kidney transplant recipients: a cross-sectional study. Am J Kidney Dis 55:132–140

    Article  PubMed  Google Scholar 

  45. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  46. Rambod M, Bross R, Zitterkoph J et al (2009) Association of malnutrition-inflammation score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis 53:298–309

    Article  PubMed  Google Scholar 

  47. Bilgic A, Akgul A, Sezer S et al (2007) Nutritional status and depression, sleep disorder, and quality of life in hemodialysis patients. J Ren Nutr 17:381–388

    Article  PubMed  Google Scholar 

  48. Kalantar-Zadeh K, Kopple JD, Block G et al (2001) Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol 12:2797–2806

    PubMed  CAS  Google Scholar 

  49. Kalantar-Zadeh K, Kuwae N, Wu DY et al (2006) Associations of body fat and its changes over time with quality of life and prospective mortality in hemodialysis patients. Am J Clin Nutr 83:202–210

    PubMed  CAS  Google Scholar 

  50. Feroze U, Noori N, Kovesdy CP et al (2011) Quality-of-life and mortality in hemodialysis patients: roles of race and nutritional status. Clin J Am Soc Nephrol 6:1100–1111

    Article  PubMed  Google Scholar 

  51. Ibrahim S, El Salamony O (2008) Depression, quality of life and malnutrition-inflammation scores in Hemodialysis Patients. Am J Nephrol 28:784–791

    Article  PubMed  Google Scholar 

  52. Micozkadioglu H, Micozkadioglu I, Zumrutdal A et al (2006) Relationship between depressive affect and malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrology (Carlton, Vic) 11:502–505

    Article  CAS  Google Scholar 

  53. Valderrabano F, Jofre R, Lopez-Gomez JM (2001) Quality of life in end-stage renal disease patients. Am J Kidney Dis 38:443–464

    Article  PubMed  CAS  Google Scholar 

  54. Shidler NR, Peterson RA, Kimmel PL (1998) Quality of life and psychosocial relationships in patients with chronic renal insufficiency. Am J Kidney Dis 32:557–566

    Article  PubMed  CAS  Google Scholar 

  55. Mucsi I, Molnar MZ, Ambrus C et al (2005) Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis. Nephrol Dial Transplant 20:571–577

    Article  PubMed  Google Scholar 

  56. Mucsi I, Molnar MZ, Rethelyi J et al (2004) Sleep disorders and illness intrusiveness in patients on chronic dialysis. Nephrol Dial Transplant 19:1815–1822

    Article  PubMed  Google Scholar 

  57. Molnar MZ, Novak M, Szeifert L et al (2007) Restless legs syndrome, insomnia, and quality of life after renal transplantation. J Psychosom Res 63:591–597

    Article  PubMed  Google Scholar 

  58. Koivunen K, Lukkarinen H (2006) Lower limb atherosclerotic disease causes various deteriorations of patients’ health-related quality of life. J Vasc Nurs 24:102–115

    Article  PubMed  Google Scholar 

  59. Kalantar-Zadeh K, Kopple JD, Kamranpour N et al (2007) HDL-inflammatory index correlates with poor outcome in hemodialysis patients. Kidney Int 72:1149–1156

    Article  PubMed  CAS  Google Scholar 

  60. Molnar MZ, Novak M, Ambrus C et al (2005) Anemia in kidney transplanted patients. Clin Transplant 19:825–833

    Article  PubMed  Google Scholar 

  61. Rebollo P, Baltar JM, Campistol JM et al (2004) Quality of life of patients with chronic renal allograft rejection and anemia. J Nephrol 17:531–536

    PubMed  Google Scholar 

  62. Gerson A, Hwang W, Fiorenza J et al (2004) Anemia and health-related quality of life in adolescents with chronic kidney disease. Am J Kidney Dis 44:1017–1023

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank the patients and the staff of the Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary for their assistance in this survey. MZ Molnar received grants from the National Developmental Agency (KTIA-OTKA-EU 7KP-HUMAN-MB08-A-81231) from the Research and Technological Innovation Fund was also supported by Hungarian Kidney Foundation. The research of M. Novak has been supported by an unrestricted research grant from Canadian Home Healthcare Inc.

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Authors and Affiliations

  1. Institute of Pathophysiology, Semmelweis University, Nagyvarad ter 4, 1089, Budapest, Hungary

    Akos Ujszaszi, Istvan Mucsi & Miklos Z. Molnar

  2. Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary

    Maria E. Czira, Katalin Fornadi, Marta Novak, Istvan Mucsi & Miklos Z. Molnar

  3. Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany

    Maria E. Czira

  4. Department of Neurology, Semmelweis University, Budapest, Hungary

    Katalin Fornadi

  5. Department of Psychiatry, University Health Network, University of Toronto, Toronto, Canada

    Marta Novak

  6. Division of Nephrology, Department of Medicine, McGill University Health Center, Montreal, QC, USA

    Istvan Mucsi

  7. Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA

    Miklos Z. Molnar

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  1. Akos Ujszaszi
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  2. Maria E. Czira
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  3. Katalin Fornadi
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  4. Marta Novak
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  6. Miklos Z. Molnar
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Correspondence to Miklos Z. Molnar.

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Ujszaszi, A., Czira, M.E., Fornadi, K. et al. Quality of life and protein-energy wasting in kidney transplant recipients. Int Urol Nephrol 44, 1257–1268 (2012). https://doi.org/10.1007/s11255-012-0122-3

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  • DOI: https://doi.org/10.1007/s11255-012-0122-3

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