Nutritional status and depression, sleep disorder, and quality of life in hemodialysis patients

Objective: The malnutrition-inflammation score (MIS) is a scoring system that measures malnutrition and inflammation. We sought to explore its associations with depression, sleep disturbance, and quality of life. Design: This was a cross-sectional study. Setting: This study took place at the Baskent University Outpatient Hemodialysis Unit (Ankara, Turkey). Patients: We enrolled 67 hemodialysis patients (male/female, 34/33; age, 47.7 +/- 11.4 years [mean +/- SD]; hemodialysis duration, 103.7 +/- 59.1 months [mean +/- SD]). Intervention: We retrospectively recorded patients' monthly clinical and laboratory findings from the previous 6 months. The same physician calculated MIS scores. We interviewed all patients, and each completed a Beck Depression Inventory (BDI) assessment. We used the Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep, and the Medical Outcomes Study 36-item short form (SF-36) questionnaire to evaluate health-related quality of life. Main Outcome Measures: The main outcome measures involved the univariate and multivariate relationships of the MIS with BDI, PSQI, and SF-36. Results: Patients with PSQI scores of <= 5 ("good sleepers") had lower MIS scores than did poor sleepers (6.8 +/- 2.5 vs. 8.8 +/- 3.2, P < .05). Patients with moderate-to-severe depression (BDI score >= 19) had higher MIS scores (9.0 +/- 3.2 vs. 6.5 +/- 2.5, P =.005) and higher PSQI scores (7.6 +/- 2.1 vs. 4.7 +/- 1.8, P = .001), compared with patients with BDI scores <1 9. Increased MIS scores were correlated with increased comorbidity (P = .01) and poor SF-36 scores (P = .009). Conclusion: Increased MIS is significantly associated with the presence of depression, sleep disorders, and poor quality of life. This close relationship may help establish the MIS as an important determinant of the increased morbidity and mortality of hemodialysis patients. (C) 2007 by the National Kidney Foundation, Inc.