Nutrition and Quality of Life in Hemodialysis – the Impact of Nutritional Status and Quality of Life on Morbidity and Mortality in Hemodialysis Patients

  • B. Feldt-Rasmussen
  • T. A. Ikizler
  • K. Kalantar-Zadeh
  • J. D. Kopple
Reference work entry


Adult patients receiving chronic hemodialysis (CHD) frequently show clinical signs of deranged nutritional status (“ protein-energy wasting”). In addition to the fact that such patients are usually anorectic and are exposed to nutrient losses during dialysis, advanced chronic kidney disease (CKD) and associated uremic milieu leads to metabolic changes that favor protein and energy catabolism over anabolism. The mortality rate of CHD patients is unacceptably high, and endpoints of morbidity and mortality in such patients have been correlated to such nutritional status measures as low lean body mass or low serum albumin. Physical debility and other symptoms frequently occur, posing challenges to lifestyle that make quality of life a common clinical issue in CHD patients. Validated tools for measuring quality of life during hemodialysis are available, including both generic (general health) and renal-disease-specific tools, sometimes having multidimensional scales. Quality of life endpoints in CHD patients have been positively correlated to such nutritional status measures as serum albumin. Even more importantly, endpoints of morbidity and mortality in CHD patients have been negatively correlated to quality of life measures. Clinical measures intended to improve nutritional status must tip the balance of catabolic/anabolic processes toward favoring anabolic processes. There are indications that treatment to target in accordance with internationally accepted guidelines early after initiation of CHD is of importance. There are also indications that treatment with anabolic agents such as growth hormone to improve nutritional status in such patients may be beneficial for improving quality of life measures and with a potential to reduce cardiovascular risk. Clinical trial confirmation of such findings is awaiting completion of larger ongoing studies.


Growth Hormone Chronic Kidney Disease Chronic Kidney Disease Patient Physical Component Summary Mental Component Summary 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:


bone mineral density


body mass index


chronic hemodialysis


chronic kidney disease


C-reactive protein


the dialysis outcomes and practice patterns study


dual energy X-ray absorptiometry


end-stage renal disease




health related quality of life


insulin-like growth factor I




International Society of Renal Nutrition and Metabolism


kidney disease component summary


kidney disease quality of life


mental component summary (of KDQOL)


magnetic resonance imaging


near-infrared interactance


physical component summary (of KDQOL)


parathyroid hormone


short-form HRQOL scoring system (36 items)

TNF alpha

tumor necrosis factor alpha


  1. Ansell D. (2007). Nephrol Dial Transplant. 22(Suppl. 7): vii–viii.Google Scholar
  2. Biolo G, Tipton KD, Klein S, Wolfe RR. (1997). Am J Physiol. 273: E122–129.PubMedGoogle Scholar
  3. Cano NJ, Fouque D, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Laville M, Leverve XM. (2007). J Am Soc Nephrol. 18(9): 2583–2591.PubMedCrossRefGoogle Scholar
  4. Capelli JP, Kushner H, Camiscioli TC, et al. (1994). Am J Kidney Dis. 23: 808.PubMedGoogle Scholar
  5. Chan M, Singh B, Cheema B, Singh MF. (2007). J Renal Nutr. 17: 84–87.CrossRefGoogle Scholar
  6. Chan W, Valerie KC, Chan JCM. (1993). Kidney Int. 43: 790–795.PubMedCrossRefGoogle Scholar
  7. Chertow GM, Ling J, Lew NL, et al. (1994). Am J Kidney Dis. 24: 912.PubMedGoogle Scholar
  8. Danish Society of Nephrology. (2005). Danish National Registry. Report on Dialysis and Transplantation in Denmark.Google Scholar
  9. Diaz-Buxo JA, Lowrie EG, Lew NL, Zhang H, Lazarus JM. (2000). Am J Kidney Dis. 35: 293–300.PubMedCrossRefGoogle Scholar
  10. Feldt-Rasmussen B, Lange M, Sulowicz W, Gafter U, Lai KN, Wiedeman J, Christiansen JS, Nahas ME. (2007). J Am Soc Nephrol. 18(7): 2161–2171.PubMedCrossRefGoogle Scholar
  11. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Treviño-Becerra A, Wanner C. (2008). Kidney Int. 73(4): 391–398.PubMedCrossRefGoogle Scholar
  12. Fouque D, Peng SC, Shamir E, Kopple JD. (2000). Kidney Int. 57: 646–654.PubMedGoogle Scholar
  13. Fukuhara S, Lopes AA, Bragg-Gresham JL, Kurokawa K, Mapes DL, Akizawa T, Bommer J, Canaud BJ, Port FK, Held PJ. (2003). Kidney Int. 64: 1903–1906.PubMedCrossRefGoogle Scholar
  14. Gautsch TA, Anthony JC, Kimball SR, Paul GL, et al. (1998). Am J Physiol. 274: C406–414.PubMedGoogle Scholar
  15. Hansen TB, Gram J, Jensen PB, Kristiansen JH, et al. (2000). Clin Nephrol. 53: 99–107.PubMedGoogle Scholar
  16. Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB. (1994). Qual Life Res. 3: 329–338.PubMedCrossRefGoogle Scholar
  17. Health Care Financing Administration: 1994 ESRD Core Indicators Project. Opportunities to Improve Care for Adult In-Center Hemodialysis Patients. 1994 December Baltimore, Department of Health and Human Services.Google Scholar
  18. Hutchinson TA, Boyd NF, Feinstein AR, Gonda A, Hollomby D, Rowat B. (1979). J Chron Dis. 32: 661–666.PubMedCrossRefGoogle Scholar
  19. Iglesias P, Diez JJ, Fernandez-Reyes MJ, Aguilera A, et al. (1998). Am J Kidney Dis. 32: 454–463.PubMedCrossRefGoogle Scholar
  20. Ikizler TA, Greene JH, Wingard RL, Parker RA, Hakim RM. (1995a). J Am Soc Nephrol. 6: 1386–1391.PubMedGoogle Scholar
  21. Ikizler TA, Hakim RM. (1996). Kidney Int. 50(2): 343–357.PubMedCrossRefGoogle Scholar
  22. Ikizler TA, Wingard RL, Hakim RM. (1995b). Am J Kidney Dis. 26: 256–265.PubMedCrossRefGoogle Scholar
  23. Johannsson G, Bengtsson BA, Ahlmen J. (1999). Am J Kidney Dis. 33: 709–717.PubMedCrossRefGoogle Scholar
  24. Johansen K, Mulligan K, Schambelan M. (1998). JAMA. 281: 1275–1281.CrossRefGoogle Scholar
  25. Johansen KL, Painter PL, Sakkas GK, Gordon P, et al. (2006). J Am Soc Nephrol. 17: 2307–2314.PubMedCrossRefGoogle Scholar
  26. Johnson JP, McCauley CR, Copley JB. (1982). Kidney Int. 22: 286–291.PubMedCrossRefGoogle Scholar
  27. Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. (2003). Kidney Int. 63: 793–808.PubMedCrossRefGoogle Scholar
  28. Kalantar-Zadeh K, Block G, McAllister CJ, Humphreys MH, Kopple JD. (2004a). Am J Clin Nutr. 80: 299–307.PubMedGoogle Scholar
  29. Kalantar-Zadeh K, Kilpatrick RD, Kuwae N, McAllister CJ, Alcorn H, Kopple JD, Greenland S. (2005). Nephrol Dial Transplant. 20(9): 1880–1888.PubMedCrossRefGoogle Scholar
  30. Kalantar-Zadeh K, Kopple JD. (2001). Am J Kidney Dis. 38 (6): 1343–1350.PubMedCrossRefGoogle Scholar
  31. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. (2001). J Am Soc Nephrol. 12: 2797–2806.PubMedGoogle Scholar
  32. Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G. (2004b). Nephrol Dial Transplant. 19: 1507–1519.PubMedCrossRefGoogle Scholar
  33. Kalantar-Zadeh K, Unruh M. (2005). Int Urol Nephrol. 37: 367–378.PubMedCrossRefGoogle Scholar
  34. Karnofsky D, Burchenal J. (1949). In: Maclead C (ed.) Evaluation of Chemotherapeutic Agents. Columbia University Press, New York, pp 191–205.Google Scholar
  35. Kopple JD. (2006). Dietary considerations in patients with chronic renal failure, acute renal failure, and transplantation. In: Schrier R.W (ed.) Diseases of the Kidney, 8th ed. Lippincott Williams & Wilkins, Philadelphia, PA.Google Scholar
  36. Kopple JD: McCollum Award Lecture. (1997). Am J Clin Nutr. 65: 1544–1557.PubMedGoogle Scholar
  37. Kopple JD, Brunori G, Leiserowitz M, Fouque D. (2005). Nephrol Dialysis Transplant. 20: 952–958.CrossRefGoogle Scholar
  38. Kopple JD, Cohen AH, Wang H, Qing D, Tang Z, Fournier M, Lewis M, Casaburi R, Storer T. (2006). J Renal Nutr. 16: 312–324.CrossRefGoogle Scholar
  39. Kopple JD, Greene T, Chumlea WC, Hollinger D, Maroni BJ, Merrill D, Scherch LK, Schulman G, Wang S, Zimmer GS. (2000). Kidney Int. 57: 1688–1703.PubMedCrossRefGoogle Scholar
  40. Kopple JD, Wang H, Casaburi R, Fournier M, Lewis MI, Taylor W, Storer TW. (2007). J Am Soc Nephrol. 18: 2975–2986.PubMedCrossRefGoogle Scholar
  41. Kotzmann H, Yilmaz N, Lercher P, Riedl M, et al. (2001). Kidney Int. 60: 1578–1585.PubMedCrossRefGoogle Scholar
  42. Kutner NG, Devins GM. (1998). Ger Nephrol Urol. 8: 77–83.CrossRefGoogle Scholar
  43. Lowrie EG, Curtin RB, Lepain N, Schatell D. (2003). Am J Kidney Dis. 41: 1286–1292.PubMedCrossRefGoogle Scholar
  44. Lowrie EG, Lew NL. (1990). Am J Kidney Dis. 15(5): 458–482.PubMedGoogle Scholar
  45. Majchrzak KM, Pupim LB, Flakoll PJ, Ikizler TA. (2008). Nephrol Dial Transplant. 23(4): 1362–1369.PubMedCrossRefGoogle Scholar
  46. Mapes DL, Lopes AA, Satayathum S, McCullough KP, Goodkin DA, Locatelli F, Fukuhara S, Young EW, Kurokawa K, Saito A, Bommer J, Wolfe RA, Held PJ, Port FK. (2003). Kidney Int. 64: 339–349.PubMedCrossRefGoogle Scholar
  47. Mehls O, Ritz E, Hunziker EB, Eggli P, et al. (1988). Kidney Int. 33: 45–52.PubMedCrossRefGoogle Scholar
  48. Mehls O, Tonshoff B, Blum WF, Heinrich U, et al. (1990). Acta Paediatr Scand Suppl. 370: 28–34.PubMedCrossRefGoogle Scholar
  49. Mehrotra R, Berman N, Alistwani A, Kopple JD. (2002). Am J Kidney Dis. 40: 133–142.PubMedCrossRefGoogle Scholar
  50. Mehrotra R, Bross R, Konishi T, Appel M, Tsoi L, Kopple JD. (2006). J Am Soc Nephrol. 17: 724A.CrossRefGoogle Scholar
  51. Mehrotra R, Kopple JD. (2001). Annu Rev Nutr. 21: 343–379.PubMedCrossRefGoogle Scholar
  52. Mehrotra R, Kopple JD. (2004). Causes of protein-energy malnutrition in chronic renal failure. In: Kopple JD, Massry SG (ed.) “Nutritional Management of Renal Disease.” Lippincott Williams & Wilkins, Baltimore, pp 167–182.Google Scholar
  53. Meyer KB, Espindle DM, DeGiacomo JM, Jenuleson CS, Kurtin PS, Davies AR. (1994). Am J Kidney Dis. 24: 267–279.PubMedGoogle Scholar
  54. Mitch WE, Medina R. Greiber S, et al. (1994). J Clin Invest. 93: 2127.PubMedCrossRefGoogle Scholar
  55. Ng YH, Meyer KB, Kusek JW, Yan G, Rocco MV, Kimmel PL, Benz RL, Beddhu S, Dwyer JT, Toto RD, Eknoyan G, Unruh ML. (2006). Am J Kidney Dis. 47(4): 614–624.PubMedCrossRefGoogle Scholar
  56. Parfrey PS, Vavasour H, Bullock M, Henry S, Harnett JD, Gault MH. (1987). Transplant Proc. 19: 3407–3409.PubMedGoogle Scholar
  57. Pupim LB, Flakoll PJ, Levenhagen DK, Ikizler TA. (2004). Am J Physiol Endocrinol Metab. 286: E589–597.PubMedCrossRefGoogle Scholar
  58. Pupim LB, Kent P, Caglar K, Shyr Y, Hakim RM, Ikizler TA. (2002). Am J Kidney Dis. 40(1): 143–151.PubMedCrossRefGoogle Scholar
  59. Rabkin R, Sun DF, Chen Y, Tan J, et al. (2005). Pediatr Nephrol. 20: 313–318.PubMedCrossRefGoogle Scholar
  60. Rocco MV, Frankenfield DL, Hopson SD, McClellan WM. (2006). Ann Intern Med. 145(7): 512–519.PubMedGoogle Scholar
  61. Rocco MV, Paranandi L, Burrowes JD, et al. (2002). Am J Kidney Dis. 39(2): 245–256.PubMedCrossRefGoogle Scholar
  62. Schulman G. (2003). Am J Kidney Dis. 41(Suppl. 1): S112–S115.PubMedCrossRefGoogle Scholar
  63. Sharma RK, Sahu KM. (2001). J Indian Med Assoc. 99(4): 206–211, 213.PubMedGoogle Scholar
  64. Shinaberger CS, Kilpatrick RD, Regidor DL, McAllister CJ, Greenland S, Kopple JD, Kalantar-Zadeh K. (2006). Am J Kidney Dis. 48: 37–49.PubMedCrossRefGoogle Scholar
  65. Storer TW, Casaburi R, Sawelson S, Kopple JD. (2005). Nephrol Dial Transplant. 20: 1429–1437.PubMedCrossRefGoogle Scholar
  66. Sun DF, Zheng Z, Tummala P, Oh J, et al. (2004). J Am Soc Nephrol. 15: 2630–2636.PubMedCrossRefGoogle Scholar
  67. Tentori F, et al. (2007). JASN. 18: 2377–2384.PubMedGoogle Scholar
  68. Tonshoff B, Schaefer F, Mehls O. (1990). Pediatr Nephrol. 4(6): 654–662.PubMedCrossRefGoogle Scholar
  69. United States Renal Data System. (2006). United States Renal Data System Annual report.Google Scholar
  70. Unruh M, Benz R, Greene T, Yan G, Beddhu S, DeVita M, Dwyer JT, Kimmel PL, Kusek JW, Martin A, Rehm-McGillicuddy J, Teehan BP, Meyer KB. (2004). Kidney Int. 66: 355–366.PubMedCrossRefGoogle Scholar
  71. Unruh M, Yan G, Radeva M, Hays RD, Benz R, Athienites NV, Kusek J, Levey AS, Meyer KB. (2003). J Am Soc Nephrol. 14: 2132–2141.PubMedCrossRefGoogle Scholar
  72. Wingard, et al. (2007). Clin J Am Soc Nephrol. 2: 1170–1175.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • B. Feldt-Rasmussen
    • 1
  • T. A. Ikizler
    • 2
  • K. Kalantar-Zadeh
    • 3
  • J. D. Kopple
    • 4
  1. 1.Division of Nephrology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  2. 2.Vanderbilt University Medical CenterVanderbilt University School of MedicineNashvilleNashville
  3. 3.Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Centerthe David Geffen School of Medicine at UCLA and the UCLA School of Public HealthNashvilleTorrance
  4. 4.Division of Nephrology and Hypertension Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Centerthe David Geffen School of Medicine at UCLA and the UCLA School of Public HealthNashvilleTorrance

Personalised recommendations