Lopes Antonio Alberto, Bragg-Gresham Jennifer L, Goodkin David A, Fukuhara Shunichi, Mapes Donna L, Young Eric W, Gillespie Brenda W, Akizawa Tadao, Greenwood Roger N, Andreucci Vittorio E, Akiba Takashi, Held Philip J, Port Friedrich K
Department of Medicine, Federal University of Bahia, Salvador, Brazil.
Qual Life Res. 2007 May;16(4):545-57. doi: 10.1007/s11136-006-9143-7. Epub 2007 Feb 8.
To identify modifiable factors associated with health-related quality of life (HRQOL) among chronic hemodialysis patients.
Analysis of baseline data of 9,526 hemodialysis patients from seven countries enrolled in phase I of the Dialysis Outcomes and Practice Patterns Study (DOPPS). Using the Kidney Disease Quality of Life Short Form (KDQOL-SF(TM)), we determined scores for 8 generic scale summaries derived from these scales, i.e., the physical component summary [PCS] and mental component summary [MCS], and 11 kidney disease- targeted scales. Regression models were used to adjust for differences in comorbidities and sociodemographic and treatment factors. The Benjamini-Hochberg procedure was used to correct P-values for multiple comparisons.
Unemployment and psychiatric disease were independently and significantly associated with lower scores for all generic and several kidney disease-targeted HRQOL measures. Several other comorbidities, lower educational level, lower income, and hypoalbuminemia were also independently and significantly associated with lower scores of PCS and/or MCS and several generic and kidney disease-targeted scales. Hemodialysis by catheter was associated with significantly lower PCS scores, partially explained by the correlation with covariates.
Associations of poorer HRQOL with preventable or controllable factors support a greater focus on psychosocial and medical interventions to improve the well-being of hemodialysis patients.
确定慢性血液透析患者中与健康相关生活质量（HRQOL）相关的可改变因素。
对参与透析结果与实践模式研究（DOPPS）第一阶段的来自七个国家的9526名血液透析患者的基线数据进行分析。使用肾脏疾病生活质量简表（KDQOL-SF(TM)），我们确定了从这些量表得出的8个通用量表摘要的得分，即身体成分摘要[PCS]和心理成分摘要[MCS]，以及11个针对肾脏疾病的量表。使用回归模型来调整合并症、社会人口统计学和治疗因素的差异。采用Benjamini-Hochberg程序对多重比较的P值进行校正。
失业和精神疾病与所有通用及几个针对肾脏疾病的HRQOL指标得分较低独立且显著相关。其他几种合并症、较低的教育水平、较低的收入和低白蛋白血症也与PCS和/或MCS得分较低以及几个通用和针对肾脏疾病的量表独立且显著相关。通过导管进行血液透析与显著较低的PCS得分相关，部分原因可由与协变量的相关性来解释。
较差的HRQOL与可预防或可控制因素之间的关联支持更加关注心理社会和医学干预措施，以改善血液透析患者的健康状况。
