SF36 quality of life and mortality across different levels of serum albumin in patients with hemodialysis

Abstract

Background: Patients on hemodialysis (HD) generally display a significant decrease in the quality of life owing to comorbidities, malnutrition, and inflammation. Methods: In this multicenter prospective study, the SF36 (short form with 36 questions scored between 0 and 100) and relevant demographic data and comorbidities (charlson comorbidity index); nutritional factors, and C-reactive protein (CRP) were evaluated in 416 HD patients in September 2012. Hospitalization and mortality were assessed in a median of a 28 month follow-up. Results: The SF36 score in survived patients was 53.6±19.3 versus 41.6±22.4 in the non-survived patients (P < 0.001). There were significant adjusted inverse correlation between the SF36 score and age (r = -0.14, P = 0.005), diabetes (r = -0.13, P = 0.009), CCI (r = -0.24, P < 0.001), serum CRP level (r = -0.13, P = 0.03), serum iPTH level (r = -0.19, P < 0.001), and also significant adjusted direct correlation with serum albumin (r = 0.15, P = 0.003), and serum creatinine (r = 0.12, P = 0.04). In Cox proportional hazard models adjusting for age, gender, dialysis vintage, diabetes and serum albumin, the hazard ratio of death for every 10 unit decrease in SF36 score was 1.10 (95% CI: 1.04 - 1.22; P = 0.006). The adjusted hazard ratio for quintiles of serum albumin as ≤3.60, > 3.60 - 3.85, > 3.85 - 4.00, > 4.00 - 4.20, > 4.20 (reference) g/dL was respectively 3.69 (1.98 - 6.89), 2.08 (1.10 - 3.94), 1.91 (0.97 - 3.85), 1.10 (0.76 - 1.49). Serum albumin revealed a strong association with mortality such that hazard ratio for every 1 g/dL decrease in serum albumin was 6.28 (95% CI: 3.80 - 10.42; P < 0.001). Conclusions: In patients with hemodialysis, SF36 shows significant association with serum albumin, comorbidities, inflammation, and clinical outcome.