Publication: Association between sociodemographic factors, dialysis malnutrition score (DMS), and quality of life (QOL) among hemodialysis patients in HPUSM
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Date
2025-07
Authors
Zakaria, Nor Zur Hafizah
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Abstract
Hemodialysis (HD) is a treatment process that removes toxins, excess fluid, and waste products from the blood in patients with end-stage kidney disease. Despite its life-saving role, HD contributes to increased protein-energy loss, inflammation, and metabolic stress, all of which heighten the risk of malnutrition, and the demanding treatment schedule and physical limitations lead to a reduced quality of life (QoL). Sociodemographic factors, like age, education, income, and work status, influence a patient’s ability to afford renal-friendly foods, understand dietary advice, and cope with the demands of long-term treatment. Lower-income patients struggle to meet dietary needs, while older patients face more physical limitations that increase their risk of malnutrition and lower their quality of life. This study contributes valuable insights into how sociodemographic factors influence the nutritional status and quality of life of hemodialysis patients and identify specific groups that may be more vulnerable to malnutrition or reduced quality of life. Objective: This study aimed to determine the association between sociodemographic factors, prevalence of malnutrition, and quality of life among hemodialysis patients in HPUSM. Methodology: A cross-sectional study was conducted among 81 hemodialysis patients at HPUSM. Sociodemographic data were collected through structured questionnaires. Meanwhile malnutrition status was assessed using the Dialysis Malnutrition Score (DMS), and quality of life was evaluated using the Kidney Disease Quality of Life-24 (KDQOL-24). Statistical analysis was performed using descriptive statistics, Mann–Whitney U-test, and Kruskal–Wallis test to determine group differences, while associations were interpreted using median and interquartile ranges (IQR). Results: The prevalence of 40–59 years (43.2%) and older adults 60–81 years (44.4%), with only (12.3%) in the younger age group. The gender distribution was balanced, with (49.4%) males and (50.6%) females. The majority of patients were Malay (92.6%), and most were married (74.1%). More than half had a secondary education level (58.0%), and most patients were unemployed or retired (65.4%). Income levels were generally low, with (75.3%) earning below RM2500 per month. More than half of the patients were mild to moderately malnourished (53.9%), while (35.8%) were considered well-nourished and (4.9%) were severe malnutrition. Quality of life scores varied across KDQOL-24 domains, with Role Limitation Physical and emotional scoring the lowest However, quality of social Interaction and dialysis staff encouragement were higher than the standard form, indicating good support from healthcare providers. The Dialysis Malnutrition Score (DMS) was significantly higher in older patients (60–81 years), divorced/widowed individuals, those with lower education, and unemployed/retired patients (p < 0.05). No significant differences were observed for gender, ethnicity, or household income. These findings suggest that age, marital status, education, and employment are key factors influencing malnutrition risk among hemodialysis patients. Most QoL domains did not differ significantly between male and female patients (p > 0.05). The exception was Work Status, where a small but significant difference was observed (p = 0.028). This indicates that gender had minimal impact on QoL among the hemodialysis patients in this study. Significant differences in QoL were observed across age groups in several domains. Work Status (p = 0.007), Cognitive Function (p = 0.043), Physical Functioning (p = 0.001), Pain (p = 0.024), and Emotional Well-being (p = 0.011) showed that younger patients (19–39 and 40–59 years) generally reported higher QoL scores compared to older patients (60–81 years). QoL scores were significantly lower in patients with worse nutritional status. Across multiple domains including Symptoms/Problem, Effect of Kidney Disease, Physical Functioning, Pain, General Health, Emotional Well-being, and Overall Health patients who were mild-moderate or severely malnourished scored lower compared to well-nourished patients (p < 0.05). This indicates that malnutrition is strongly associated with reduced QoL Conclusion: Malnutrition remains highly prevalent among hemodialysis patients in HPUSM, with most patients falling into the moderate category. Both sociodemographic and malnutrition significantly associated with quality of life, underscoring the need for early nutritional interventions and patient-centered care strategies to improve long-term outcomes
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