Comparison of Longer and Shorter Hemodialysis Duration on Nutritional Status and Quality of Life of Hemodialysis Patients

Authors

  • Nur Samsu Department of Internal Medicine, Division of Nephrology and Hypertension, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia http://orcid.org/0000-0003-4610-3796
  • Devi Santi Fatmawati Dialysis unit of Wava Husada Hospital, Malang, Indonesia
  • Farida Wibisono Dialysis unit of Wava Husada Hospital, Malang, Indonesia
  • Kartin Kartin Dialysis unit of Panti Nirmala Hospital, Malang, Indonesia
  • Wahyu Wulandari Dialysis Unit of Saiful Anwar General Hospital, Malang, Indonesia
  • Ayu Radyan Sephani Resident of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
  • Renny Tandya Resident of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
  • Angelia Gemilang Kartikasari Kosasih Resident of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia

Keywords:

subjective global assessment, SF-36 questionnaire, blood flow rate, dialysis time

Abstract

Background: Important determinants of dialysis adequacy are blood flow rate (BFR) and dialysis time. This study aimed to evaluate the impact of BFR and duration of dialysis session on nutritional status and quality of life (QoL) in hemodialysis (HD) patients. Methods: Real-world evidence studies (RWE) of 3 HD units that differ in BFR and/or dialysis time. Group I, HD 5 hours and BFR 200-250 mL/minute; group II, HD 4 hours and BFR 270-320 mL/minute, and group III, HD 4 hours and BFR 200-250 mL/minute. All HD units use the same dialysate flow and dialysis frequency. The 3-point Subjective Global Assessment (SGA) scale is used to assess nutritional status, while QOL is assessed using the SF-36. Results: There were 291 chronic HD patients with an average age of 51 (12.3) years, 50.5% were male. The proportion of SGA classes between groups did not differ significantly. Group I was associated with significantly higher PF and RP domain scores of PC and VT domain scores of MC compared to Group III. On the other hand, Group II was associated with significantly lower VT and MH domain scores of MC compared to Group I, while the other domains were not significantly different. In general, Group III had the lowest SF-36 scores compared to the other 2 groups. Conclusion: Duration of HD was not associated with nutritional status. Compared with 4-hour HD but with a faster BFR, 5-hour HD was associated with higher Mental Component QOL scores, but not Physical Component scores.

References

Nunes FT, Campos G de, Paula SMX de, et al. Dialysis adequacy and nutritional status of hemodialysis patients. Hemodial Int. 2008;12(1):45–51. Doi: 10.1111/j.1542-4758.2008.00239.x.

Visiedo L, Rey L, Rivas F, et al. The impact of nutritional status on health-related quality of life in hemodialysis patients. Sci Rep. 2022;12(1):3029. Doi: 10.1038/s41598-022-07055-0.

National Kidney Foundation. KDOQI clinical practice guideline for hemodialysis: 2015 update. 2015.

Jindal K, Chan CT, Deziel C, et al. Chapter 1. J Am Soc Nephrol 2006;17(3 suppl1):S4–7. Doi: 10.1681/01.asn.0000926792.54780.79.

Borzou SR, Gholyaf M, Zandiha M, et al. The effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients. Saudi J Kidney Dis Transpl. 2009;20(4):639–42.

Hassell DRM, van der Sande FM, Kooman JP, et al. Optimizing dialysis dose by increasing blood flow rate in patients with reduced vascular-access flow rate. Am J Kidney Dis. 2001;38(5):948–55. Doi: 10.1053/ajkd.2001.28580.

Locatelli F, Buoncristiani U, Canaud B, et al. Dialysis dose and frequency. Nephrol Dial Transplant. 2005;20(2):285–96. Doi: 10.1093/ndt/gfh550.

Hauk M, Kuhlmann MK, Riegel W, et al. In vivo effects of dialysate flow rate on Kt/V in maintenance hemodialysis patients. Am J Kidney Dis. 2000;35(1):105–11. Doi: 10.1016/S0272-6386(00)70308-8.

Samsu N, Fatmawati F, Permatasari A, et al. The impact of blood flow rate and duration of dialysis session on nutritional status in hemodialysis patients. Glob J Health Sci. 2020;12(11):106. Doi: 10.5539/gjhs.v12n11p106.

George KS, Whitlum L, Duncan J. Examining the effect of blood flow rate on hemodialysis urea clearanceo Title. CANNT J. 2017;27(3).

Saran R, Robinson B, Abbott KC, et al. US renal data system 2019. Annual data report: Epidemiology of kidney disease in the United States. Am J Kidney Dis 2020;75(1): A6–7. Doi: 10.1053/j.ajkd.2019.09.003.

Detsky A, McLaughlin, Baker J, et al. What is the subjective global assessment of nutritional status? J Parenter Enter Nutr. 1987;11(1):8–13. Doi: 10.1177/014860718701100108.

SF-36 - OrthoToolKit. Available at: https://orthotoolkit.com/sf-36/.

Saris-Baglama R, Dewey C, Chisholm G, et al. Quality metric health outcomesTM scoring software 4.0. Lincoln, RI 2010:138.

Campolina AG, Bortoluzzo AB, Ferraz MB, et al. Validação da versão brasileira do questionário genérico de qualidade de vida short-form 6 Dimensions (SF-6D Brasil). Ciên Saúde Colet. 2011;16(7):3103–10. Doi: 10.1590/S1413-81232011000800010.

Garrido Pérez L, Sanz Turrado M, Caro Domínguez C. Variables de la desnutrición en pacientes en diálisis. Enfermería Nefrológica. 2016;19(4):307–16. Doi: 10.4321/S2254-28842016000400002.

Nagy E, Mahmoud M, El-kannishy G, et al. Impact of malnutrition on health-related quality of life in patients on maintenance hemodialysis. Ther Apher Dial. 2021;25(4):467–74. Doi: 10.1111/1744-9987.13588.

Jassal S V, Watson D. Dialysis in late life. Clin J Am Soc Nephrol. 2009;4(12):2008–12. Doi: 10.2215/CJN.04610709.

Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Prim Care Clin Off Pract. 2008;35(2):329–44. Doi: 10.1016/j.pop.2008.01.008.

Sohrabi Z, Eftekhari MH, Eskandari MH, et al. Malnutrition-inflammation score and quality of life in hemodialysis patients: Is there any correlation? Nephrourol Mon. 2015;7(3). Doi: 10.5812/numonthly.7(3)2015.27445.

Campbell KL, Ash S, Bauer JD. The impact of nutrition intervention on quality of life in pre-dialysis chronic kidney disease patients. Clin Nutr 2008;27(4):537–44. Doi: 10.1016/j.clnu.2008.05.002.

Johansen KL. Exercise and chronic kidney disease. Sport Med. 2005;35(6):485–99. Doi: 10.2165/00007256-200535060-00003.

Lessan-Pezeshki M, Rostami Z. Contributing factors in health-related quality of life assessment of ESRD patients: A single center study. Int J Nephrol Urol. 2009;1(2):129–36.

Kutner NG, Jassal SV. Quality of life and rehabilitation of elderly dialysis patients. Semin Dial. 2002;15(2):107–12. Doi: 10.1046/j.1525-139X.2002.00034.x.

Tu H-Y, Shao J-H, Wu F-J, et al. Stressors and coping strategies of 20–45-year-old hemodialysis patients. Collegian. 2014;21(3):185–92. Doi: 10.1016/j.colegn.2013.02.003.

Qaddumi JS, Al-Tell M, Almahmoud O, et al. Physiological and psychosocial stressors among Palestinian hemodialysis patients: A cross-sectional study. Saudi J Heal Sci. 2020;9(1):50. Doi: 10.4103/sjhs.sjhs_88_19.

Mahdavi A, Janati Y, Illayi E, et al. Physiological and psychosocial stressors among hemodialysis patients in educational hospitals of northern Iran. Indian J Palliat Care. 2013;19(3):166. Doi: 10.4103/0973-1075.121533.

Lok P. Stressors, coping mechanisms, and quality of life among dialysis patients in Australia. J Adv Nurs. 1996;23(5):873–81. Doi: 10.1046/j.1365-2648.1996.00893.x.

Kim YO, Song W J, Yoon S A, et al. The effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients with low Kt/V. Hemodial Int. 2004;8(1):85–6. Doi: 10.1111/j.1492-7535.2004.0085q.x.

NKF-KDOQI 2006 Updates: Clinical practice guidelines and recommendations. Available at: https://www.kidney.org/sites/default/files/docs/12-500210_jag_dcp_guidelines-hd_oct06_sectiona_ofc.pdf.

Nugroho P, Siregar J, Putranto R, et al. Relationship between blood flow rate and quality of life in patients undergoing hemodialysis. J Nat Sci Biol Med 2019;10(3):s53–8. Doi: https://doi.org/10.4103/jnsbm.JNSBM_33_19.

Md. Yusop NB, Yoke Mun C, Shariff ZM, et al. Factors associated with quality of life among hemodialysis patients in Malaysia. PLoS One. 2013;8(12):e84152. Doi: 10.1371/journal.pone.0084152.

Chazot C, Wabel P, Chamney P, et al. Importance of normohydration for the long-term survival of haemodialysis patients. Nephrol Dial Transplant. 2012;27(6):2404–10. Doi: 10.1093/ndt/gfr678.

Flythe JE, Curhan GC, Brunelli SM. Shorter length dialysis sessions are associated with increased mortality, independent of body weight. Kidney Int. 2013;83(1):104–13. Doi: 10.1038/ki.2012.346.

Daugirdas JT. Dialysis time, survival, and dose-targeting bias. Kidney Int. 2013;83(1):9–13. Doi: 10.1038/ki.2012.365.

Tentori F, Zhang J, Li Y, et al. Longer dialysis session length is associated with better intermediate outcomes and survival among patients on in-center three times per week hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2012;27(11):4180–8. Doi: 10.1093/ndt/gfs021.

Kitagawa M, Sada K, Hinamoto N, et al. Shorter dialysis session length was not associated with lower mental health and physical functioning in elderly hemodialysis patients: Results from the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS). PLoS One. 2017;12(9):e0184019. Doi: 10.1371/journal.pone.0184019.

Bohlke M, Nunes DL, Marini SS, et al. Predictors of quality of life among patients on dialysis in southern Brazil. Sao Paulo Med J. 2008;126(5):252–6. Doi: 10.1590/S1516-31802008000500002.

Odette Dorcas TM, Youth TB, Atuhaire C, et al. Physiological and psychosocial stressors among hemodialysis patients in the Buea Regional Hospital, Cameroon. Pan Afr Med J. 2018;30. Doi: 10.11604/pamj.2018.30.49.15180.

Downloads

Published

2026-04-09

How to Cite

Samsu, N., Fatmawati, D. S. ., Wibisono, F. ., Kartin, K. ., Wulandari, W. ., Sephani, A. R. ., Tandya, R. ., & Kosasih, A. G. K. . (2026). Comparison of Longer and Shorter Hemodialysis Duration on Nutritional Status and Quality of Life of Hemodialysis Patients. Acta Medica Indonesiana, 58(1), 15. Retrieved from https://www.actamedindones.org/index.php/ijim/article/view/3064

Most read articles by the same author(s)