Murtagh Fliss E M, Addington-Hall Julia, Higginson Irene J
Department of Palliative Care and Policy, Kings College London, London, UK.
Adv Chronic Kidney Dis. 2007 Jan;14(1):82-99. doi: 10.1053/j.ackd.2006.10.001.
Symptoms in end-stage renal disease (ESRD) are underrecognized. Prevalence studies have focused on single symptoms rather than on the whole range of symptoms experienced. This systematic review aimed to describe prevalence of all symptoms, to better understand total symptom burden. Extensive database, "gray literature," and hand searches were undertaken, by predefined protocol, for studies reporting symptom prevalence in ESRD populations on dialysis, discontinuing dialysis, or without dialysis. Prevalence data were extracted, study quality assessed by use of established criteria, and studies contrasted/combined to show weighted mean prevalence and range. Fifty-nine studies in dialysis patients, one in patients discontinuing dialysis, and none in patients without dialysis met the inclusion criteria. For the following symptoms, weighted mean prevalence (and range) were fatigue/tiredness 71% (12% to 97%), pruritus 55% (10% to 77%), constipation 53% (8% to 57%), anorexia 49% (25% to 61%), pain 47% (8% to 82%), sleep disturbance 44% (20% to 83%), anxiety 38% (12% to 52%), dyspnea 35% (11% to 55%), nausea 33% (15% to 48%), restless legs 30% (8%to 52%), and depression 27% (5%to 58%). Prevalence variations related to differences in symptom definition, period of prevalence, and level of severity reported. ESRD patients on dialysis experience multiple symptoms, with pain, fatigue, pruritus, and constipation in more than 1 in 2 patients. In patients discontinuing dialysis, evidence is more limited, but it suggests they too have significant symptom burden. No evidence is available on symptom prevalence in ESRD patients managed conservatively (without dialysis). The need for greater recognition of and research into symptom prevalence and causes, and interventions to alleviate them, is urgent.
终末期肾病（ESRD）的症状未得到充分认识。患病率研究主要关注单一症状，而非患者所经历的全部症状范围。本系统评价旨在描述所有症状的患病率，以更好地了解总体症状负担。按照预先设定的方案，对广泛的数据库、“灰色文献”进行了检索，并进行了手工检索，以查找报告ESRD透析人群、停止透析人群或未透析人群症状患病率的研究。提取患病率数据，使用既定标准评估研究质量，并对研究进行对比/合并，以显示加权平均患病率和范围。59项关于透析患者的研究、1项关于停止透析患者的研究以及0项关于未透析患者的研究符合纳入标准。对于以下症状，加权平均患病率（及范围）分别为：疲劳/疲倦71%（12%至97%）、瘙痒55%（10%至77%）、便秘53%（8%至57%）、厌食49%（25%至61%）、疼痛47%（8%至82%）、睡眠障碍44%（20%至83%）、焦虑38%（12%至52%）、呼吸困难35%（11%至55%）、恶心33%（15%至48%）、不安腿综合征30%（8%至52%）以及抑郁27%（5%至58%）。患病率差异与症状定义、患病率时间段以及所报告的严重程度水平的差异有关。接受透析的ESRD患者会出现多种症状，超过半数的患者有疼痛、疲劳、瘙痒和便秘症状。在停止透析的患者中，证据更为有限，但表明他们也有显著的症状负担。对于保守治疗（未透析）的ESRD患者的症状患病率，尚无证据。迫切需要更多地认识和研究症状患病率及其原因，以及缓解症状的干预措施。
