The association of body composition with quality of life in adult patients with end stage renal disease on hemodialysis visiting a tertiary care hospital in Karachi, Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


The perception of patients with end stage renal disease (ESRD) has received considerable attention in recent years as they are facing devastating medical, social, and economic problems. A large body size in HD patient is associated with poor quality of life (QOL). It is not clear whether body fat or muscle mass confers a better QOL. The research on QOL has emerged as valuable tool in measuring the outcome of patient receiving healthcare. In this study, we hypothesized that increase muscle mass and lower body fat percentage are independently associated with a better QOL score. Objective: To assess the relationship of body fat (%) and muscle mass with QOL in patients with ESRD on HD visiting tertiary care hospital in Karachi, Pakistan. Methods: We conducted an analytical cross-sectional study on 72 patients with ESRD, visiting Aga Khan University Hospital (AKUH) twice or thrice per week for HD during 8 months of data collection, from November 23, 2015 to June 8, 2016. These patients underwent a detail assessment of body compositions, body fat and muscle mass using Bio Scan, along with that socio-demographic and medical related information was assessed through a questionnaire. The outcome variable quality of life (QOL) was assessed using WHOQOL-BREF questionnaire. As the outcome variable overall WHOQOL-BREF is based °ha. continuous scale, we used multiple linear regression technique for the analysis. For continues variables, we calculated means and standard deviation. Frequencies with percentages were reported for categorical variables. For all important associations B coefficients with 95% confidence interval were reported. iv Results: Out of 92 ESRD patients 72 were recruited for the study. The mean score of overall WHOQOL-BREF was 84.5 ± 12.50. Out of all 4 domains, mean QOL of environmental domain scored highest. ESRD patients had a mean age of .57.9 ± 14.2 years. Around 52.78% were male and 47.22% were female of which majority 49 patients were on thrice per week HD and few 23 were on twice per week HD. Among all ESRD patients those who were employed, the mean estimated overall WHOQ0LBREF score was 7.77 higher as compared to unemployed (95% CI: 0.41, 15.12). There was an interaction between muscle mass and hypertension as a cause of kidney disease. The estimated mean score increase by 27.93, for every one kg/m2 increase in muscle mass among patients who complained hypertension as the cause for kidney disease as compared to patients who did not complained hypertension as the cause of kidney disease. According to another interaction between body fat % add frequency of I-ID, patients who undergo HD thrice per week, for every one percent increase in body fat percentage, the estimated mean overall WHOQOL-BREF score decreases by 10.86 when compared with patients undergoing HD twice per week. There was an interaction between depression and duration in months for HD. The mean estimated score also decreases by15.99, for every one month increase in duration for HD among patients diagnosed with depression as compared to patients not having depression. Moreover another interaction was between sex and marital status. Among all ESRD patients, females who were currently married, the estimated mean score decreases by 9.18 as compared to males and single, divorced, widow patients. Conclusion: For ESRD patient's assessment of QOL is a useful and important clinical measure to monitor patient's well-being. Assessment of body fat % and muscle mass are also valuable in clinical practice for health professionals to advise their patient accordingly. In future controlled trials are warranted to examine weather intervention to improve nutrition status along with muscle mass improve QOL in HD patients.

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