Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
BMC Nephrol. 2009 Nov 24;10:39. doi: 10.1186/1471-2369-10-39.
Although health-related quality of life (HRQOL) is a potential independent predictor of mortality, nephrologists have shown little interest in HRQOL with respect to mortality in chronic kidney disease (CKD). The aim of this article is to evaluate the impact of HRQOL on mortality in the elderly, who are likely to develop or already have CKD.
Among 1,000 randomly sampled participants aged more than 65 years (sourced from the Korean Longitudinal Study on Health and Ageing), 944 subjects were evaluated for HRQOL. HRQOL was assessed using a 36-item Short-Form health survey (SF36). A cumulative survival rate was calculated according to tertiles of SF36 scores and classified by the presence of CKD (estimated GFR <60 ml/min/1.73 m2).
Among 944 subjects, 46.6% had CKD. CKD patients had lower total and physical component scores compared with subjects without CKD. The 3-year cumulative survival rate was 90.0% (non-CKD vs. CKD: 92.6% vs. 87.4%, P = 0.005 by log rank test). After adjusting for multiple variables, a reduced SF36 score (physical and mental components) was a strong predictor of all-cause mortality. Physical components were consistently able to predict mortality after CKD classification, but mental components were statistically significant only in the CKD group.
In addition to traditional risk factors of mortality, nephrologists should be aware of HRQOL as a predictor of mortality and should make efforts to improve HRQOL in CKD patients.
尽管健康相关生活质量（HRQOL）是死亡率的潜在独立预测因素，但肾病学家对慢性肾脏病（CKD）患者的 HRQOL 与死亡率之间的关系几乎没有兴趣。本文旨在评估 HRQOL 对老年患者死亡率的影响，这些患者可能患有或已经患有 CKD。
在从韩国健康老龄化纵向研究中随机抽取的 1000 名 65 岁以上的参与者中，对 944 名参与者进行了 HRQOL 评估。使用 36 项简短健康调查问卷（SF36）评估 HRQOL。根据 SF36 评分的三分位数计算累积生存率，并按 CKD （估计肾小球滤过率 <60 ml/min/1.73 m2）的存在情况进行分类。
在 944 名参与者中，46.6%患有 CKD。与无 CKD 者相比，CKD 患者的总评分和生理成分评分较低。3 年累积生存率为 90.0%（非 CKD 与 CKD：92.6%与 87.4%，对数秩检验 P=0.005）。在校正了多个变量后，SF36 评分（生理和心理成分）降低是全因死亡率的一个强有力的预测因素。生理成分能够持续预测 CKD 分类后的死亡率，而心理成分仅在 CKD 组中有统计学意义。
除了死亡率的传统危险因素外，肾病学家还应该意识到 HRQOL 是死亡率的预测因素，并努力改善 CKD 患者的 HRQOL。
