Purpose

To identify relationships between health-related quality of life (HRQOL) and nutritional status in hemodialysis (HD) patients.

Method

Secondary data from a cross-sectional survey was utilized. HRQOL was assessed for 379 HD patients using the generic Short Form 36 (SF-36) and disease-specific Kidney-Disease Quality of Life-36 (KDQOL-36). Malnutrition was indicated by malnutrition inflammation score (MIS) ≥ 5, and presence of protein-energy wasting (PEW). The individual nutritional parameters included the domains of physical status, serum biomarkers, and dietary intake. Multivariate associations were assessed using the general linear model.

Results

MIS ≥ 5 was negatively associated with SF-36 scores of physical functioning (MIS < 5 = 73.4 ± 8.0 SE vs MIS ≥ 5 = 64.6 ± 7.7 SE, P < 0.001), role-limitation-physical (MIS < 5 = 65.3 ± 14.3 SE vs MIS ≥ 5 = 52.9 ± 14.0 SE, P = 0.006), general health (MIS < 5 = 53.7 ± 7.5 SE vs MIS ≥ 5 = 47.0 ± 7.1 SE, P = 0.003), and PCS-36 (MIS < 5 = 40.5 ± 3.3 SE vs MIS ≥ 5 = 35.9 ± 3.1 SE, P < 0.001); and KDQOL-36 score of symptoms/problems (MIS < 5 = 78.9 ± 5.6 SE vs MIS ≥ 5 = 74.8 ± 5.4 SE, P = 0.022), but not with PEW by any tool. Of individual nutritional parameters, underweight (68.1 ± 5.4 SE, P = 0.031), normal weight (63.8 ± 2.8 SE, P = 0.023), and overweight (64.3 ± 2.9 SE, P = 0.003) patients had significantly higher physical functioning scores compared to obese patients (44.8 ± 5.5 SE). Serum albumin levels were positively associated with physical functioning (P = 0.041) score. HGS was also positively associated with physical functioning (P = 0.036), and vitality (P = 0.041) scores. Greater dietary phosphorus intakes were significantly associated with lower scores for role limitation-physical (P = 0.008), bodily pain (P = 0.043), and PCS-36 (P = 0.024).

Conclusion

Malnutrition diagnosis by MIS, but not PEW, indicated associations with HRQOL in HD patients. Individual nutritional parameters that related to higher HRQOL were BMI < 30 kg/m², better dietary phosphorus control, greater muscle strength and higher visceral protein pool.

1. Kalantar-Zadeh, Kopple, Block, & Humphreys. (2001). Association among SF-36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. Journal of the American Society of Nephrology, 12(12), 2797–2806.
   DOI: 10.1681/ASN.V12122797
2. Hall, R. K., Luciano, A., Pieper, C., & Colon-Emeric, C. S. (2018). Association of Kidney Disease Quality of Life (KDQOL-36) with mortality and hospitalization in older adults receiving hemodialysis. BMC Nephrology, 19(1), 11. https://doi.org/10.1186/s12882-017-0801-5
   DOI: 10.1186/s12882-017-0801-5
3. Peng, Y.-S., Chiang, C.-K., Hung, K.-Y., Chang, C.-H., Lin, C.-Y., Yang, C.-S., Chen, T.-W., Hsia, C.-C., Chen, D.-L., & Hsu, W.-D. (2010). Are both psychological and physical dimensions in health-related quality of life associated with mortality in hemodialysis patients: A 7-year Taiwan cohort study. Blood Purification, 30(2), 98–105. https://doi.org/10.1159/000319002
   DOI: 10.1159/000319002
4. Perl, J., Karaboyas, A., Morgenstern, H., Sen, A., Rayner, H. C., Vanholder, R. C., Combe, C., Hasegawa, T., Finkelstein, F. O., & Lopes, A. A. (2016). Association between changes in quality of life and mortality in hemodialysis patients: Results from the DOPPS. Nephrology Dialysis Transplantation, 32(3), 521–527. https://doi.org/10.1093/ndt/gfw233
   DOI: 10.1093/ndt/gfw233
5. Ambriz Murillo, Y., Menor Almagro, R., Campos-González, I. D., & Cardiel, M. H. (2015). Health-related quality of life in rheumatoid arthritis, osteoarthritis, diabetes mellitus, end stage renal disease and geriatric subjects. Experience from a general hospital in Mexico. Reumatología Clínica (English Edition), 11(2), 68–72. https://doi.org/10.1016/j.reumae.2014.03.014
   DOI: 10.1016/j.reumae.2014.03.014
6. James, S. L., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., Abdollahpour, I., Abdulkader, R. S., Abebe, Z., Abera, S. F., Abil, O. Z., Abraha, H. N., Abu-Raddad, L. J., Abu-Rmeileh, N. M. E., Accrombessi, M. M. K., et al. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1789–1858. https://doi.org/10.1016/S0140-6736(18)32279-7
   DOI: 10.1016/S0140-6736(18)32279-7
7. Urquhart-Secord, R., Craig, J. C., Hemmelgarn, B., Tam-Tham, H., Manns, B., Howell, M., Polkinghorne, K. R., Kerr, P. G., Harris, D. C., Thompson, S., Schick-Makaroff, K., Wheeler, D. C., van Biesen, W., Winkelmayer, W. C., Johnson, D. W., Howard, K., Evangelidis, N., & Tong, A. (2016). Patient and caregiver priorities for outcomes in hemodialysis: An International Nominal Group Technique Study. American Journal of Kidney Diseases, 68(3), 444–454. https://doi.org/10.1053/j.ajkd.2016.02.037
   DOI: 10.1053/j.ajkd.2016.02.037
8. Cukor, D., Cohen, S. D., Peterson, R. A., & Kimmel, P. L. (2007). Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness. Journal of the American Society of Nephrology, 18(12), 3042–3055. https://doi.org/10.1681/asn.2007030345
   DOI: 10.1681/asn.2007030345
9. Jacobson, J., Ju, A., Baumgart, A., Unruh, M., O’Donoghue, D., Obrador, G., Craig, J. C., Dapueto, J. M., Dew, M. A., & Germain, M. (2019). Patient perspectives on the meaning and impact of fatigue in hemodialysis: A systematic review and thematic analysis of qualitative studies. American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2019.01.034
   DOI: 10.1053/j.ajkd.2019.01.034
10. Cleary, J., & Drennan, J. (2005). Quality of life of patients on haemodialysis for end-stage renal disease. Journal of Advanced Nursing, 51(6), 577–586. https://doi.org/10.1111/j.1365-2648.2005.03547.x
    DOI: 10.1111/j.1365-2648.2005.03547.x
11. Dwyer, J. T., Larive, B., Leung, J., Rocco, M., Burrowes, J. D., Chumlea, W. C., Frydrych, A., Kusek, J. W., & Uhlin, L. (2002). Nutritional status affects quality of life in Hemodialysis (HEMO) Study patients at baseline. Journal of Renal Nutrition, 12(4), 213–223. https://doi.org/10.1053/jren.2002.35297
    DOI: 10.1053/jren.2002.35297
12. Mazairac, A. H. A., de Wit, G. A., Penne, E. L., van der Weerd, N. C., Grooteman, M. P. C., van den Dorpel, M. A., Nubé, M. J., Buskens, E., Lévesque, R., ter Wee, P. M., Bots, M. L., & Blankestijn, P. J. (2011). Protein-energy nutritional status and kidney disease-specific quality of life in hemodialysis patients. Journal of Renal Nutrition, 21(5), 376-386.e1. https://doi.org/10.1053/j.jrn.2010.08.004
    DOI: 10.1053/j.jrn.2010.08.004
13. Md Yusop, N. B., Yoke Mun, C., Shariff, Z. M., & Beng Huat, C. (2013). Factors associated with quality of life among hemodialysis patients in Malaysia. PLoS ONE, 8(12), e84152. https://doi.org/10.1371/journal.pone.0084152
    DOI: 10.1371/journal.pone.0084152
14. Vero, L. M., Byham-Gray, L., Parrott, J. S., & Steiber, A. L. (2013). Use of the subjective global assessment to predict health-related quality of life in chronic kidney disease stage 5 patients on maintenance hemodialysis. Journal of Renal Nutrition, 23(2), 141–147. https://doi.org/10.1053/j.jrn.2012.03.003
    DOI: 10.1053/j.jrn.2012.03.003
15. Donciu, M.-D., Florea, L., Mititiuc, L.-I., Popescu, E.-R., & Chirita, R. (2019). Biochemical and bioimpedance orrelation with quality of life and illness perception in hemodialysis patients. Revista de Chimie, 70(2), 679–684. https://doi.org/10.37358/RC.19.2.6984
    DOI: 10.37358/RC.19.2.6984
16. Chiang, C. K., Peng, Y. S., Chiang, S. S., Yang, C. S., He, Y. H., Hung, K. Y., Wu, K. D., Wu, M. S., Fang, C. C., Tsai, T. J., & Chen, W. Y. (2004). Health-related quality of life of hemodialysis patients in Taiwan: A multicenter study. Blood Purification, 22(6), 490–498. https://doi.org/10.1159/000081730
    DOI: 10.1159/000081730
17. Germin-Petrović, D., Mesaros-Devcić, I., Lesac, A., Mandić, M., Soldatić, M., Vezmar, D., Petrić, D., Vujicić, B., Basić-Jukić, N., & Racki, S. (2011). Health-related quality of life in the patients on maintenance hemodialysis: The analysis of demographic and clinical factors. Collegium Antropologicum, 35(3), 687–693.
18. Carrero, J. J., Johansen, K. L., Lindholm, B., Stenvinkel, P., Cuppari, L., & Avesani, C. M. (2016). Screening for muscle wasting and dysfunction in patients with chronic kidney disease. Kidney International, 90(1), 53–66. https://doi.org/10.1016/j.kint.2016.02.025
    DOI: 10.1016/j.kint.2016.02.025
19. Fouque, D., Kalantar-Zadeh, K., Kopple, J., Cano, N., Chauveau, P., Cuppari, L., Franch, H., Guarnieri, G., Ikizler, T. A., Kaysen, G., Lindholm, B., Massy, Z., Mitch, W., Pineda, E., Stenvinkel, P., Trevino-Becerra, A., & Wanner, C. (2008). A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney International, 73(4), 391–398. https://doi.org/10.1038/sj.ki.5002585
    DOI: 10.1038/sj.ki.5002585
20. Sahathevan, S., Khor, B.-H., Ng, H.-M., Abdul Gafor, A. H., Mat Daud, Z. A., Mafra, D., & Karupaiah, T. (2020). Understanding development of malnutrition in hemodialysis patients: A narrative review. Nutrients, 12(10), 3147. https://doi.org/10.3390/nu12103147
    DOI: 10.3390/nu12103147
21. Giglio, J., Kamimura, M. A., Lamarca, F., Rodrigues, J., Santin, F., & Avesani, C. M. (2018). Association of sarcopenia with nutritional parameters, quality of life, hospitalization, and mortality rates of elderly patients on hemodialysis. Journal of Renal Nutrition, 28(3), 197–207. https://doi.org/10.1053/j.jrn.2017.12.003
    DOI: 10.1053/j.jrn.2017.12.003
22. Noori, N., Sharma Parpia, A., Lakhani, R., Janes, S., & Goldstein, M. B. (2018). Frailty and the quality of life in hemodialysis patients: The importance of waist circumference. Journal of Renal Nutrition, 28(2), 101–109. https://doi.org/10.1053/j.jrn.2017.07.007
    DOI: 10.1053/j.jrn.2017.07.007
23. Brown, E. A., Zhao, J., McCullough, K., Fuller, D. S., Figueiredo, A. E., Bieber, B., Finkelstein, F. O., Shen, J., Kanjanabuch, T., Kawanishi, H., Pisoni, R. L., & Perl, J. (2021). Burden of kidney disease, health-related quality of life, and employment among patients receiving peritoneal dialysis and in-center hemodialysis: Findings from the DOPPS program. American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2021.02.327
    DOI: 10.1053/j.ajkd.2021.02.327
24. Carrero, J. J., Thomas, F., Nagy, K., Arogundade, F., Avesani, C. M., Chan, M., Chmielewski, M., Cordeiro, A. C., Espinosa-Cuevas, A., Fiaccadori, E., Guebre-Egziabher, F., Hand, R. K., Hung, A. M., Ikizler, T. A., Johansson, L. R., Kalantar-Zadeh, K., Karupaiah, T., Lindholm, B., Marckmann, P., … Kovesdy, C. P. (2018). Global prevalence of protein-energy wasting in kidney disease: A meta-analysis of contemporary observational studies from the International Society of Renal Nutrition and Metabolism. Journal of Renal Nutrition, 28(6), 380–392. https://doi.org/10.1053/j.jrn.2018.08.006
    DOI: 10.1053/j.jrn.2018.08.006
25. Borges, M. C. C., Vogt, B. P., Martin, L. C., & Caramori, J. C. T. (2017). Malnutrition-inflammation score cut-off predicting mortality in maintenance hemodialysis patients. Clinical Nutrition ESPEN, 17, 63–67. https://doi.org/10.1016/j.clnesp.2016.10.006
    DOI: 10.1016/j.clnesp.2016.10.006
26. Kalantar-Zadeh, K., Kopple, J. D., Block, G., & Humphreys, M. H. (2001). A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. American Journal of Kidney Diseases, 38(6), 1251–1263. https://doi.org/10.1053/ajkd.2001.29222
    DOI: 10.1053/ajkd.2001.29222
27. Ma, L., & Zhao, S. (2017). Risk factors for mortality in patients undergoing hemodialysis: A systematic review and meta-analysis. International Journal of Cardiology, 238, 151–158. https://doi.org/10.1016/j.ijcard.2017.02.095
    DOI: 10.1016/j.ijcard.2017.02.095
28. Carrero, J. J., Stenvinkel, P., Cuppari, L., Ikizler, T. A., Kalantar-Zadeh, K., Kaysen, G., Mitch, W. E., Price, S. R., Wanner, C., Wang, A. Y., ter Wee, P., & Franch, H. A. (2013). Etiology of the protein-energy wasting syndrome in chronic kidney disease: A consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). Journal of Renal Nutrition, 23(2), 77–90. https://doi.org/10.1053/j.jrn.2013.01.001
    DOI: 10.1053/j.jrn.2013.01.001
29. Opiyo, R. O., Nyasulu, P. S., Olenja, J., Zunza, M., Nguyen, K. A., Bukania, Z., Nabakwe, E., Mbogo, A., & Were, A. O. (2019). Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya: A mixed-methods survey. Renal Replacement Therapy, 5(1), 41. https://doi.org/10.1186/s41100-019-0237-4
    DOI: 10.1186/s41100-019-0237-4
30. Kawate, Y., & Miyata, H. (2017). The importance of nutritional intervention by dietitians for hyperphosphatemia in maintained hemodialysis patients. Renal Replacement Therapy, 3(1), 19. https://doi.org/10.1186/s41100-017-0095-x
    DOI: 10.1186/s41100-017-0095-x
31. Clark-Cutaia, M. N., Sevick, M. A., Thurheimer-Cacciotti, J., Hoffman, L. A., Snetselaar, L., Burke, L. E., & Zickmund, S. L. (2019). Perceived barriers to adherence to hemodialysis dietary recommendations. Clinical Nursing Research, 28(8), 1009–1029. https://doi.org/10.1177/1054773818773364
    DOI: 10.1177/1054773818773364
32. Zimmerer, J. L., Leon, J. B., Covinsky, K. E., Desai, U., & Sehgal, A. R. (2003). Diet monotony as a correlate of poor nutritional intake among hemodialysis patients. Journal of Renal Nutrition, 13(2), 72–77. https://doi.org/10.1053/jren.2003.50025
    DOI: 10.1053/jren.2003.50025
33. Sualeheen, A., Khor, B. H., Balasubramanian, G. V., Sahathevan, S., Ali, M. S. M., Narayanan, S. S., Chinna, K., Daud, Z. A. M., Khosla, P., Gafor, A. H. A., & Karupaiah, T. (2020). Habitual dietary patterns of patients on hemodialysis indicate nutritional risk. Journal of Renal Nutrition, 30(4), 322–332. https://doi.org/10.1053/j.jrn.2019.09.010
    DOI: 10.1053/j.jrn.2019.09.010
34. Zabel, R., Ash, S., King, N., Juffs, P., & Bauer, J. (2012). Relationships between appetite and quality of life in hemodialysis patients. Appetite, 59(1), 194–199. https://doi.org/10.1016/j.appet.2012.02.016
    DOI: 10.1016/j.appet.2012.02.016
35. Feroze, U., Noori, N., Kovesdy, C. P., Molnar, M. Z., Martin, D. J., Reina-Patton, A., Benner, D., Bross, R., Norris, K. C., Kopple, J. D., & 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, 6(5), 1100–1111. https://doi.org/10.2215/cjn.07690910
    DOI: 10.2215/cjn.07690910
36. Al-Ali, F., Bieber, B., Pisoni, R., Ezzat, H., AlGhonaim, M., AlHejaili, F., AlGhareeb, S., Saleh, A., Al Maimani, Y., Alyousef, A., Ahmed, H., Hamad, A., & GCC-DOPPS 5 Study Group. (2016). Nutritional status and outcomes in hemodialysis patients from the Gulf Cooperation Council countries enrolled in the dialysis outcome and practice patterns study phase 5 (2012–2015). Saudi Journal of Kidney Diseases and Transplantation, 27(7), 31–41. https://doi.org/10.4103/1319-2442.194888
    DOI: 10.4103/1319-2442.194888
37. Broers, N. J., Usvyat, L. A., Kooman, J. P., van der Sande, F. M., Lacson, E., Jr., Kotanko, P., & Maddux, F. W. (2015). Quality of life in dialysis patients: A retrospective cohort study. Nephron, 130(2), 105–112. https://doi.org/10.1159/000430814
    DOI: 10.1159/000430814
38. Allen, K. L., Miskulin, D., Yan, G., Dwyer, J. T., Frydrych, A., Leung, J., & Poole, D. (2002). Association of nutritional markers with physical and mental health status in prevalent hemodialysis patients from the HEMO study. Journal of Renal Nutrition, 12(3), 160–169. https://doi.org/10.1053/jren.2002.33512
    DOI: 10.1053/jren.2002.33512
39. Moreira, A. C., Carolino, E., Domingos, F., Gaspar, A., Ponce, P., & Camilo, M. E. (2013). Nutritional status influences generic and disease-specific quality of life measures in haemodialysis patients. Nutricion Hospitalaria, 28(3), 951–957. https://doi.org/10.3305/nh.2013.28.3.6454
    DOI: 10.3305/nh.2013.28.3.6454
40. dos Santos, A. C. B., do Carmo Machado, M., Pereira, L. R., Abreu, J. L. P., & Lyra, M. B. (2013). Association between the level of quality of life and nutritional status in patients undergoing chronic renal hemodialysis. Brazilian Journal of Nephrology, 35(4), 279–288. https://doi.org/10.5935/0101-2800.20130047
    DOI: 10.5935/0101-2800.20130047
41. Veerappan, I., Arvind, R. M., & Ilayabharthi, V. (2012). Predictors of quality of life of hemodialysis patients in India. Indian Journal of Nephrology, 22(1), 18–25. https://doi.org/10.4103/0971-4065.91185
    DOI: 10.4103/0971-4065.91185
42. Sohrabi, Z., Eftekhari, M. H., Eskandari, M. H., Rezaeianzadeh, A., & Sagheb, M. M. (2015). Malnutrition-inflammation score and quality of life in hemodialysis patients: Is there any correlation? Nephro-Urology Monthly, 7(3), e27445–e27445. https://doi.org/10.5812/numonthly.7(3)2015.27445
    DOI: 10.5812/numonthly.7(3)2015.27445
43. de Roij van Zuijdewijn, C., Grooteman, M., Bots, M., Blankestijn, P., van den Dorpel, M., Nubé, M., & ter Wee, P. (2016). Comparing tests assessing protein-energy wasting: Relation with quality of life. Journal of Renal Nutrition, 26(2), 111–117. https://doi.org/10.1053/j.jrn.2015.09.003
    DOI: 10.1053/j.jrn.2015.09.003
44. Han, H., Burrowes, J. D., Houser, R., Chung, M.-C., & Dwyer, J. T. (2012). What is the impact of nutritional status on health-related quality of life in hemodialysis patients? Journal of Renal Nutrition, 22(2), 237–243. https://doi.org/10.1053/j.jrn.2011.05.003
    DOI: 10.1053/j.jrn.2011.05.003
45. Bilgic, A., Akgul, A., Sezer, S., Arat, Z., Ozdemir, F. N., & Haberal, M. (2007). Nutritional status and depression, sleep disorder, and quality of life in hemodialysis patients. Journal of Renal Nutrition, 17(6), 381–388. https://doi.org/10.1053/j.jrn.2007.08.008
    DOI: 10.1053/j.jrn.2007.08.008
46. Rambod, M., Bross, R., Zitterkoph, J., Benner, D., Pithia, J., Colman, S., Kovesdy, C. P., Kopple, J. D., & Kalantar-Zadeh, K. (2009). Association of malnutrition-inflammation score with quality of life and mortality in hemodialysis patients: A 5-year prospective cohort study. American Journal of Kidney Diseases, 53(2), 298–309. https://doi.org/10.1053/j.ajkd.2008.09.018
    DOI: 10.1053/j.ajkd.2008.09.018
47. Fouque, D., Vennegoor, M., Ter Wee, P., Wanner, C., Basci, A., Canaud, B., Haage, P., Konner, K., Kooman, J., & Martin-Malo, A. (2007). EBPG guideline on nutrition. Nephrology Dialysis Transplantation, 22(suppl_2), ii45–ii87. https://doi.org/10.1093/ndt/gfm020
    DOI: 10.1093/ndt/gfm020
48. K/DOQI. (2020). Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guideline for nutrition in chronic kidney disease: 2020 update. https://doi.org/10.1053/j.ajkd.2020.05.006
    DOI: 10.1053/j.ajkd.2020.05.006
49. Memmer, D. (2013). Implementation and practical application of the nutrition care process in the dialysis unit. Journal of Renal Nutrition, 23(1), 65–73. https://doi.org/10.1053/j.jrn.2012.01.025
    DOI: 10.1053/j.jrn.2012.01.025
50. Swan, W. I., Vivanti, A., Hakel-Smith, N. A., Hotson, B., Orrevall, Y., Trostler, N., Beck Howarter, K., & Papoutsakis, C. (2017). Nutrition care process and model update: Toward realizing people-centered care and outcomes management. Journal of the Academy of Nutrition and Dietetics, 117(12), 2003–2014. https://doi.org/10.1016/j.jand.2017.07.015
    DOI: 10.1016/j.jand.2017.07.015
51. Wight, J., Edwards, L., Brazier, J., Walters, S., Payne, J., & Brown, C. (1998). The SF-36 as an outcome measure of services for end stage renal failure. BMJ Quality & Safety, 7(4), 209–221. https://doi.org/10.1136/qshc.7.4.209
    DOI: 10.1136/qshc.7.4.209
52. Hays, R. D., Kallich, J. D., Mapes, D. L., Coons, S. J., & Carter, W. B. (1994). Development of the kidney disease quality of life (KDQOL) instrument. Quality of Life Research, 3(5), 329–338. https://doi.org/10.1007/BF00451725
    DOI: 10.1007/BF00451725
53. Aiyegbusi, O. L., Kyte, D., Cockwell, P., Marshall, T., Gheorghe, A., Keeley, T., Slade, A., & Calvert, M. (2017). Measurement properties of patient-reported outcome measures (PROMs) used in adult patients with chronic kidney disease: A systematic review. PLoS ONE, 12(6), e0179733. https://doi.org/10.1371/journal.pone.0179733
    DOI: 10.1371/journal.pone.0179733
54. Black, A. E. (2000). Critical evaluation of energy intake using the Goldberg cut-off for energy intake: Basal metabolic rate. A practical guide to its calculation, use and limitations. International Journal of Obesity, 24(9), 1119. https://doi.org/10.1038/sj.ijo.0801376
    DOI: 10.1038/sj.ijo.0801376
55. Krejcie, R. V., & Morgan, D. W. (1970). Determining sample size for research activities. Educational and psychological measurement, 30(3), 607–610.
    DOI: 10.1177/001316447003000308
56. Sararaks, S., Azman, A., Low, L., Rugayah, B., Aziah, A., Hooi, L., Razak, M. A., Norhaya, M., Lim, K., & Azian, A. (2005). Validity and reliability of the SF-36: The Malaysian context. Medical Journal of Malaysia, 60(2), 163.
57. Goh, K. K. K., Lai, P. S. M., & Lim, S. K. (2019). Cross cultural adaptation and validation of the Malay Kidney Disease Quality of Life (KDQOL-36). BMC Nephrology, 20(1), 226. https://doi.org/10.1186/s12882-019-1397-8
    DOI: 10.1186/s12882-019-1397-8
58. Joshi, V. D., Mooppil, N., & Lim, J. F. Y. (2010). Validation of the Kidney Disease Quality of Life-Short Form: A cross-sectional study of a dialysis-targeted health measure in Singapore. BMC Nephrology, 11(1), 36. https://doi.org/10.1186/1471-2369-11-36
    DOI: 10.1186/1471-2369-11-36
59. Ware, J. E. (1993). SF-36 health survey: Manual and interpretation guide. The Health Institute, New England Medical Center.
60. Ware, J. E., Kosinski, M. A., & Keller, S. D. (1995). SF-36 physical and mental health summary scales: A user’s manual. The Health Institute, New England Medical Center.
61. Peipert, J. D., Nair, D., Klicko, K., Schatell, D. R., & Hays, R. D. (2019). Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36) normative values for the united states dialysis population and new single summary score. Journal of the American Society of Nephrology, 30(4), 654–663. https://doi.org/10.1681/asn.2018100994
    DOI: 10.1681/asn.2018100994
62. Ware, J., Kosinski, M., & Susan, K. (1995). SF-12: How to score the SF-12 Physical and Mental Health Summary Scales. The Health Institute, New England Medical Center.
63. Khor, B.-H., Sualeheen, A., Sahathevan, S., Chinna, K., Gafor, A. H. A., Bavanandan, S., Goh, B.-L., Morad, Z., Daud, Z. A. M., Khosla, P., Wang, A.Y.-M., Karupaiah, T., Bee, B. C., Ahmad, G., Lim, S. K., Wahab, M. Z. A., Visvanathan, R., Yahya, R., & Pa, T. C. H. I. (2020). Association of dietary patterns with serum phosphorus in maintenance haemodialysis patients: A cross-sectional study. Scientific Reports, 10(1), 12278. https://doi.org/10.1038/s41598-020-68893-4
    DOI: 10.1038/s41598-020-68893-4
64. Kalantar-Zadeh, K., Kopple, J. D., Humphreys, M. H., & Block, G. (2004). Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrology, Dialysis, Transplantation, 19(6), 1507–1519. https://doi.org/10.1093/ndt/gfh143
    DOI: 10.1093/ndt/gfh143
65. Pisetkul, C., Chanchairujira, K., Chotipanvittayakul, N., Ong-Ajyooth, L., & Chanchairujira, T. (2010). Malnutrition-inflammation score associated with atherosclerosis, inflammation and short-term outcome in hemodialysis patients. Journal of the Medical Association of Thailand, 93(Suppl 1), S147–S156.
66. Frisancho, A. R. (1981). New norms of upper limb fat and muscle areas for assessment of nutritional status. American Journal of Clinical Nutrition, 34(11), 2540–2545. https://doi.org/10.1093/ajcn/34.11.2540
    DOI: 10.1093/ajcn/34.11.2540
67. K/DOQI. (2000). K/DOQI clinical practice guidelines for nutrition in chronic renal failure. American Journal of Kidney Diseases, 37(1), S66–S70.
68. Tee, E., Ismail, M., Nasir, M., & Khatijah, I. (1997). Nutrient composition of Malaysian foods. Malaysian food composition database programme (p. 310). Institute for Medical Research, Kuala Lumpur
69. Singapore Health Promotion Board. (2003). Food composition guide Singapore. Singapore Health Promotion Board.
70. Organization, W. H. (1995). Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization Technical Report Series, 854, 1–452.
71. James, G., Witten, D., Hastie, T., & Tibshirani, R. (2013). An introduction to statistical learning (Vol. 112). Springer.
    DOI: 10.1007/978-1-4614-7138-7
72. Beto, J. A., Ramirez, W. E., & Bansal, V. K. (2014). Medical nutrition therapy in adults with chronic kidney disease: Integrating evidence and consensus into practice for the generalist registered dietitian nutritionist. Journal of the Academy of Nutrition and Dietetics, 114(7), 1077–1087. https://doi.org/10.1016/j.jand.2013.12.009
    DOI: 10.1016/j.jand.2013.12.009
73. Mak, R. H., Ikizler, A. T., Kovesdy, C. P., Raj, D. S., Stenvinkel, P., & Kalantar-Zadeh, K. (2011). Wasting in chronic kidney disease. Journal of Cachexia, Sarcopenia and Muscle, 2(1), 9–25. https://doi.org/10.1007/s13539-011-0019-5
    DOI: 10.1007/s13539-011-0019-5
74. Vogt, B. P., & Caramori, J. C. T. (2016). Are nutritional composed scoring systems and protein-energy wasting score associated with mortality in maintenance hemodialysis patients? Journal of Renal Nutrition, 26(3), 183–189. https://doi.org/10.1053/j.jrn.2015.11.003
    DOI: 10.1053/j.jrn.2015.11.003
75. Toledo, F. R., Antunes, A. A., Vannini, F. C., Silveira, L. V., Martin, L. C., Barretti, P., & Caramori, J. C. (2013). Validity of malnutrition scores for predicting mortality in chronic hemodialysis patients. International Urology and Nephrology, 45(6), 1747–1752. https://doi.org/10.1007/s11255-013-0482-3
    DOI: 10.1007/s11255-013-0482-3
76. Gracia-Iguacel, C., González-Parra, E., Mahillo, I., & Ortiz, A. (2019). Criteria for classification of protein–energy wasting in dialysis patients: Impact on prevalence. British Journal of Nutrition, 121(11), 1271–1278. https://doi.org/10.1017/S0007114519000400
    DOI: 10.1017/S0007114519000400
77. Takahashi, H., Inoue, K., Shimizu, K., Hiraga, K., Takahashi, E., Otaki, K., Yoshikawa, T., Furuta, K., Tokunaga, C., Sakakibara, T., & Ito, Y. (2017). Comparison of nutritional risk scores for predicting mortality in Japanese chronic hemodialysis patients. Journal of Renal Nutrition, 27(3), 201–206. https://doi.org/10.1053/j.jrn.2016.12.005
    DOI: 10.1053/j.jrn.2016.12.005
78. de Roij van Zuijdewijn, C. L. M., ter Wee, P. M., Chapdelaine, I., Bots, M. L., Blankestijn, P. J., van den Dorpel, M. A., Nubé, M. J., & Grooteman, M. P. C. (2015). A comparison of 8 nutrition-related tests to predict mortality in hemodialysis patients. Journal of Renal Nutrition, 25(5), 412–419. https://doi.org/10.1053/j.jrn.2015.02.005
    DOI: 10.1053/j.jrn.2015.02.005
79. Lopes, M. B., Silva, L. F., Lopes, G. B., Penalva, M. A., Matos, C. M., Robinson, B. M., & Lopes, A. A. (2017). Additional Contribution of the Malnutrition-Inflammation Score to predict mortality and patient-reported outcomes as compared with its components in a cohort of African descent hemodialysis patients. Journal of Renal Nutrition, 27(1), 45–52. https://doi.org/10.1053/j.jrn.2016.08.006
    DOI: 10.1053/j.jrn.2016.08.006
80. Johansen, K. L., Kutner, N. G., Young, B., & Chertow, G. M. (2006). Association of body size with health status in patients beginning dialysis. The American Journal of Clinical Nutrition, 83(3), 543–549.
    DOI: 10.1093/ajcn.83.3.543
81. Forhan, M., & Gill, S. V. (2013). Obesity, functional mobility and quality of life. Best Practice & Research Clinical Endocrinology & Metabolism, 27(2), 129–137. https://doi.org/10.1016/j.beem.2013.01.003
    DOI: 10.1016/j.beem.2013.01.003
82. Tong, A., Manns, B., Wang, A. Y. M., Hemmelgarn, B., Wheeler, D. C., Gill, J., Tugwell, P., Pecoits-Filho, R., Crowe, S., Harris, T., Van Biesen, W., Winkelmayer, W. C., Levin, A., Thompson, A., Perkovic, V., Ju, A., Gutman, T., Bernier-Jean, A., Viecelli, A. K., … ONG Implementation Workshop Investigators. (2018). Implementing core outcomes in kidney disease: Report of the Standardized Outcomes in Nephrology (SONG) implementation workshop. Kidney International, 94(6), 1053–1068. https://doi.org/10.1016/j.kint.2018.08.018
    DOI: 10.1016/j.kint.2018.08.018
83. Evangelidis, N., Tong, A., Manns, B., Hemmelgarn, B., Wheeler, D. C., Tugwell, P., Crowe, S., Harris, T., Van Biesen, W., & Winkelmayer, W. C. (2017). Developing a set of core outcomes for trials in hemodialysis: An international Delphi survey. American Journal of Kidney Diseases, 70(4), 464–475. https://doi.org/10.1053/j.ajkd.2016.11.029
    DOI: 10.1053/j.ajkd.2016.11.029
84. Chan, W., Chin, S. H., Whittaker, A. C., Jones, D., Kaur, O., Bosch, J. A., & Borrows, R. (2019). The associations of muscle strength, muscle mass, and adiposity with clinical outcomes and quality of life in prevalent kidney transplant recipients. Journal of Renal Nutrition, 29(6), 536–547. https://doi.org/10.1053/j.jrn.2019.06.009
    DOI: 10.1053/j.jrn.2019.06.009
85. Sayer, A. A., Syddall, H. E., Martin, H. J., Dennison, E. M., Roberts, H. C., & Cooper, C. (2006). Is grip strength associated with health-related quality of life? Findings from the Hertfordshire Cohort Study. Age and Ageing, 35(4), 409–415. https://doi.org/10.1093/ageing/afl024
    DOI: 10.1093/ageing/afl024
86. Jakobsen, L. H., Rask, I. K., & Kondrup, J. (2010). Validation of handgrip strength and endurance as a measure of physical function and quality of life in healthy subjects and patients. Nutrition, 26(5), 542–550. https://doi.org/10.1016/j.nut.2009.06.015
    DOI: 10.1016/j.nut.2009.06.015
87. Kang, S. Y., Lim, J., & Park, H. S. (2018). Relationship between low handgrip strength and quality of life in Korean men and women. Quality of Life Research, 27(10), 2571–2580. https://doi.org/10.1007/s11136-018-1920-6
    DOI: 10.1007/s11136-018-1920-6
88. Nishikawa, H., Enomoto, H., Yoh, K., Iwata, Y., Sakai, Y., Kishino, K., Ikeda, N., Takashima, T., Aizawa, N., Takata, R., Hasegawa, K., Ishii, N., Yuri, Y., Nishimura, T., Iijima, H., & Nishiguchi, S. (2018). Health-related quality of life in chronic liver diseases: A strong impact of hand grip strength. Journal of Clinical Medicine, 7(12), 553. https://doi.org/10.3390/jcm7120553
    DOI: 10.3390/jcm7120553
89. Sayer, A. A., Dennison, E. M., Syddall, H. E., Gilbody, H. J., Phillips, D. I., & Cooper, C. (2005). Type 2 diabetes, muscle strength, and impaired physical function: The tip of the iceberg? Diabetes Care, 28(10), 2541–2542. https://doi.org/10.2337/diacare.28.10.2541
    DOI: 10.2337/diacare.28.10.2541
90. McNicholl, T., Curtis, L., Dubin, J. A., Mourtzakis, M., Nasser, R., Laporte, M., & Keller, H. (2020). Handgrip strength predicts length of stay and quality of life in and out of hospital. Clinical Nutrition, 39(8), 2501–2509. https://doi.org/10.1016/j.clnu.2019.11.006
    DOI: 10.1016/j.clnu.2019.11.006
91. Oliveira, M. C., Bufarah, M. N. B., & Balbi, A. L. (2018). Handgrip strength in end stage of renal disease—A narrative review. Nutrire, 43(1), 14. https://doi.org/10.1186/s41110-018-0073-2
    DOI: 10.1186/s41110-018-0073-2
92. Martin-Alemañy, G., de los Ángeles Espinosa-Cuevas, M., Pérez-Navarro, M., Wilund, K. R., Miranda-Alatriste, P., Cortés-Pérez, M., García-Villalobos, G., Gómez-Guerrero, I., Cantú-Quintanilla, G., Ramírez-Mendoza, M., & Valdez-Ortiz, R. (2020). Effect of oral nutritional supplementation with and without exercise on nutritional status and physical function of adult hemodialysis patients: A Parallel Controlled Clinical Trial (AVANTE-HEMO Study). Journal of Renal Nutrition, 30(2), 126–136. https://doi.org/10.1053/j.jrn.2019.06.010
    DOI: 10.1053/j.jrn.2019.06.010
93. Lopes, A. A., Bragg-Gresham, J. L., Goodkin, D. A., Fukuhara, S., Mapes, D. L., Young, E. W., Gillespie, B. W., Akizawa, T., Greenwood, R. N., Andreucci, V. E., Akiba, T., Held, P. J., & Port, F. K. (2007). Factors associated with health-related quality of life among hemodialysis patients in the DOPPS. Quality of Life Research, 16(4), 545–557. https://doi.org/10.1007/s11136-006-9143-7
    DOI: 10.1007/s11136-006-9143-7
94. Keller, U. (2019). Nutritional laboratory markers in malnutrition. Journal of Clinical Medicine, 8(6), 775. https://doi.org/10.3390/jcm8060775
    DOI: 10.3390/jcm8060775
95. Hanafusa, N., Nitta, K., Okazaki, M., Komatsu, M., Shiohira, S., Kawaguchi, H., & Tsuchiya, K. (2017). Serum albumin level adjusted with C-reactive protein predicts hemodialysis patient survival. Renal Replacement Therapy, 3(1), 9. https://doi.org/10.1186/s41100-016-0085-4
    DOI: 10.1186/s41100-016-0085-4
96. Kalantar-Zadeh, K., Kuwae, N., Wu, D. Y., Shantouf, R. S., Fouque, D., Anker, S. D., Block, G., & Kopple, J. D. (2006). Associations of body fat and its changes over time with quality of life and prospective mortality in hemodialysis patients. The American Journal of Clinical Nutrition, 83(2), 202–210. https://doi.org/10.1093/ajcn/83.2.202
    DOI: 10.1093/ajcn/83.2.202
97. Kalender, B., Ozdemir, A. C., Dervisoglu, E., & Ozdemir, O. (2007). Quality of life in chronic kidney disease: Effects of treatment modality, depression, malnutrition and inflammation. International Journal of Clinical Practice, 61(4), 569–576. https://doi.org/10.1111/j.1742-1241.2006.01251.x
    DOI: 10.1111/j.1742-1241.2006.01251.x
98. Nowak, K. L., & Chonchol, M. (2018). Does inflammation affect outcomes in dialysis patients? Seminars in Dialysis, 31(4), 388–397. https://doi.org/10.1111/sdi.12686
    DOI: 10.1111/sdi.12686
99. K/DOQI. (2003). K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. American Journal of Kidney Diseases, 42(4 Suppl 3), S1-201.
100. Lacson, E., Jr., Xu, J., Lin, S. F., Dean, S. G., Lazarus, J. M., & Hakim, R. (2009). Association between achievement of hemodialysis quality-of-care indicators and quality-of-life scores. American Journal of Kidney Diseases, 54(6), 1098–1107. https://doi.org/10.1053/j.ajkd.2009.07.017
     DOI: 10.1053/j.ajkd.2009.07.017
101. Ware, J. E., Jr., Gandek, B., Kosinski, M., Aaronson, N. K., Apolone, G., Brazier, J., Bullinger, M., Kaasa, S., Leplège, A., & Prieto, L. (1998). The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: Results from the IQOLA project. Journal of Clinical Epidemiology, 51(11), 1167–1170. https://doi.org/10.1016/s0895-4356(98)00108-5
     DOI: 10.1016/s0895-4356(98)00108-5
102. Lam, C. L., Eileen, Y., Gandek, B., & Fong, D. Y. (2005). The SF-36 summary scales were valid, reliable, and equivalent in a Chinese population. Journal of Clinical Epidemiology, 58(8), 815–822. https://doi.org/10.1016/j.jclinepi.2004.12.008
     DOI: 10.1016/j.jclinepi.2004.12.008
103. Yarlas, A. S., White, M. K., Yang, M., Saris-Baglama, R. N., Bech, P. G., & Christensen, T. (2011). Measuring the health status burden in hemodialysis patients using the SF-36(R) health survey. Quality of Life Research, 20(3), 383–389. https://doi.org/10.1007/s11136-010-9764-8
     DOI: 10.1007/s11136-010-9764-8