Mau Lih-Wen, Chiu Herng-Chia, Chang Pi-Yu, Hwang Su-Chen, Hwang Shang-Jyh
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA.
Kaohsiung J Med Sci. 2008 Sep;24(9):453-60. doi: 10.1016/s1607-551x(09)70002-6.
Taiwan has the highest incidence and prevalence of end-stage renal disease worldwide. However, not many studies have focused on the influence of dialysis modality on health-related quality of life (HRQoL) for dialysis patients in Taiwan. This study intended to compare the differences in HRQoL between peritoneal dialysis (PD) and hemodialysis (HD) and to evaluate the effects of dialysis modality on patient HRQoL. A cross-sectional survey using the Taiwan-version 36-item short-form health survey questionnaire (SF-36) was completed by 244 dialysis patients (58 PD and 186 HD patients) at two hospital-based dialysis units in southern Taiwan. Patient characteristics, diagnoses and laboratory data were individually extracted from the annual survey and matched with primary HRQoL data. Multiple linear regression analysis was performed to evaluate the effects of dialysis modality on HRQoL. Compared with HD patients, PD patients had higher scores in six of the eight SF-36 subscales, including physical functioning, role limitations due to physical and emotional problems, bodily pain, vitality, and mental health. However, only role limitations due to emotional problems and bodily pain reached significant difference levels (p < 0.05). After controlling for patient characteristics, comorbid conditions and laboratory values, the bodily pain score was 7.88 points higher for PD patients compared with HD patients, while the social functioning score was 9.00 points higher for HD patients compared with PD patients (p < 0.05). The present study provides cross-sectional confirmation for equivalent levels of HRQoL between PD and HD patients except for the subscales of bodily pain and social functioning. In addition to dialysis modality, HRQoL for dialysis patients may be more related to personal attributes, interactions with multiple diseases, social support and quality of care received. When informing patients about modality choices for dialysis, trade-offs should be discussed and individual preferences for specific aspects of HRQoL should be considered.
台湾是全球终末期肾病发病率和患病率最高的地区。然而，针对透析方式对台湾透析患者健康相关生活质量（HRQoL）影响的研究并不多。本研究旨在比较腹膜透析（PD）和血液透析（HD）患者HRQoL的差异，并评估透析方式对患者HRQoL的影响。在台湾南部两家医院的透析科室，244名透析患者（58名PD患者和186名HD患者）完成了一项采用台湾版36项简明健康调查问卷（SF-36）的横断面调查。从年度调查中分别提取患者特征、诊断和实验室数据，并与主要的HRQoL数据进行匹配。采用多元线性回归分析来评估透析方式对HRQoL的影响。与HD患者相比，PD患者在SF-36的八个分量表中的六个分量表上得分更高，包括身体功能、因身体和情绪问题导致的角色受限、身体疼痛、活力和心理健康。然而，只有因情绪问题导致的角色受限和身体疼痛达到了显著差异水平（p < 0.05）。在控制了患者特征、合并症和实验室值后，与HD患者相比，PD患者的身体疼痛得分高7.88分，而与PD患者相比，HD患者的社会功能得分高9.00分（p < 0.05）。本研究提供了横断面证据，证明除身体疼痛和社会功能分量表外，PD和HD患者的HRQoL水平相当。除透析方式外，透析患者的HRQoL可能更与个人属性以及多种疾病的相互作用、社会支持和所接受的护理质量有关。在告知患者透析方式的选择时，应讨论利弊，并考虑患者对HRQoL特定方面的个人偏好。
