Department of Medicine, San Francisco General Hospital and University of California, San Francisco, California 94110, USA.
Clin J Am Soc Nephrol. 2010 Aug;5(8):1480-8. doi: 10.2215/CJN.01240210. Epub 2010 Apr 29.
The association of social support with outcomes in ESRD, overall and by peritoneal dialysis (PD) versus hemodialysis (HD), remains understudied.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In an incident cohort of 949 dialysis patients from 77 US clinics, we examined functional social support scores (scaled 0 to 100 and categorized by tertile) both overall and in emotional, tangible, affectionate, and social interaction subdomains. Outcomes included 1-year patient satisfaction and quality of life (QOL), dialysis modality switching, and hospitalizations and mortality (through December 2004). Associations were examined using overall and modality-stratified multivariable logistic, Poisson, and Cox proportional hazards models.
We found that mean social support scores in this population were higher in PD versus HD patients (overall 80.5 versus 76.1; P < 0.01). After adjustment, highest versus lowest overall support predicted greater 1-year satisfaction and QOL in all patients (odds ratio 2.47 [95% confidence interval (CI) 1.18 to 5.15] and 2.06 [95% CI 1.31 to 3.22] for recommendation of center and higher mental component summary score, respectively). In addition, patients were less likely to be hospitalized (incidence rate ratio 0.86; 95% CI 0.77 to 0.98). Results were similar with subdomain scores. Modality switching and mortality did not differ by social support in these patients, and associations of social support with outcomes did not generally differ by dialysis modality.
Social support is important for both HD and PD patients in terms of greater satisfaction and QOL and fewer hospitalizations. Intervention studies to possibly improve these outcomes are warranted.
社会支持与终末期肾病（ESRD）结局的相关性，尤其是腹膜透析（PD）与血液透析（HD）之间的相关性，仍研究不足。
设计、地点、参与者和测量：在一项来自美国 77 家诊所的 949 名透析患者的事件队列研究中，我们检查了功能社会支持评分（范围为 0 至 100，并按三分位数分类）的总体情况以及情感、有形、感情和社会互动子领域。结局包括 1 年患者满意度和生活质量（QOL）、透析方式转换以及住院和死亡（截至 2004 年 12 月）。使用总体和方式分层多变量逻辑、泊松和 Cox 比例风险模型检查关联。
我们发现，该人群中 PD 患者的社会支持评分高于 HD 患者（总体 80.5 与 76.1；P < 0.01）。调整后，最高与最低总体支持预测所有患者 1 年满意度和 QOL 更高（比值比 2.47[95%置信区间（CI）1.18 至 5.15]和 2.06[95%CI 1.31 至 3.22]，分别为推荐中心和较高的心理成分综合评分）。此外，患者住院的可能性降低（发病率比 0.86；95%CI 0.77 至 0.98）。亚领域评分结果相似。在这些患者中，社会支持与透析方式转换和死亡率无关，社会支持与结局的关联也没有因透析方式的不同而存在显著差异。
社会支持对 HD 和 PD 患者都很重要，可提高患者的满意度和 QOL，并减少住院。需要进行干预研究以改善这些结局。
