Novak Matthew J, Sheth Heena, Bender Filitsa H, Fried Linda, Piraino Beth
Renal/Electrolyte Divisione, University of Pittsburgh School of Medicine, Pennsylvania 15261, USA.
Adv Perit Dial. 2008;24:46-50.
The Kidney Disease Outcomes Quality Initiative (K/ DOQI) 2006 recommended a minimum weekly Kt/V of 1.7 for peritoneal dialysis (PD) patients while emphasizing the importance of keeping the patient free of uremic symptoms. We examined a symptom score index [Pittsburgh Symptom Score (PSS)] designed to evaluate uremic symptoms to determine if the score improved in the first year of PD. The PSS is a 10-symptom (fatigue, trouble sleeping, difficulty concentrating, restless legs, change in taste, loss of appetite, nausea or vomiting, pruritus, bone pain, muscle pain or weakness) questionnaire that uses a Likert scale of 0 (none) to 5 (severe). From January 1, 2003, to December 31, 2006, incident PD patients completed the PSS at 0, 3, 6, 9, and 12 months. Patients were excluded from analysis if they had been on PD for less than 6 months or on hemodialysis 6 months or more before starting PD. Prevalences of individual symptoms at 1 year and at baseline were compared using the chi-square test. Differences in PSS at the various time intervals were compared using the sign test. The study included 45 patients [51% women; 31% African Americans; 33% with diabetes; mean age: 58.0 years (range: 30 - 89 years); mean initial Charlson Comorbidity Index: 5 (range: 2 - 11)]. Initial median total score improved to 8 from 12 (p = 0.005) by 3 months, with no further improvement. Improvements occurred in change in taste (p = 0.029 at 3 months), difficulty concentrating (p = 0.04 at 6 months), itching (p = 0.007 at 3 months), loss of appetite (p = 0.009 at 3 months), muscle pain or weakness (p = 0.002 at 3 months), sleep disturbance (p = 0.04 at 9 months), and restless legs (p = 0.026 at 9 months). Fatigue, bone pain, and nausea or vomiting scores were low at the start and did not significantly change over the first year. Significant decreases in symptom prevalence were seen in difficulty concentrating (p = 0.03), change in taste (p = 0.005), loss of appetite (p = 0.04), and muscle pain or weakness (p = 0.02) at 1 year. Initiation of PD results in improvement in the prevalence and severity of most uremic symptoms by 3 to 9 months and is maintained at 12 months. We recommend routine checklist evaluation of symptoms at regular clinical intervals.
肾脏疾病预后质量倡议组织（K/DOQI）2006年建议腹膜透析（PD）患者的最低每周Kt/V值为1.7，同时强调使患者摆脱尿毒症症状的重要性。我们研究了一个用于评估尿毒症症状的症状评分指数[匹兹堡症状评分（PSS）]，以确定PD第一年症状评分是否有所改善。PSS是一份包含10种症状（疲劳、睡眠困难、注意力不集中、不安腿综合征、味觉改变、食欲不振、恶心或呕吐、瘙痒、骨痛、肌肉疼痛或无力）的问卷，采用0（无）至5（严重）的李克特量表。从2003年1月1日至2006年12月31日，新发PD患者在第0、3、6、9和12个月时完成PSS问卷。如果患者接受PD治疗时间少于6个月，或在开始PD治疗前接受血液透析6个月或更长时间，则排除在分析之外。使用卡方检验比较1年时和基线时各症状的患病率。使用符号检验比较不同时间间隔的PSS差异。该研究纳入了45例患者[51%为女性；31%为非裔美国人；33%患有糖尿病；平均年龄：58.0岁（范围：30 - 89岁）；初始查尔森合并症指数平均为5（范围：2 - 11）]。初始中位数总分在3个月时从12分降至8分（p = 0.005），之后未进一步改善。味觉改变（3个月时p = 0.029）、注意力不集中（6个月时p = 0.04）、瘙痒（3个月时p = 0.007）、食欲不振（3个月时p = 0.009）、肌肉疼痛或无力（3个月时p = 0.002）、睡眠障碍（9个月时p = 0.04）和不安腿综合征（9个月时p = 0.026）等症状有所改善。疲劳、骨痛以及恶心或呕吐评分在开始时较低，在第一年未发生显著变化。1年时，注意力不集中（p = 0.03）、味觉改变（p = 0.005）、食欲不振（p = 0.04）和肌肉疼痛或无力（p = 0.02）的症状患病率显著下降。开始PD治疗后3至9个月，大多数尿毒症症状的患病率和严重程度有所改善，并在12个月时保持稳定。我们建议在定期临床检查时对症状进行常规清单评估。
