Merkus M P, Jager K J, Dekker F W, de Haan R J, Boeschoten E W, Krediet R T
Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands.
Nephrol Dial Transplant. 1999 May;14(5):1163-70. doi: 10.1093/ndt/14.5.1163.
So far, little attention has been paid to the value of dialysis adequacy for patients' quality of life (QL). Therefore we studied the impact of demographic, clinical, and dialysis characteristics on physical symptoms and perceived QL.
The study population consisted of 120 incident chronic haemodialysis (HD) and 106 peritoneal dialysis (PD) patients, starting dialysis treatment in 13 Dutch centres. Data were collected 3 months after the start of dialysis. Nine physical symptoms were assessed with a self-administered questionnaire. Patient's self-assessment of QL was measured with the 36-item MOS Short Form (SF-36).
The most common symptoms in HD and PD were fatigue (respectively 82 and 87%) and itching (73 and 68%). In HD only a medium to high comorbidity--age risk index was associated with greater symptom burden. In PD also a lower percentage lean body mass, a lower rGFR, and past episodes of underhydration were associated with greater symptom burden. The explained variance by these variables was only 12% in HD and 21% in PD. However, greater symptom burden explained a substantial additional amount of impaired physical and mental QL on top of demographics and clinical status. Dialysis variables were associated neither with symptoms nor with QL.
Symptom burden can be explained to a limited extent by demographic and clinical variables and not by dialysis characteristics. Addition of symptom burden to the other variables makes it possible to explain one-third of perceived QL. This underlines the importance of symptom reduction in order to improve patient's QL.
迄今为止，透析充分性对患者生活质量（QL）的价值鲜受关注。因此，我们研究了人口统计学、临床及透析特征对身体症状及感知生活质量的影响。
研究人群包括120例初发慢性血液透析（HD）患者和106例腹膜透析（PD）患者，他们在荷兰13个中心开始透析治疗。透析开始3个月后收集数据。通过一份自填问卷评估9种身体症状。用36项简明健康调查量表（SF - 36）测量患者的生活质量自我评估。
HD和PD中最常见的症状是疲劳（分别为82%和87%）和瘙痒（73%和68%）。在HD中，只有中至高度的共病——年龄风险指数与更大的症状负担相关。在PD中，较低的瘦体重百分比、较低的残余肾小球滤过率（rGFR）以及既往的脱水发作也与更大的症状负担相关。这些变量在HD中解释的方差仅为12%，在PD中为21%。然而，除了人口统计学和临床状况外，更大的症状负担还解释了相当一部分身心生活质量受损情况。透析变量与症状及生活质量均无关联。
症状负担在一定程度上可由人口统计学和临床变量解释，而非透析特征。将症状负担加入其他变量后，可以解释三分之一的感知生活质量。这凸显了减轻症状对改善患者生活质量的重要性。
