Chang W K, Hung K Y, Huang J W, Wu K D, Tsai T J
Department of Internal Medicine, Jen-Ai Municipal Hospital, Taipei, Taiwan, ROC.
Am J Nephrol. 2001 Nov-Dec;21(6):479-85. doi: 10.1159/000046652.
Fatigue is a common symptom in long-term dialysis patients. This study investigated possible clinical factors which may cause the development of fatigue in patients receiving peritoneal dialysis (PD). We also investigated the relationship between total solute clearance (TSC) and fatigue symptoms in PD patients.
A cross-sectional study design was used to compare the clinical characteristics among groups of PD patients classified by different degrees of fatigue. The relationship among dialysis adequacy (including Kt/V(urea) and weekly creatinine clearance; C(cr)), clinical characteristics and fatigue symptoms were also assessed.
The PD unit of a major university teaching hospital in Taipei, Taiwan.
Consecutive patients who had received PD for a minimum duration of 4 months were recruited for participation in the study. Patients were excluded if they had a history of ischemic heart disease, severe heart failure (NYHA function III or IV), malignant neoplasm, active infection, major psychiatric problems, chronic obstructive pulmonary disease, or disturbed consciousness. Finally, a total of 64 patients, 31 of whom were receiving continuous ambulatory peritoneal dialysis and 33 who were receiving continuous cycling-assisted peritoneal dialysis, were enrolled in the study.
Fatigue was evaluated using a specially designed questionnaire that includes fourteen items. Patients were divided into three groups according to their fatigue scores (FS): mild (FS, 0-3), moderate (FS, 4-8), and severe (FS, 9-14) fatigue. The demographic data, dialysis variables, and clinical parameters of patients were compared among these groups. The relationship between fatigue and TSC was also examined.
The FS were correlated with serum intact parathyroid hormone (iPTH) level and total cholesterol concentration (p < 0.05). A linear correlation was also noted between serum iPTH level and total cholesterol level. When the patients were divided into an adequate- and an inadequate-dialysis group according to values of TSC, Kt/V(urea) as well as weekly creatinine clearance, a significant correlation was found between weekly C(cr) and FS.
This study has demonstrated that dialysis adequacy plays a key role in the development chronic fatigue. In addition, weekly C(cr) was better correlated with fatigue than Kt/V(urea).
疲劳是长期透析患者的常见症状。本研究调查了可能导致接受腹膜透析（PD）患者出现疲劳的临床因素。我们还研究了PD患者的总溶质清除率（TSC）与疲劳症状之间的关系。
采用横断面研究设计，比较按不同疲劳程度分类的PD患者组的临床特征。还评估了透析充分性（包括Kt/V（尿素）和每周肌酐清除率；C（cr））、临床特征与疲劳症状之间的关系。
台湾台北一所主要大学教学医院的腹膜透析科。
招募接受PD至少4个月的连续患者参与本研究。有缺血性心脏病、严重心力衰竭（纽约心脏协会功能III或IV级）、恶性肿瘤、活动性感染、严重精神问题、慢性阻塞性肺疾病或意识障碍病史的患者被排除。最后，共有64例患者纳入研究，其中31例接受持续非卧床腹膜透析，33例接受持续循环辅助腹膜透析。
使用一份专门设计的包含14个项目的问卷评估疲劳。根据疲劳评分（FS）将患者分为三组：轻度（FS，0 - 3）、中度（FS，4 - 8）和重度（FS，9 - 14）疲劳。比较这些组患者的人口统计学数据、透析变量和临床参数。还检查了疲劳与TSC之间的关系。
FS与血清完整甲状旁腺激素（iPTH）水平和总胆固醇浓度相关（p < 0.05）。血清iPTH水平与总胆固醇水平之间也存在线性相关性。根据TSC、Kt/V（尿素）以及每周肌酐清除率的值将患者分为透析充分组和透析不充分组时，发现每周C（cr）与FS之间存在显著相关性。
本研究表明透析充分性在慢性疲劳的发生中起关键作用。此外，每周C（cr）与疲劳的相关性比Kt/V（尿素）更好。
