The Importance of Biochemical Parameters, Immunonutritional Status, and Social Support for Quality of Life in Chronic Hemodialysis Patients

Abstract

Background and Objectives: Chronic kidney disease (CKD) is a growing public health problem and one of the leading causes of premature death worldwide. The progressive nature of CKD is associated with serious complications that can reduce the quality of life in CKD patients. Additional factors that can worsen well-being include dialysis treatment, malnutrition, inflammation, and lack of social support. The aim of our study was to analyze the quality of life of CKD patients undergoing hemodialysis and its association with certain biochemical and immunonutritional parameters, as well as with social support. Materials and Methods: This research was conducted as a cross-sectional study that included 170 patients, divided into two groups: a group of patients undergoing hemodialysis (HD group) (n = 85), and a control group of non-hemodialysis patients (group with CKD stage 3-4) (n = 85). The Health-Related Quality of Life (HRQoL) score was used to assess the quality of life of the study population. Measurement of biochemical and immunonutritional parameters was also performed in all patients. The Oslo-3 Social Support Scale (OSSS-3) was used to analyze social support. Results: The HRQoL score was significantly lower in HD patients compared to patients with CKD stage 3-4 (0.701 ± 0.137 vs. 0.832 ± 0.122, p < 0.001). It declined significantly as the concentrations of urea (β = -0.347, p < 0.001), creatinine (β = -0.699, p = 0.005), uric acid (β = -0.184, p = 0.016), β2-microglobulin (β = -0.432, p < 0.001), and parathormone (β = -0.209, p = 0.006) increased in HD patients. In addition to uremic toxins, an increase in glucose (β = -0.278, p = 0.010) and triglyceride (β = -0.354, p = 0.001) concentrations was associated with poor HRQoL in patients with CKD stage 3-4. There was a significant connection between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and HRQoL in HD patients (β = 0.229, p = 0.035). Additionally, C-reactive protein (β = -0.361, p < 0.001) and neutrophil-to-lymphocyte ratio (β = -0.288, p < 0.001), as markers of systemic inflammation, directly affected HRQoL in HD patients. In both study groups, perceived social support positively influenced the HRQoL scores (β = 0.192, p = 0.012 for hemodialysis; β = 0.225, p = 0.038 for non-hemodialysis). Conclusions: There is a decline in HRQoL in chronic hemodialysis patients, significantly affected by certain biochemical and immunonutritional parameters, along with perceived social support.

Keywords: chronic kidney disease; hemodialysis; immunonutrition; quality of life; social support; systemic inflammation; uremia.

Figure 1

The distribution of the study population according to the main cause of chronic kidney disease.

Figure 2

Histograms of HRQoL score distribution in hemodialysis patients (A) and CKD stage 3–4 patients (B).

Figure 3

OSSS-3 scores in the study population.