Division of Palliative Care & Ethics, Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
J Pain Symptom Manage. 2010 Feb;39(2):211-8. doi: 10.1016/j.jpainsymman.2009.07.003. Epub 2009 Dec 5.
Hemodialysis patients suffer a large symptom burden, and little is known about how effectively symptoms are treated.
To assess the management of treatable symptoms in hemodialysis patients, we administered a 30-item questionnaire on physical and emotional symptoms to patients receiving outpatient hemodialysis at the University of Virginia.
We asked patients whether they were prescribed therapy for potentially treatable symptoms and assessed who prescribed the therapy. By means of chart review, we also documented whether medications were prescribed for these symptoms.
We approached 87 patients and enrolled 62 (71%). The most commonly reported, potentially treatable symptoms included bone/joint pain, insomnia, mood disturbance, sexual dysfunction, paresthesia, and nausea. Only 45% of patients with bone/joint pain reported receiving an analgesic medication. Twenty-three percent of patients with trouble falling asleep and 53% of patients with nausea reported receiving a medication to alleviate this symptom. Chart review revealed that 58% of patients who reported the presence of bone/joint pain were prescribed an analgesic, 23% of patients with trouble falling asleep were prescribed a sleep aid, and 42% of patients with nausea received an antiemetic. Primary care providers were more likely than nephrologists to provide for all symptoms except nausea and numbness or tingling in the feet, and this difference was significant for the treatment of worrying (3/3 vs. 0/3, P=0.05) and nervousness (4/5 vs. 0/5, P=0.02).
Potentially treatable symptoms in hemodialysis are undertreated. Pharmacologic therapy, particularly for emotional symptoms, was more commonly prescribed by primary care providers than nephrologists. Additional study of the barriers to symptom treatment and interventions that increase nephrologist and primary care provider symptom management are needed.
血液透析患者承受着巨大的症状负担，但对于这些症状的治疗效果知之甚少。
为了评估可治疗症状在血液透析患者中的管理情况，我们向在弗吉尼亚大学接受门诊血液透析的患者发放了一份包含 30 个项目的身体和情绪症状问卷。
我们询问患者是否接受了针对潜在可治疗症状的治疗，并评估了谁为他们开具了治疗方案。通过病历回顾，我们还记录了是否为这些症状开具了药物。
我们共接触了 87 名患者，并纳入了 62 名（71%）患者。报告的最常见的潜在可治疗症状包括骨骼/关节疼痛、失眠、情绪障碍、性功能障碍、感觉异常和恶心。仅有 45%的骨骼/关节疼痛患者报告接受了止痛药物治疗。23%的入睡困难患者和 53%的恶心患者报告接受了缓解该症状的药物治疗。病历回顾显示，报告有骨骼/关节疼痛的患者中有 58%接受了止痛药物治疗，23%的入睡困难患者接受了助眠药物治疗，42%的恶心患者接受了止吐药物治疗。初级保健医生比肾脏病医生更有可能为所有症状提供治疗，除了恶心和脚麻或刺痛，而且在治疗焦虑（3/3 与 0/3，P=0.05）和紧张（4/5 与 0/5，P=0.02）方面的差异具有统计学意义。
血液透析患者的潜在可治疗症状治疗不足。药物治疗，特别是针对情绪症状的治疗，更常见于初级保健医生而非肾脏病医生开具。需要进一步研究症状治疗的障碍以及增加肾脏病医生和初级保健医生症状管理的干预措施。
