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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Protein-energy wasting &#40;PEW&#41; is a state of decreased protein and energy body stores observed in a large proportion of patients on continuous ambulatory peritoneal dialysis &#40;CAPD&#44; approximately 80&#37; in our setting&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">1</span></a> which in turn is potently associated with increased morbidity and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">2&#44;3</span></a> Causes of PEW in CAPD are multiple&#44; including decreased dietary nutrient intake&#44; depression&#44; comorbidity&#44; and dialysis procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Other factors&#44; as health-related quality of life &#40;HRQoL&#41;&#44; may strongly influence morbi-mortality in end-stage renal disease &#40;ESRD&#41; population&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">5&#44;6</span></a> It is well established that HRQoL components such as physical&#44; emotional&#44; mental and social aspects are more affected in ESRD patients compared to the general healthy population<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">7</span></a> or patients with other chronic diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">8</span></a> Malnutrition is associated with poor HRQoL in hemodialysis patients<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">9&#8211;12</span></a>&#59; however&#44; these studies do not differentiate quality of life according to the severity of PEW&#46; Moreover&#44; it is not completely clear the association between HRQoL and individual criteria of nutritional status such as dietary intake&#44; body mass and biochemical parameters&#46; Alterations in several nutritional criteria and unhealthy lifestyle contributing to obesity may affect both HRQoL and PEW&#44; and as obesity affect it in other conditions<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">13</span></a>&#59; consequently&#44; it is necessary to evaluate this information gap in the chronic kidney disease population&#46; In the case of CAPD&#44; there is more limited information in this regard&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">14&#44;15</span></a> Therefore&#44; this study was performed to evaluate the HRQoL according to the PEW severity in CAPD patients&#44; as well as the possible association between nutritional status indicators and HRQoL&#46; We hypothesized that HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This is a cross-sectional study performed in CAPD patients&#44; randomly selected from an outpatient clinic &#40;Hospital General de Zona No&#46; 89&#41;&#46; Adult patients&#44; both genders&#44; age 18&#8211;65 years&#44; who had been on CAPD for at least 3 months&#44; were invited to participate&#44; with a <span class="elsevierStyleItalic">K</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">t</span></span>&#47;<span class="elsevierStyleItalic">V</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&#46;6 to ensure adequate dialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">16</span></a> They were excluded if had hospitalization 1 month before the study&#44; were pregnant or breastfeeding&#44; had a physical or mental disability to complete the evaluation&#44; or other severe disease that could affect HRQoL &#40;i&#46;e&#46;&#44; cancer&#44; heart failure&#44; liver failure&#41;&#46; Patients who did not complete the whole questionnaire were eliminated from the analysis&#46; Demographic and clinical data were obtained from direct interview and clinical evaluation&#46; This study adhered to the Declaration of Helsinki and was approved by the Local Committee of Research and Ethics &#40;R-2009-1304-23&#41;&#59; written-informed consent was obtained from all participants&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Measurement of health-related quality of life</span><p id="par0020" class="elsevierStylePara elsevierViewall">The self-administered questionnaire Kidney Disease Quality of Life &#40;KDQOL&#44; short form&#44; v&#46;1&#46;3&#44; KDQOL-SF&#8482;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">17</span></a> previously validated in Mexican population&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">18</span></a> was employed to measure HRQoL&#46; The KDQOL-SF&#8482; combines the generic SF-36 with a kidney disease-specific instrument&#44; and measures 3 domains of functioning and well-being on a 100-point scale &#40;the higher the scale the better the HRQoL&#41;&#58; &#40;a&#41; physical component summary &#40;PCS&#41;&#44; &#40;b&#41; mental component summary &#40;MCS&#41;&#44; and &#40;c&#41; kidney disease component summary &#40;KDCS&#41;&#46; The PCS aggregates subscales from general health&#44; physical functioning&#44; role-physical&#44; bodily pain&#46; The MCS aggregates subscales from role-emotional&#44; social functioning&#44; vitality and mental health&#44; whereas KDCS aggregates subscales from burden of kidney disease&#44; cognitive function&#44; dialysis-staff encouragement&#44; effects of kidney disease&#44; patient&#39;s satisfaction&#44; quality of social interaction&#44; sexual function&#44; sleep&#44; social support&#44; symptom&#47;problem list and work status&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Nutritional status</span><p id="par0025" class="elsevierStylePara elsevierViewall">Nutrition evaluation was performed with a 24-h dietary recall&#44; a quantitative version of subjective global assessment &#40;SGA&#41;&#44; body mass index &#40;BMI&#41; and biochemical variables&#46; SGA&#44; 24-h dietary recall&#44; and BMI were evaluated by an experienced renal dietitian&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The 24-h dietary recall was used to assess energy and protein intake&#46; To calculate the consumption of nutrients&#44; information of 24-h recalls was processed manually using reference tables from the Mexican System of Foods for Renal Patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">19&#44;20</span></a> Consumed calories and proteins were compared to the usual CAPD recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">21</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Quantitative version of SGA was utilized to evaluate wasting&#46; This scale evaluates weight loss&#44; change in dietary intake&#44; gastrointestinal symptoms&#44; functional impairment&#44; loss of subcutaneous fat&#44; muscle wasting&#44; and presence of edema&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">22</span></a> Results are expressed in a score of 7&#8211;35 points&#44; and nutritional status has been classified in dialysis patients<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">23&#44;24</span></a> as&#58; normal &#40;7&#8211;13 points&#41;&#44; mild-moderate PEW &#40;14&#8211;23 points&#41;&#44; and severe PEW &#40;24&#8211;35 points&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Anthropometric variables were measured using standard techniques for height and body weight &#40;edema free and peritoneal cavity empty&#41; to calculate BMI&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">25</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Biochemical variables considered as part of nutritional evaluation in this study were serum albumin&#44; creatinine and cholesterol&#46; A blood sample in fasting condition was obtained to determine serum creatinine and cholesterol by habitual techniques in a VITROS 950&#47;950AT Chemistry System &#40;Johnson &#38; Johnson&#44; Langhorne&#44; PA&#44; USA&#41;&#46; Serum albumin was determined by the green bromocresol method&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The following nutritional indicators reflecting PEW<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">21&#44;26</span></a> were evaluated in their possible association with HRQoL&#58; energy intake &#60;25<span class="elsevierStyleHsp" style=""></span>kcal&#47;kg&#44; protein intake &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#44; serum creatinine &#60;10<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; serum albumin &#60;3&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; serum cholesterol &#60;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; and BMI &#60;23<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; BMI was also analyzed considering obesity &#40;&#8805;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Data are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#44; median &#40;percentiles 25&#8211;75&#37;&#41; or percentage&#44; as appropriated&#46; Comparisons between groups were made by Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span>&#44; analysis of variance and Chi-square tests&#44; as appropriate&#46; Multivariate general linear regression analyses to identify factors predicting HRQoL and its components &#40;PCS&#44; MCS and KDCS&#41; were performed&#46; A <span class="elsevierStyleItalic">p</span> value &#60;0&#46;05 was accepted as significant&#44; but preferably the exact value was shown&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">One hundred fifty-one patients were evaluated&#58; 70 with normal nutritional status&#44; 66 with mild-moderate PEW and 15 with severe PEW&#46; Comparisons of sociodemographic characteristics according to the nutritional status are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Patients with normal nutritional status were younger&#44; had more frequently a full or part time work&#44; were more independent&#44; and had less frequently diabetes as cause of ESRD and comorbidity after diagnosis than those with mild-moderate and severe PEW&#46; No other differences were found in this regard&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In the whole sample&#44; KDQOL-SF&#8482; results by components were&#58; PCS 51 &#40;35&#8211;78&#41;&#44; MCS 67 &#40;44&#8211;78&#41;&#44; KDCS 60 &#40;55&#8211;67&#41;&#44; and overall HQRoL 59 &#40;47&#8211;72&#41;&#46; In general&#44; quality of life seemed to be decreased as the nutritional status was more affected &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Patients with severe PEW had significantly the lowest HRQoL scores &#40;overall and PCS&#44; MCS and KDCS components&#41;&#44; whereas patients with mild-moderate PEW had a worse total HRQoL and KDCS score than those with normal nutritional status&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the comparison of HRQoL subscales results according to nutritional status&#46; Regarding PCS&#44; physical functioning progressively decreased as PEW worsened&#44; whereas general health was significantly lower only in patients with severe PEW in comparison with well-nourished patients&#46; In MCS&#44; all the subscales seemed to be decreased in patients with PEW compared to subjects with normal nutrition&#44; but only social functioning&#44; vitality and mental health reached statistical significance in the case of patients with severe PEW&#46; When KDCS was considered&#44; burden of kidney disease was progressively worse as PEW was more severe&#44; cognitive function and patient&#39;s satisfaction were lower in both PEW groups compared to normal subjects&#44; whereas sleep and symptom&#47;problem list were worse in patients with severe PEW than in those with normal nutritional status or with mild-moderate PEW&#46; No other differences were found between groups&#59; however&#44; it is important to note that all groups reported excellent dialysis-staff encouragement&#44; social support seemed to be higher as PEW was worse&#44; sexual function &#40;although decreased with PEW&#41; seemed to be not importantly affected&#44; and that work status &#40;with the lowest value in both PEW groups&#41; did not reach statistical significance&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding nutritional indicators reflecting PEW&#44; the following results were observed&#58; 56&#37; of the patients had an energy intake &#60;25<span class="elsevierStyleHsp" style=""></span>kcal&#47;kg and 41&#37; had a protein intake &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#46; BMI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>23<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> was observed in 35&#37;&#44; whereas 20&#37; had obesity&#44; and only 45&#37; had a BMI 23&#8211;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; From biochemical variables&#44; 39&#37; had serum creatinine levels &#60;10<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 70&#37; serum albumin &#60;3&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; and 23&#37; serum cholesterol &#60;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the comparisons of overall HRQoL and its components according to the individual nutritional status indicators&#46; It was remarkable that patients with obesity had lower scores of all HRQoL components compared to those with ideal and low BMI&#46; In the same way&#44; patients with higher serum albumin levels displayed the better values in the overall and all the components of HRQoL&#46; Additionally&#44; those patients with higher serum creatinine had higher PCS score than those with lower values&#46; No other significant differences were found in the energy intake&#44; protein intake and serum cholesterol levels&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows results from multivariate general linear regression analysis&#46; Obesity was the only nutritional status indicator that significantly predicted all the components and overall scores of quality of life&#59; SGA did almost the same&#44; except in the case of MCS in which statistical significance was marginal&#46; Serum albumin was marginally associated to MCS and overall HRQoL&#44; but significantly predicted PCS&#44; whereas serum creatinine only predicted KDCS&#46; A lower educational level predicted MCS and overall HRQoL score&#44; whereas employment status was not associated to quality of life&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Our results showed that PEW is significantly associated with poor HRQoL&#44; which is in agreement with previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">9&#44;10</span></a> However&#44; the present data demonstrated as well that severe PEW was associated with decreased HRQoL more frequently than mild-moderate PEW&#44; measured either as overall or by component and subscale &#40;PCS&#44; MCS and KDCS&#41; scores&#44; which had not been completely studied before&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">PEW is characterized by loss of muscle mass&#44; strength&#44; and function&#44; contributing to limited physical activities&#44; which explain the poor PCS subscale scores&#44; specially found in the severe form&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Moreover&#44; our results demonstrated that the higher the PEW the worse the MCS scores&#46; Previous studies<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">12&#44;27</span></a> did not find differences in MCS between malnourished and well-nourished patients&#44; probably because they did not evaluate MCS specifically using subscales nor PEW severity&#46; Our data showed that patients with mild-moderate PEW have similar mental status than those with normal nutrition&#44; probably due to the possible psychological adjustment and a response shift to deal with illness&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">28&#44;29</span></a> However&#44; patients with severe wasting had significantly impaired social functioning&#44; vitality and mental health&#46; The latter could be associated with depression&#44; which is commonly found<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">30</span></a> and contributes to poor oral intake and malnutrition<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">31</span></a> in chronic dialysis patients&#46; Some psychological interventions have shown improvement in depressive symptoms and treatment adherence in other chronic conditions &#40;i&#46;e&#46;&#44; diabetes&#41;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">32</span></a>&#59; however&#44; the effect of the latter has been poorly described patients with ESRD&#46; Thus&#44; it would be advisable to evaluate psychological strategies in conjunction with dietary treatment to more precisely discriminate those malnourished patients with impairment on mental health&#44; social functioning and vitality&#44; as well as those with low resilience to illness&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">KDCS&#44; on the other hand&#44; displayed poor scores as previously reported<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">11</span></a>&#59; however&#44; analysis by subscales showed that patients with PEW&#44; independently of the degree&#44; had more burden of disease&#44; more alterations in cognitive function and lower satisfaction than those without PEW&#46; Moreover&#44; patients with the more severe PEW had additional alterations in terms of sleep quality and in problems&#47;symptoms list&#44; which have been reported in association with uremia<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">33</span></a>&#44; but its relation with PEW deserves further investigation&#46; Although without statistical significance&#44; it is notable that all patients reported encouragement by dialysis staff&#44; which has been previously reported<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">34</span></a> and that could be associated with a good dialysis service indeed or with fear of not receiving adequate treatment if they do not respond positively&#46; In the same way&#44; patients were less frequently laborally active and received more social support when they had severe PEW&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Regarding the individual clinical indicators of nutritional status&#44; only the presence of obesity and hypoalbuminemia were significantly associated with worse overall and all the components of HRQoL scores&#46; In reverse epidemiology&#44; obesity is a protective factor for mortality in dialysis patients<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">35</span></a>&#59; however&#44; some studies suggest that this could be different in the case of peritoneal dialysis&#44; as patients with obesity may have a higher mortality at &#8805;2 years than those with normal or overweight&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">36</span></a> In our study&#44; patients with obesity had the worse HRQoL score as overall and in each of its components compared to patients with low or with normal BMI&#46; Several factors in obese individuals may affect the physical and mental well-being<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">37</span></a>&#59; its implications in peritoneal dialysis need further clarification&#46; Low serum albumin was significantly associated with lower scores of overall HRQoL and all its components&#46; Hypoalbuminemia<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">38</span></a> as well as poor HRQoL<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">39</span></a> have been shown as predictors for morbi-mortality in dialysis&#46; Moreover&#44; HRQoL has been reported as associated with low serum albumin levels<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">10</span></a>&#59; however&#44; it was not previously shown&#44; particularly in peritoneal dialysis&#44; that hypoalbuminemia is associated with all the components of HRQoL&#46; No relation between HRQoL and dietary intake was found in this study&#59; this finding is not completely clear but it has been reported in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">40&#44;41</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">PEW was defined based on SGA results&#59; in the present study&#44; PEW was associated with worse HRQoL as previously reported&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">14</span></a> but additionally we demonstrated that HRQoL was worse as PEW was more severe&#46; Results of multivariate analysis showed that for each point SGA increase &#40;worse nutritional status&#41;&#44; PCS&#44; MCS&#44; KDCS and overall HRQoL scores worsened almost at the same degree&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Finally&#44; low educational level was associated with worse score for MCS and overall HRQoL&#44; which is consistent with previous reports in patients with chronic illnesses<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">42</span></a>&#59; it seems to be that individuals with higher education are more resilient&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Our study has strengths and limitations&#46; To the best of our knowledge this is the first study in peritoneal dialysis patients assessing the association between HRQoL and PEW severity&#46; In order to find a clear relationship between PEW severity and HRQoL&#44; and reduce the risk of bias&#44; we decided not to include patients whose quality of life could be affected by reasons such as recent hospitalization&#44; severe illness&#44; physical or mental disability and advanced age&#44; conditions previously reported as associated with poor HRQoL&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">43&#8211;45</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Among strengths&#44; severity of PEW was defined according to the quantitative version of SGA with cutoff points that have been reported to have highest sensitivity and specificity for diagnosis of mild-moderate and severe PEW&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">23</span></a> Moreover&#44; our study included important nutritional indicators reflecting PEW &#40;energy and protein intake&#44; serum biochemical markers and BMI&#41; that supported our findings&#46; Age&#44; dialysis vintage and sex commonly affect HRQoL but all regression models were adjusted for such variables&#46; On the other hand&#44; the cross-sectional design of our study does not allow to establish causality&#59; however&#44; improvement in nutritional status has been shown to increase HRQoL of dialysis patients in longitudinal series&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">46</span></a> Due to financial limitations in our setting&#44; bioimpedance evaluation &#40;recognized as more accurate methods to assess nutritional status in this kind of patients&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">47&#44;48</span></a> was not performed&#46; Peritoneal membrane function and inflammation markers &#40;i&#46;e&#46;&#44; C-reactive protein&#41; measurements are not routinely available in our setting&#46; Unfortunately&#44; we did not collect data to calculate the neutrophil&#47;lymphocyte or platelet&#47;lymphocyte ratios to explore their correlation with PEW&#46; Future studies investigating the latter issues could help to clarify such possible relation&#46; In addition&#44; exercise programs have favorable actions on social interaction&#44; cognitive and physical function and depression<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">49&#44;50</span></a>&#59; thus&#44; the practice of regular exercise and healthy lifestyle and their effect on each HRQoL component &#40;i&#46;e&#46;&#44; PCS&#44; MCS and KDCS&#41; deserve to be explored more in depth in future research&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Based on the results of this study&#44; it could be suggested to implement strategies for prevention and management of PEW in patients in order to improve quality of life&#46; The impact of multidisciplinary strategies such as nutritional intervention&#44; physical training and psychology strategies on HRQoL&#44; lifestyle and therapeutic adherence of ESRD patients with nutritional disorders &#40;PEW and&#47;or obesity&#41; could be considered in further investigations&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; PEW severity was related with worse HRQoL in CAPD patients&#46; This finding was observed evaluating HRQoL either as overall score or in every of its components and subscales&#46; Obesity&#44; PEW&#44; hypoalbuminemia&#44; and lower educational level were the only variables significantly predicting poor HRQoL&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Funding</span><p id="par0155" class="elsevierStylePara elsevierViewall">No funders pertaining to this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">All the authors declare no conflict of interests&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Protein-energy wasting &#40;PEW&#41; and poor health-related quality of life &#40;HRQoL&#41; are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis &#40;CAPD&#41;&#46; PEW may reduce HRQoL&#59; however&#44; we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This is a cross-sectional study in 151 patients&#46; Subjective global assessment &#40;SGA&#41; was employed&#44; and nutritional status classified as normal&#44; mild-moderate PEW&#44; and severe PEW&#46; HRQoL was evaluated using Kidney Disease Quality of Life Short Form&#8482;&#44; including physical &#40;PCS&#41;&#44; mental &#40;MCS&#41; and kidney disease &#40;KDCS&#41; components&#44; and their subscales&#46; Dietary intake&#44; anthropometric and biochemical variables were measured&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Forty-six percent of patients were well-nourished&#44; 44&#37; had mild-moderate PEW&#44; and 10&#37; severe PEW&#46; Compared with well-nourished patients&#44; those with mild-moderate &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;06&#41; and severe &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41; PEW had lower HRQoL score &#91;68 &#40;52&#8211;75&#41;&#44; 55 &#40;45&#8211;72&#41;&#44; 46 &#40;43&#8211;58&#41;&#44; respectively&#93;&#46; PCS&#44; MCS&#44; and KDCS and their subscales had lower values as PEW was more severe&#46; Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts&#46; Dietary intake was not associated with quality of life&#46; In multivariate analysis obesity&#44; PEW &#40;by SGA&#41;&#44; hypoalbuminemia&#44; and low educational level predicted poor HRQoL &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> 58&#46;2&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">As conclusion&#44; PEW severity was related with worse HRQoL&#44; either as overall score or in every component or subscale in CAPD patients&#46; Poor HRQoL was predicted independently by PEW severity and obesity&#59; additional predictors were hypoalbuminemia and low education&#46;</p></span>"
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        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El desgaste proteico-energ&#233;tico &#40;DEP&#41; y la mala calidad de vida relacionada con la salud &#40;CVRS&#41; se asocian de forma independiente con la morbimortalidad en di&#225;lisis peritoneal continua ambulatoria &#40;DPCA&#41;&#46; El DEP puede reducir la CVRS&#59; sin embargo&#44; planteamos la hip&#243;tesis de que la CVRS se ve afectada de forma independiente por los grados de DEP o por los criterios individuales del estado nutricional&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluar la CVRS de acuerdo a la gravedad de la DEP e indicadores del estado nutricional en DPCA&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este es un estudio transversal en 151 pacientes&#46; Se emple&#243; la evaluaci&#243;n global subjetiva &#40;EGS&#41; y el estado nutricional se clasific&#243; como normal&#44; DEP leve-moderada y DEP grave&#46; La CVRS se evalu&#243; mediante el uso del cuestionario <span class="elsevierStyleItalic">Kidney Disease Quality of Life Short Form</span>&#8482;&#44; incluidos los componentes f&#237;sicos &#40;PCS&#41;&#44; mentales &#40;MCS&#41; y de enfermedad renal &#40;KDCS&#41; y sus subescalas&#46; Se midieron la ingesta diet&#233;tica&#44; las variables antropom&#233;tricas y bioqu&#237;micas&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El 46&#37; de los pacientes ten&#237;a un estado nutricional normal&#44; el 44&#37; ten&#237;a DEP leve-moderada y el 10&#37; DEP grave&#46; En comparaci&#243;n con los pacientes bien nutridos&#44; aquellos con DEP leve-moderada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;06&#41; y grave &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; ten&#237;an una puntuaci&#243;n de CVRS m&#225;s baja &#40;68 &#91;52-75&#93;&#44; 55 &#91;45-72&#93;&#44; 46 &#91;43-58&#93;&#44; respectivamente&#41;&#46; Igualmente&#44; la PCS&#44; MCS y KDCS y sus subescalas tuvieron valores m&#225;s bajos&#44; conforme la DEP fue m&#225;s severa&#46; Los pacientes con obesidad e hipoalbuminemia ten&#237;an puntuaciones de CVRS general y de sus componentes significativamente m&#225;s bajas que sus contrapartes&#46; La ingesta diet&#233;tica no se asoci&#243; con la calidad de vida&#46; En el an&#225;lisis multivariado la obesidad&#44; el DEP &#40;por EGS&#41;&#44; la hipoalbuminemia y el bajo nivel educativo predijeron una mala CVRS &#40;&#967;<span class="elsevierStyleSup">2</span> 58&#44;2&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En conclusi&#243;n&#44; la gravedad del DEP se relacion&#243; con una peor CVRS&#44; ya sea como puntuaci&#243;n global o en cada componente o subescala de los pacientes con DPCA&#46; La mala CVRS se predijo de forma independiente por la gravedad del DEP y la obesidad&#59; predictores adicionales fueron hipoalbuminemia y la baja educaci&#243;n&#46;</p></span>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; PEW&#58; protein-energy wasting&#59; ESRD&#58; end-stage of renal disease&#46; Results are expressed as mean 1 standard deviation or median &#40;percentiles 25&#8211;75&#37;&#41; or as the percentage of total participants&#46; Statistical differences were determined using analysis of variance test&#44; and <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#44; respectively&#46;</p>"
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                  \t\t\t\t">32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sex male&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">39 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">10 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">12 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;6 to &#60;9 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;21&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">38 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mixed&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Primary caregiver&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">57 &#40;86&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;87&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Type 2 diabetes&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;38&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unknown&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">12 &#40;6&#8211;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidity&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Type 2 diabetes&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;44&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; PEW&#58; protein energy wasting&#59; PCS&#58; physical component summary&#59; MCS&#58; mental component summary&#59; KDCS&#58; kidney disease component summary&#46; Results are expressed as median &#40;percentiles 25&#8211;75&#37;&#41;&#46; Statistical differences were determined using analysis of variance test&#46;</p>"
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                  \t\t\t\t">55 &#40;45&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">46 &#40;43&#8211;58&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;39&#8211;79&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47 &#40;33&#8211;76&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;21&#8211;49&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>General health&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;20&#8211;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;15&#8211;40&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Physical functioning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;50&#8211;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;29&#8211;80&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;10&#8211;55&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Role-physical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;0&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#8211;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bodily pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;55&#8211;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;45&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;45&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">MCS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;56&#8211;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;36&#8211;79&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;30&#8211;68&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Role emotional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;33&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Social functioning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;50&#8211;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;38&#8211;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;25&#8211;75&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vitality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;40&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;25&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;20&#8211;50&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mental health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;60&#8211;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;43&#8211;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;40&#8211;60&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">KDCS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;62&#8211;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;55&#8211;69&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;54&#8211;63&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Burden of kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;31&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;17&#8211;64&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;0&#8211;44&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cognitive function&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;73&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;53&#8211;87&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;47&#8211;87&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dialysis-staff encouragement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;88&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;88&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;88&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Effects of kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;52&#8211;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;55&#8211;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;41&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patient&#39;s satisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;57&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;57&#8211;86&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;57&#8211;86&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Quality of social interaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;33&#8211;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;33&#8211;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;47&#8211;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">75 &#40;67&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100 &#40;67&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">79 &#40;69&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73 &#40;57&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60 &#40;48&#8211;73&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#163;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">25 &#40;0&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">&#946;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">&#946;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">&#946;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6&#8211;9 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;13&#46;4&#44; 2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;182&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;10&#46;9&#44; 6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;580&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BMI&#44; kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>23&#8211;30 Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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Original article
Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients
La severidad del desgaste energético-proteico y la obesidad se relacionan independientemente con la mala calidad de vida en pacientes de diálisis peritoneal
Claudia N. Orozco-Gonzáleza,b, Roxana M. Márquez-Herreraa, Laura Cortés-Sanabriaa,
Corresponding author
cortes_sanabria@yahoo.com.mx

Corresponding author.
, Alfonso M. Cueto-Manzanoa, Margarita Gutiérrez-Medinac, Erika F. Gómez-Garcíaa, Enrique Rojas-Camposa, José R. Paniagua-Sierrad, Fabiola Martín del Campoa
a Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
b Universidad Internacional Iberoamericana, Campeche, Mexico
c Dirección de Enfermería, Hospital de Especialidades, IMSS, Guadalajara, Mexico
d Unidad de Investigación en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Protein-energy wasting &#40;PEW&#41; is a state of decreased protein and energy body stores observed in a large proportion of patients on continuous ambulatory peritoneal dialysis &#40;CAPD&#44; approximately 80&#37; in our setting&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">1</span></a> which in turn is potently associated with increased morbidity and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">2&#44;3</span></a> Causes of PEW in CAPD are multiple&#44; including decreased dietary nutrient intake&#44; depression&#44; comorbidity&#44; and dialysis procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Other factors&#44; as health-related quality of life &#40;HRQoL&#41;&#44; may strongly influence morbi-mortality in end-stage renal disease &#40;ESRD&#41; population&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">5&#44;6</span></a> It is well established that HRQoL components such as physical&#44; emotional&#44; mental and social aspects are more affected in ESRD patients compared to the general healthy population<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">7</span></a> or patients with other chronic diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">8</span></a> Malnutrition is associated with poor HRQoL in hemodialysis patients<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">9&#8211;12</span></a>&#59; however&#44; these studies do not differentiate quality of life according to the severity of PEW&#46; Moreover&#44; it is not completely clear the association between HRQoL and individual criteria of nutritional status such as dietary intake&#44; body mass and biochemical parameters&#46; Alterations in several nutritional criteria and unhealthy lifestyle contributing to obesity may affect both HRQoL and PEW&#44; and as obesity affect it in other conditions<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">13</span></a>&#59; consequently&#44; it is necessary to evaluate this information gap in the chronic kidney disease population&#46; In the case of CAPD&#44; there is more limited information in this regard&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">14&#44;15</span></a> Therefore&#44; this study was performed to evaluate the HRQoL according to the PEW severity in CAPD patients&#44; as well as the possible association between nutritional status indicators and HRQoL&#46; We hypothesized that HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This is a cross-sectional study performed in CAPD patients&#44; randomly selected from an outpatient clinic &#40;Hospital General de Zona No&#46; 89&#41;&#46; Adult patients&#44; both genders&#44; age 18&#8211;65 years&#44; who had been on CAPD for at least 3 months&#44; were invited to participate&#44; with a <span class="elsevierStyleItalic">K</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">t</span></span>&#47;<span class="elsevierStyleItalic">V</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&#46;6 to ensure adequate dialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">16</span></a> They were excluded if had hospitalization 1 month before the study&#44; were pregnant or breastfeeding&#44; had a physical or mental disability to complete the evaluation&#44; or other severe disease that could affect HRQoL &#40;i&#46;e&#46;&#44; cancer&#44; heart failure&#44; liver failure&#41;&#46; Patients who did not complete the whole questionnaire were eliminated from the analysis&#46; Demographic and clinical data were obtained from direct interview and clinical evaluation&#46; This study adhered to the Declaration of Helsinki and was approved by the Local Committee of Research and Ethics &#40;R-2009-1304-23&#41;&#59; written-informed consent was obtained from all participants&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Measurement of health-related quality of life</span><p id="par0020" class="elsevierStylePara elsevierViewall">The self-administered questionnaire Kidney Disease Quality of Life &#40;KDQOL&#44; short form&#44; v&#46;1&#46;3&#44; KDQOL-SF&#8482;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">17</span></a> previously validated in Mexican population&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">18</span></a> was employed to measure HRQoL&#46; The KDQOL-SF&#8482; combines the generic SF-36 with a kidney disease-specific instrument&#44; and measures 3 domains of functioning and well-being on a 100-point scale &#40;the higher the scale the better the HRQoL&#41;&#58; &#40;a&#41; physical component summary &#40;PCS&#41;&#44; &#40;b&#41; mental component summary &#40;MCS&#41;&#44; and &#40;c&#41; kidney disease component summary &#40;KDCS&#41;&#46; The PCS aggregates subscales from general health&#44; physical functioning&#44; role-physical&#44; bodily pain&#46; The MCS aggregates subscales from role-emotional&#44; social functioning&#44; vitality and mental health&#44; whereas KDCS aggregates subscales from burden of kidney disease&#44; cognitive function&#44; dialysis-staff encouragement&#44; effects of kidney disease&#44; patient&#39;s satisfaction&#44; quality of social interaction&#44; sexual function&#44; sleep&#44; social support&#44; symptom&#47;problem list and work status&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Nutritional status</span><p id="par0025" class="elsevierStylePara elsevierViewall">Nutrition evaluation was performed with a 24-h dietary recall&#44; a quantitative version of subjective global assessment &#40;SGA&#41;&#44; body mass index &#40;BMI&#41; and biochemical variables&#46; SGA&#44; 24-h dietary recall&#44; and BMI were evaluated by an experienced renal dietitian&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The 24-h dietary recall was used to assess energy and protein intake&#46; To calculate the consumption of nutrients&#44; information of 24-h recalls was processed manually using reference tables from the Mexican System of Foods for Renal Patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">19&#44;20</span></a> Consumed calories and proteins were compared to the usual CAPD recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">21</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Quantitative version of SGA was utilized to evaluate wasting&#46; This scale evaluates weight loss&#44; change in dietary intake&#44; gastrointestinal symptoms&#44; functional impairment&#44; loss of subcutaneous fat&#44; muscle wasting&#44; and presence of edema&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">22</span></a> Results are expressed in a score of 7&#8211;35 points&#44; and nutritional status has been classified in dialysis patients<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">23&#44;24</span></a> as&#58; normal &#40;7&#8211;13 points&#41;&#44; mild-moderate PEW &#40;14&#8211;23 points&#41;&#44; and severe PEW &#40;24&#8211;35 points&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Anthropometric variables were measured using standard techniques for height and body weight &#40;edema free and peritoneal cavity empty&#41; to calculate BMI&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">25</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Biochemical variables considered as part of nutritional evaluation in this study were serum albumin&#44; creatinine and cholesterol&#46; A blood sample in fasting condition was obtained to determine serum creatinine and cholesterol by habitual techniques in a VITROS 950&#47;950AT Chemistry System &#40;Johnson &#38; Johnson&#44; Langhorne&#44; PA&#44; USA&#41;&#46; Serum albumin was determined by the green bromocresol method&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The following nutritional indicators reflecting PEW<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">21&#44;26</span></a> were evaluated in their possible association with HRQoL&#58; energy intake &#60;25<span class="elsevierStyleHsp" style=""></span>kcal&#47;kg&#44; protein intake &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#44; serum creatinine &#60;10<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; serum albumin &#60;3&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; serum cholesterol &#60;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; and BMI &#60;23<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; BMI was also analyzed considering obesity &#40;&#8805;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Data are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#44; median &#40;percentiles 25&#8211;75&#37;&#41; or percentage&#44; as appropriated&#46; Comparisons between groups were made by Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span>&#44; analysis of variance and Chi-square tests&#44; as appropriate&#46; Multivariate general linear regression analyses to identify factors predicting HRQoL and its components &#40;PCS&#44; MCS and KDCS&#41; were performed&#46; A <span class="elsevierStyleItalic">p</span> value &#60;0&#46;05 was accepted as significant&#44; but preferably the exact value was shown&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">One hundred fifty-one patients were evaluated&#58; 70 with normal nutritional status&#44; 66 with mild-moderate PEW and 15 with severe PEW&#46; Comparisons of sociodemographic characteristics according to the nutritional status are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Patients with normal nutritional status were younger&#44; had more frequently a full or part time work&#44; were more independent&#44; and had less frequently diabetes as cause of ESRD and comorbidity after diagnosis than those with mild-moderate and severe PEW&#46; No other differences were found in this regard&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In the whole sample&#44; KDQOL-SF&#8482; results by components were&#58; PCS 51 &#40;35&#8211;78&#41;&#44; MCS 67 &#40;44&#8211;78&#41;&#44; KDCS 60 &#40;55&#8211;67&#41;&#44; and overall HQRoL 59 &#40;47&#8211;72&#41;&#46; In general&#44; quality of life seemed to be decreased as the nutritional status was more affected &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Patients with severe PEW had significantly the lowest HRQoL scores &#40;overall and PCS&#44; MCS and KDCS components&#41;&#44; whereas patients with mild-moderate PEW had a worse total HRQoL and KDCS score than those with normal nutritional status&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the comparison of HRQoL subscales results according to nutritional status&#46; Regarding PCS&#44; physical functioning progressively decreased as PEW worsened&#44; whereas general health was significantly lower only in patients with severe PEW in comparison with well-nourished patients&#46; In MCS&#44; all the subscales seemed to be decreased in patients with PEW compared to subjects with normal nutrition&#44; but only social functioning&#44; vitality and mental health reached statistical significance in the case of patients with severe PEW&#46; When KDCS was considered&#44; burden of kidney disease was progressively worse as PEW was more severe&#44; cognitive function and patient&#39;s satisfaction were lower in both PEW groups compared to normal subjects&#44; whereas sleep and symptom&#47;problem list were worse in patients with severe PEW than in those with normal nutritional status or with mild-moderate PEW&#46; No other differences were found between groups&#59; however&#44; it is important to note that all groups reported excellent dialysis-staff encouragement&#44; social support seemed to be higher as PEW was worse&#44; sexual function &#40;although decreased with PEW&#41; seemed to be not importantly affected&#44; and that work status &#40;with the lowest value in both PEW groups&#41; did not reach statistical significance&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding nutritional indicators reflecting PEW&#44; the following results were observed&#58; 56&#37; of the patients had an energy intake &#60;25<span class="elsevierStyleHsp" style=""></span>kcal&#47;kg and 41&#37; had a protein intake &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#46; BMI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>23<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> was observed in 35&#37;&#44; whereas 20&#37; had obesity&#44; and only 45&#37; had a BMI 23&#8211;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; From biochemical variables&#44; 39&#37; had serum creatinine levels &#60;10<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; 70&#37; serum albumin &#60;3&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; and 23&#37; serum cholesterol &#60;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the comparisons of overall HRQoL and its components according to the individual nutritional status indicators&#46; It was remarkable that patients with obesity had lower scores of all HRQoL components compared to those with ideal and low BMI&#46; In the same way&#44; patients with higher serum albumin levels displayed the better values in the overall and all the components of HRQoL&#46; Additionally&#44; those patients with higher serum creatinine had higher PCS score than those with lower values&#46; No other significant differences were found in the energy intake&#44; protein intake and serum cholesterol levels&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows results from multivariate general linear regression analysis&#46; Obesity was the only nutritional status indicator that significantly predicted all the components and overall scores of quality of life&#59; SGA did almost the same&#44; except in the case of MCS in which statistical significance was marginal&#46; Serum albumin was marginally associated to MCS and overall HRQoL&#44; but significantly predicted PCS&#44; whereas serum creatinine only predicted KDCS&#46; A lower educational level predicted MCS and overall HRQoL score&#44; whereas employment status was not associated to quality of life&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Our results showed that PEW is significantly associated with poor HRQoL&#44; which is in agreement with previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">9&#44;10</span></a> However&#44; the present data demonstrated as well that severe PEW was associated with decreased HRQoL more frequently than mild-moderate PEW&#44; measured either as overall or by component and subscale &#40;PCS&#44; MCS and KDCS&#41; scores&#44; which had not been completely studied before&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">PEW is characterized by loss of muscle mass&#44; strength&#44; and function&#44; contributing to limited physical activities&#44; which explain the poor PCS subscale scores&#44; specially found in the severe form&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Moreover&#44; our results demonstrated that the higher the PEW the worse the MCS scores&#46; Previous studies<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">12&#44;27</span></a> did not find differences in MCS between malnourished and well-nourished patients&#44; probably because they did not evaluate MCS specifically using subscales nor PEW severity&#46; Our data showed that patients with mild-moderate PEW have similar mental status than those with normal nutrition&#44; probably due to the possible psychological adjustment and a response shift to deal with illness&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">28&#44;29</span></a> However&#44; patients with severe wasting had significantly impaired social functioning&#44; vitality and mental health&#46; The latter could be associated with depression&#44; which is commonly found<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">30</span></a> and contributes to poor oral intake and malnutrition<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">31</span></a> in chronic dialysis patients&#46; Some psychological interventions have shown improvement in depressive symptoms and treatment adherence in other chronic conditions &#40;i&#46;e&#46;&#44; diabetes&#41;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">32</span></a>&#59; however&#44; the effect of the latter has been poorly described patients with ESRD&#46; Thus&#44; it would be advisable to evaluate psychological strategies in conjunction with dietary treatment to more precisely discriminate those malnourished patients with impairment on mental health&#44; social functioning and vitality&#44; as well as those with low resilience to illness&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">KDCS&#44; on the other hand&#44; displayed poor scores as previously reported<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">11</span></a>&#59; however&#44; analysis by subscales showed that patients with PEW&#44; independently of the degree&#44; had more burden of disease&#44; more alterations in cognitive function and lower satisfaction than those without PEW&#46; Moreover&#44; patients with the more severe PEW had additional alterations in terms of sleep quality and in problems&#47;symptoms list&#44; which have been reported in association with uremia<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">33</span></a>&#44; but its relation with PEW deserves further investigation&#46; Although without statistical significance&#44; it is notable that all patients reported encouragement by dialysis staff&#44; which has been previously reported<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">34</span></a> and that could be associated with a good dialysis service indeed or with fear of not receiving adequate treatment if they do not respond positively&#46; In the same way&#44; patients were less frequently laborally active and received more social support when they had severe PEW&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Regarding the individual clinical indicators of nutritional status&#44; only the presence of obesity and hypoalbuminemia were significantly associated with worse overall and all the components of HRQoL scores&#46; In reverse epidemiology&#44; obesity is a protective factor for mortality in dialysis patients<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">35</span></a>&#59; however&#44; some studies suggest that this could be different in the case of peritoneal dialysis&#44; as patients with obesity may have a higher mortality at &#8805;2 years than those with normal or overweight&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">36</span></a> In our study&#44; patients with obesity had the worse HRQoL score as overall and in each of its components compared to patients with low or with normal BMI&#46; Several factors in obese individuals may affect the physical and mental well-being<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">37</span></a>&#59; its implications in peritoneal dialysis need further clarification&#46; Low serum albumin was significantly associated with lower scores of overall HRQoL and all its components&#46; Hypoalbuminemia<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">38</span></a> as well as poor HRQoL<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">39</span></a> have been shown as predictors for morbi-mortality in dialysis&#46; Moreover&#44; HRQoL has been reported as associated with low serum albumin levels<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">10</span></a>&#59; however&#44; it was not previously shown&#44; particularly in peritoneal dialysis&#44; that hypoalbuminemia is associated with all the components of HRQoL&#46; No relation between HRQoL and dietary intake was found in this study&#59; this finding is not completely clear but it has been reported in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">40&#44;41</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">PEW was defined based on SGA results&#59; in the present study&#44; PEW was associated with worse HRQoL as previously reported&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">14</span></a> but additionally we demonstrated that HRQoL was worse as PEW was more severe&#46; Results of multivariate analysis showed that for each point SGA increase &#40;worse nutritional status&#41;&#44; PCS&#44; MCS&#44; KDCS and overall HRQoL scores worsened almost at the same degree&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Finally&#44; low educational level was associated with worse score for MCS and overall HRQoL&#44; which is consistent with previous reports in patients with chronic illnesses<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">42</span></a>&#59; it seems to be that individuals with higher education are more resilient&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Our study has strengths and limitations&#46; To the best of our knowledge this is the first study in peritoneal dialysis patients assessing the association between HRQoL and PEW severity&#46; In order to find a clear relationship between PEW severity and HRQoL&#44; and reduce the risk of bias&#44; we decided not to include patients whose quality of life could be affected by reasons such as recent hospitalization&#44; severe illness&#44; physical or mental disability and advanced age&#44; conditions previously reported as associated with poor HRQoL&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">43&#8211;45</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Among strengths&#44; severity of PEW was defined according to the quantitative version of SGA with cutoff points that have been reported to have highest sensitivity and specificity for diagnosis of mild-moderate and severe PEW&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">23</span></a> Moreover&#44; our study included important nutritional indicators reflecting PEW &#40;energy and protein intake&#44; serum biochemical markers and BMI&#41; that supported our findings&#46; Age&#44; dialysis vintage and sex commonly affect HRQoL but all regression models were adjusted for such variables&#46; On the other hand&#44; the cross-sectional design of our study does not allow to establish causality&#59; however&#44; improvement in nutritional status has been shown to increase HRQoL of dialysis patients in longitudinal series&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">46</span></a> Due to financial limitations in our setting&#44; bioimpedance evaluation &#40;recognized as more accurate methods to assess nutritional status in this kind of patients&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">47&#44;48</span></a> was not performed&#46; Peritoneal membrane function and inflammation markers &#40;i&#46;e&#46;&#44; C-reactive protein&#41; measurements are not routinely available in our setting&#46; Unfortunately&#44; we did not collect data to calculate the neutrophil&#47;lymphocyte or platelet&#47;lymphocyte ratios to explore their correlation with PEW&#46; Future studies investigating the latter issues could help to clarify such possible relation&#46; In addition&#44; exercise programs have favorable actions on social interaction&#44; cognitive and physical function and depression<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">49&#44;50</span></a>&#59; thus&#44; the practice of regular exercise and healthy lifestyle and their effect on each HRQoL component &#40;i&#46;e&#46;&#44; PCS&#44; MCS and KDCS&#41; deserve to be explored more in depth in future research&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Based on the results of this study&#44; it could be suggested to implement strategies for prevention and management of PEW in patients in order to improve quality of life&#46; The impact of multidisciplinary strategies such as nutritional intervention&#44; physical training and psychology strategies on HRQoL&#44; lifestyle and therapeutic adherence of ESRD patients with nutritional disorders &#40;PEW and&#47;or obesity&#41; could be considered in further investigations&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; PEW severity was related with worse HRQoL in CAPD patients&#46; This finding was observed evaluating HRQoL either as overall score or in every of its components and subscales&#46; Obesity&#44; PEW&#44; hypoalbuminemia&#44; and lower educational level were the only variables significantly predicting poor HRQoL&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Funding</span><p id="par0155" class="elsevierStylePara elsevierViewall">No funders pertaining to this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">All the authors declare no conflict of interests&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Protein-energy wasting &#40;PEW&#41; and poor health-related quality of life &#40;HRQoL&#41; are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis &#40;CAPD&#41;&#46; PEW may reduce HRQoL&#59; however&#44; we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This is a cross-sectional study in 151 patients&#46; Subjective global assessment &#40;SGA&#41; was employed&#44; and nutritional status classified as normal&#44; mild-moderate PEW&#44; and severe PEW&#46; HRQoL was evaluated using Kidney Disease Quality of Life Short Form&#8482;&#44; including physical &#40;PCS&#41;&#44; mental &#40;MCS&#41; and kidney disease &#40;KDCS&#41; components&#44; and their subscales&#46; Dietary intake&#44; anthropometric and biochemical variables were measured&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Forty-six percent of patients were well-nourished&#44; 44&#37; had mild-moderate PEW&#44; and 10&#37; severe PEW&#46; Compared with well-nourished patients&#44; those with mild-moderate &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;06&#41; and severe &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41; PEW had lower HRQoL score &#91;68 &#40;52&#8211;75&#41;&#44; 55 &#40;45&#8211;72&#41;&#44; 46 &#40;43&#8211;58&#41;&#44; respectively&#93;&#46; PCS&#44; MCS&#44; and KDCS and their subscales had lower values as PEW was more severe&#46; Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts&#46; Dietary intake was not associated with quality of life&#46; In multivariate analysis obesity&#44; PEW &#40;by SGA&#41;&#44; hypoalbuminemia&#44; and low educational level predicted poor HRQoL &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> 58&#46;2&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">As conclusion&#44; PEW severity was related with worse HRQoL&#44; either as overall score or in every component or subscale in CAPD patients&#46; Poor HRQoL was predicted independently by PEW severity and obesity&#59; additional predictors were hypoalbuminemia and low education&#46;</p></span>"
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        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El desgaste proteico-energ&#233;tico &#40;DEP&#41; y la mala calidad de vida relacionada con la salud &#40;CVRS&#41; se asocian de forma independiente con la morbimortalidad en di&#225;lisis peritoneal continua ambulatoria &#40;DPCA&#41;&#46; El DEP puede reducir la CVRS&#59; sin embargo&#44; planteamos la hip&#243;tesis de que la CVRS se ve afectada de forma independiente por los grados de DEP o por los criterios individuales del estado nutricional&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluar la CVRS de acuerdo a la gravedad de la DEP e indicadores del estado nutricional en DPCA&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este es un estudio transversal en 151 pacientes&#46; Se emple&#243; la evaluaci&#243;n global subjetiva &#40;EGS&#41; y el estado nutricional se clasific&#243; como normal&#44; DEP leve-moderada y DEP grave&#46; La CVRS se evalu&#243; mediante el uso del cuestionario <span class="elsevierStyleItalic">Kidney Disease Quality of Life Short Form</span>&#8482;&#44; incluidos los componentes f&#237;sicos &#40;PCS&#41;&#44; mentales &#40;MCS&#41; y de enfermedad renal &#40;KDCS&#41; y sus subescalas&#46; Se midieron la ingesta diet&#233;tica&#44; las variables antropom&#233;tricas y bioqu&#237;micas&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El 46&#37; de los pacientes ten&#237;a un estado nutricional normal&#44; el 44&#37; ten&#237;a DEP leve-moderada y el 10&#37; DEP grave&#46; En comparaci&#243;n con los pacientes bien nutridos&#44; aquellos con DEP leve-moderada &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;06&#41; y grave &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; ten&#237;an una puntuaci&#243;n de CVRS m&#225;s baja &#40;68 &#91;52-75&#93;&#44; 55 &#91;45-72&#93;&#44; 46 &#91;43-58&#93;&#44; respectivamente&#41;&#46; Igualmente&#44; la PCS&#44; MCS y KDCS y sus subescalas tuvieron valores m&#225;s bajos&#44; conforme la DEP fue m&#225;s severa&#46; Los pacientes con obesidad e hipoalbuminemia ten&#237;an puntuaciones de CVRS general y de sus componentes significativamente m&#225;s bajas que sus contrapartes&#46; La ingesta diet&#233;tica no se asoci&#243; con la calidad de vida&#46; En el an&#225;lisis multivariado la obesidad&#44; el DEP &#40;por EGS&#41;&#44; la hipoalbuminemia y el bajo nivel educativo predijeron una mala CVRS &#40;&#967;<span class="elsevierStyleSup">2</span> 58&#44;2&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En conclusi&#243;n&#44; la gravedad del DEP se relacion&#243; con una peor CVRS&#44; ya sea como puntuaci&#243;n global o en cada componente o subescala de los pacientes con DPCA&#46; La mala CVRS se predijo de forma independiente por la gravedad del DEP y la obesidad&#59; predictores adicionales fueron hipoalbuminemia y la baja educaci&#243;n&#46;</p></span>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; PEW&#58; protein-energy wasting&#59; ESRD&#58; end-stage of renal disease&#46; Results are expressed as mean 1 standard deviation or median &#40;percentiles 25&#8211;75&#37;&#41; or as the percentage of total participants&#46; Statistical differences were determined using analysis of variance test&#44; and <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#44; respectively&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Normal nutrition<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mild-moderate PEW<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Severe PEW<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex male&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Educational level&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;6 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;6 to &#60;9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Employment status&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Working full&#47;part time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;21&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unemployed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retired&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Source of income&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Employee income&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dependent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mixed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Primary caregiver&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;86&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cause of ESRD</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Type 2 diabetes&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;38&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unknown&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dialysis vintage&#44; months</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;10&#8211;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;6&#8211;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;6&#8211;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidity&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;44&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; PEW&#58; protein energy wasting&#59; PCS&#58; physical component summary&#59; MCS&#58; mental component summary&#59; KDCS&#58; kidney disease component summary&#46; Results are expressed as median &#40;percentiles 25&#8211;75&#37;&#41;&#46; Statistical differences were determined using analysis of variance test&#46;</p>"
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                  \t\t\t\t">68 &#40;52&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">55 &#40;45&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;43&#8211;58&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">PCS</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">59 &#40;39&#8211;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;33&#8211;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">38 &#40;21&#8211;49&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>General health&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;30&#8211;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;20&#8211;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;15&#8211;40&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Physical functioning&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;50&#8211;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;29&#8211;80&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;10&#8211;55&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Role-physical&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;0&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#8211;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bodily pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;55&#8211;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;45&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;45&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">MCS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;56&#8211;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;36&#8211;79&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;30&#8211;68&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Role emotional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;33&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;0&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Social functioning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;50&#8211;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;38&#8211;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;25&#8211;75&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vitality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;40&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;25&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;20&#8211;50&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mental health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;60&#8211;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;43&#8211;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;40&#8211;60&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">KDCS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;62&#8211;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;55&#8211;69&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;54&#8211;63&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Burden of kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;31&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;17&#8211;64&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;0&#8211;44&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cognitive function&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;73&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;53&#8211;87&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;47&#8211;87&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dialysis-staff encouragement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;88&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;88&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;88&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Effects of kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;52&#8211;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;55&#8211;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;41&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patient&#39;s satisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;57&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;57&#8211;86&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;57&#8211;86&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Quality of social interaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;33&#8211;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;33&#8211;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;47&#8211;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sexual function&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;63&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;50&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;25&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sleep&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;44&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;44&#8211;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;28&#8211;55&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#163;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Social support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;67&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83 &#40;67&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;67&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Symptom&#47;problem list&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;69&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;57&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;48&#8211;73&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#163;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Work status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6&#8211;9 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;5&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;13&#46;4&#44; 2&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;1&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;3&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;132&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;63&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;3&#46;4&#44; 4&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;760&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;30 Obesity&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 20132514
Original language: English
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