Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
Clin J Am Soc Nephrol. 2010 Apr;5(4):659-66. doi: 10.2215/CJN.08151109. Epub 2010 Feb 25.
Despite potential significance of fatigue and its underlying components in the occurrence of cardiovascular diseases, epidemiologic data showing the link are virtually limited. This study was designed to examine whether fatigue symptoms or fatigue's underlying components are a predictor for cardiovascular diseases in high-risk subjects with ESRD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 788 volunteer patients under hemodialysis therapy (506 male, 282 female) completed the survey between October and November 2005, with the follow-up period up to 26 months to monitor occurrence of fatal or nonfatal cardiovascular events. The questionnaire consisted of 64 questions, and promax rotation analysis of the principal component method conceptualized eight fatigue-related factors: fatigue itself, anxiety and depression, loss of attention and memory, pain, overwork, autonomic imbalance, sleep problems, and infection.
14.7% of the patients showed fatigue scores higher than twice the SD of the mean for healthy volunteers. These highly fatigued patients exhibited a significantly higher risk for cardiovascular events (hazard ratio: 2.17; P < 0.01), with the relationship independent of the well-known risk factors, including age, diabetes, cardiovascular disease history, and inflammation and malnutrition markers. Moreover, comparisons of the risk in key subgroups showed that the risk of high fatigue score for cardiovascular events was more prominent in well-nourished patients, including lower age, absence of past cardiovascular diseases, higher serum albumin, and high non-HDL cholesterol.
Fatigue can be an important predictor for cardiovascular events in patients with ESRD, with the relationship independent of the nutritional or inflammatory status.
尽管疲劳及其潜在成分对心血管疾病的发生有潜在的重要意义，但表明这种关联的流行病学数据实际上非常有限。本研究旨在检验疲劳症状或疲劳的潜在成分是否是 ESRD 高危患者发生心血管疾病的预测因子。
设计、地点、参与者和测量方法：2005 年 10 月至 11 月期间，788 名接受血液透析治疗的志愿者患者（506 名男性，282 名女性）完成了调查，随访期长达 26 个月，以监测致命或非致命心血管事件的发生。问卷包括 64 个问题，主成分方法的 promax 旋转分析将 8 个与疲劳相关的因素概念化：疲劳本身、焦虑和抑郁、注意力和记忆力丧失、疼痛、过度劳累、自主失衡、睡眠问题和感染。
14.7%的患者表现出疲劳评分高于健康志愿者平均分数标准差的两倍。这些高度疲劳的患者发生心血管事件的风险显著增加（风险比：2.17；P < 0.01），这种关系独立于已知的风险因素，包括年龄、糖尿病、心血管疾病史以及炎症和营养不良标志物。此外，对关键亚组的风险比较表明，高疲劳评分与心血管事件的风险在营养良好的患者中更为突出，包括年龄较低、无既往心血管疾病、血清白蛋白较高和非高密度脂蛋白胆固醇较高。
疲劳可能是 ESRD 患者心血管事件的一个重要预测因子，这种关系独立于营养或炎症状态。
