Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Curr Opin Nephrol Hypertens. 2010 Mar;19(2):153-9. doi: 10.1097/MNH.0b013e328335f939.
Patients with chronic kidney disease (CKD) endure compromised health-related quality of life (HRQOL). Although the link between HRQOL and increased mortality in patients with end-stage renal disease (ESRD) is well documented, less is known about the relationship between CKD and HRQOL. This article reviews the recent evidence on HRQOL, its correlates and proposed intervention strategies to improve HRQOL in CKD.
A growing body of literature indicates that various comorbid conditions related to CKD play a substantial role in impaired HRQOL in CKD. Hypertension, both a cause and complication of CKD, negatively affects HRQOL due to associated comorbidities, side effects from antihypertensive medications and awareness of the diagnosis. Anemia has been associated with HRQOL, but concerns about the safety of erythropoietin-stimulating agents (ESAs) have led to more conservative anemia treatment. Frailty, symptom burden and depression are also major contributory factors to HRQOL in CKD.
Certain determinants of HRQOL in CKD, namely anemia and depression, are treatable. Early identification and correction may improve overall well being of patients. Clinical trials are required to demonstrate whether treatment interventions benefit HRQOL in this high-risk population. Furthermore, whether integration of HRQOL assessment into routine clinical practice will improve HRQOL outcomes remains to be determined.
慢性肾脏病（CKD）患者的健康相关生活质量（HRQOL）受损。虽然终末期肾病（ESRD）患者的 HRQOL 与死亡率增加之间的联系已有充分记录，但关于 CKD 与 HRQOL 之间的关系知之甚少。本文综述了最近关于 CKD 患者 HRQOL 及其相关因素和改善 HRQOL 的干预策略的证据。
越来越多的文献表明，与 CKD 相关的各种合并症在 CKD 患者的 HRQOL 受损中起着重要作用。高血压既是 CKD 的病因也是其并发症，由于相关合并症、降压药物的副作用以及对诊断的认识，会对 HRQOL 产生负面影响。贫血与 HRQOL 相关，但对促红细胞生成素刺激剂（ESA）安全性的担忧导致了更保守的贫血治疗。虚弱、症状负担和抑郁也是 CKD 患者 HRQOL 的主要影响因素。
某些 CKD 患者 HRQOL 的决定因素，即贫血和抑郁，可以得到治疗。早期识别和纠正可能会改善患者的整体健康状况。需要进行临床试验来证明治疗干预措施是否有益于这一高危人群的 HRQOL。此外，将 HRQOL 评估纳入常规临床实践是否会改善 HRQOL 结果仍有待确定。
