Reports to date have indicated no strong relationship between hemodialysis (HD) prescription and health-related quality of life (HRQOL). However, none of these reports addressed the effect of protein-energy nutritional status on the relationship between HD prescription and HRQOL. Thus, taking the creatinine (Cr) generation rate as a marker of protein-energy nutritional status, we divided maintenance HD patients into two groups with high and low Cr generation rates compared with the average rate. We then investigated the relationship between HD prescription and HRQOL in the two groups. The subjects were 1887 patients receiving HD three times weekly. Together with conducting an HRQOL survey using SF-36 on these patients, we surveyed Kt/V, K/V, and Cr generation rate. In the present study, K/V (the marker of HD efficiency) was obtained by dividing Kt/V by the duration of the HD session. Lower HRQOL scores tended to be associated with higher Kt/V only in patients with a low Cr generation rate; in patients with a high Cr generation rate, almost no association was found between Kt/V and HRQOL scores. In patients with a low Cr generation rate, lower HRQOL scores were associated with higher K/V, whereas in those with a high Cr generation rate, there was almost no association between K/V and HRQOL scores. In terms of duration of the HD session, almost no relationship was found between HD prescription and HRQOL scores in other patient group. These results suggest that a high HD efficiency lowers HRQOL among patients with poor protein-energy nutritional status. In such patients, HRQOL could be improved by extending the duration of the HD session with lowering of the HD efficiency.
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