Department of Nephrology, Kaunas University of Medicine, Eivenių 2, 50028 Kaunas, Lithuania.
Medicina (Kaunas). 2010;46(8):531-7.
Mortality rates for patients undergoing maintenance hemodialysis remain high. Published data regarding association between health-related quality of life (HRQOL) and mortality among hemodialysis patients are inconsistent. Very few data are published on the change in HRQOL over time as a predictor of mortality. The aim of this study was to assess whether HRQOL and change of it over time could be considered an independent predictor of mortality in hemodialysis patients.
This prospective observational study enrolled 183 patients undergoing maintenance hemodialysis. HRQOL was measured annually 2004-2008 using a generic Short Form 36 questionnaire. Physical component summary (PSC) and mental component summary (MSC) scores were calculated. The change of the patient's HRQOL over time was calculated as a difference between SF-36 scores of the first and the last HRQOL measurements.
The median follow-up was 48 months (range, 1-72 months). Cutoff values for HRQOL predicting mortality for PSC score was ≥35 and for MSC score was ≥45. In the model adjusted for age, sex, dialysis months, creatinine, albumin and hemoglobin levels, mortality risk decreased by 0.96 (95% CI, 0.95-0.99) for 1-point increase in the baseline PSC score and decreased by 0.97 (95% CI, 0.95-0.98) for 1-point increase in the baseline MSC score. A 1-point decline in the PSC score (relative risk, 1.11; 95% CI, 1.008-1.221) and MSC score (relative risk, 1.07; 95% CI, 1.002-1.149) over the period of follow-up were associated with a significant additional increase in mortality.
Both baseline HRQOL and decline of HRQOL are independent predictors of mortality in hemodialysis patients.
接受维持性血液透析的患者死亡率仍然很高。关于血液透析患者的健康相关生活质量（HRQOL）与死亡率之间的关联，已有文献报道，但结果并不一致。关于 HRQOL 随时间变化作为死亡率预测指标的数据很少。本研究旨在评估 HRQOL 及其随时间的变化是否可作为血液透析患者死亡率的独立预测指标。
这项前瞻性观察性研究纳入了 183 名接受维持性血液透析的患者。2004-2008 年，每年使用通用的 36 项简短健康调查问卷评估 HRQOL。计算生理成分综合评分（PSC）和心理成分综合评分（MSC）。通过计算 SF-36 评分的首次和末次 HRQOL 测量值之间的差值，来评估患者 HRQOL 随时间的变化。
中位随访时间为 48 个月（范围，1-72 个月）。PSC 评分预测死亡率的 HRQOL 截断值为≥35，MSC 评分预测死亡率的 HRQOL 截断值为≥45。在调整年龄、性别、透析月数、肌酐、白蛋白和血红蛋白水平的模型中，PSC 评分基线每增加 1 分，死亡风险降低 0.96（95%CI，0.95-0.99），MSC 评分基线每增加 1 分，死亡风险降低 0.97（95%CI，0.95-0.98）。PSC 评分（相对风险，1.11；95%CI，1.008-1.221）和 MSC 评分（相对风险，1.07；95%CI，1.002-1.149）在随访期间每下降 1 分，与死亡率显著增加相关。
基线 HRQOL 和 HRQOL 的下降均是血液透析患者死亡率的独立预测指标。
