每日血液透析对抑郁症状和透析后恢复时间的影响：来自 FREEDOM（康复、经济学和日常透析结果测量）研究的中期报告。

Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study.

机构信息

Tufts University School of Medicine, St. Elizabeth's Medical Center, Tufts Medical Center, Boston, MA 02135, USA.

出版信息

Am J Kidney Dis. 2010 Sep;56(3):531-9. doi: 10.1053/j.ajkd.2010.04.019. Epub 2010 Jul 29.

DOI:10.1053/j.ajkd.2010.04.019

PMID:20673601

Abstract

BACKGROUND

Clinical depression and postdialysis fatigue are important concerns for patients with kidney failure and can have a negative impact on quality of life and survival.

STUDY DESIGN

The FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study is an ongoing prospective cohort study investigating the clinical and economic benefits of daily (6 times per week) hemodialysis (HD). In this interim report, as part of an a priori planned analysis, we examine the long-term impact of daily HD on depressive symptoms, measured using the Beck Depression Inventory (BDI) survey, and postdialysis recovery time, measured using a previously validated questionnaire.

SETTING & PARTICIPANTS: Adult patients initiating daily HD with a planned 12-month follow-up.

OUTCOMES & MEASUREMENTS: The BDI survey and postdialysis recovery time question were administered at baseline, and changes were assessed at months 4 and 12.

RESULTS

239 participants were enrolled (intention-to-treat cohort) and 128 completed the study (per-protocol cohort). Mean age was 52 years, 64% were men, 55% had an arteriovenous fistula, and 90% transitioned from in-center HD therapy. In the per-protocol cohort, there was a significant decrease in mean BDI score over 12 months (11.2 [95% CI, 9.6-12.9] vs 7.8 [95% CI, 6.5-9.1]; P<0.001). For robustness, the intention-to-treat analysis was performed, yielding similar results. The percentage of patients with depressive symptoms (BDI score>10) significantly decreased during 12 months (41% vs 27%; P=0.03). Similarly, in the per-protocol cohort, there was a significant decrease in postdialysis recovery time over 12 months (476 [95% CI, 359-594] vs 63 minutes [95% CI, 32-95]; P<0.001). The intention-to-treat analysis yielded similar results. The percentage of patients experiencing prolonged postdialysis recovery time (>or=60 minutes) also significantly decreased (81% vs 35%; P=0.001).

LIMITATIONS

Observational study with lack of control arm.

CONCLUSIONS

Daily HD is associated with long-term improvement in depressive symptoms and postdialysis recovery time.

摘要

背景

临床抑郁症和透析后疲劳是肾衰竭患者的重要关注点，会对生活质量和存活率产生负面影响。

研究设计

FREEDOM（后续康复、经济学和日常透析结果测量）研究是一项正在进行的前瞻性队列研究，旨在调查每日（每周 6 次）血液透析（HD）的临床和经济效益。在本中期报告中，作为预先计划的分析的一部分，我们检查了每日 HD 对抑郁症状（使用贝克抑郁量表（BDI）调查测量）和透析后恢复时间（使用先前验证的问卷测量）的长期影响。

地点和参与者

开始每日 HD 并计划进行 12 个月随访的成年患者。

结果和测量

BDI 调查和透析后恢复时间问题在基线时进行，在第 4 个月和第 12 个月评估变化。

结果

共有 239 名参与者入组（意向治疗队列），其中 128 名完成了研究（方案规定队列）。平均年龄为 52 岁，64%为男性，55%有动静脉瘘，90%从中心 HD 治疗转为每日 HD。在方案规定的队列中，BDI 评分在 12 个月内显著下降（11.2 [95%CI，9.6-12.9] 与 7.8 [95%CI，6.5-9.1]；P<0.001）。为了稳健性，进行了意向治疗分析，得出了类似的结果。12 个月期间，有抑郁症状（BDI 评分>10）的患者比例显著下降（41%比 27%；P=0.03）。同样，在方案规定的队列中，透析后恢复时间在 12 个月内显著缩短（476 [95%CI，359-594] 与 63 分钟 [95%CI，32-95]；P<0.001）。意向治疗分析得出了类似的结果。经历长时间透析后恢复时间（>60 分钟）的患者比例也显著下降（81%比 35%；P=0.001）。