Nephrology, Dialysis, Hypertension and Renal Transplantation Unit, Azienda Ospedaliera, Reggio Calabria, Italy.
Perit Dial Int. 2012 Sep-Oct;32(5):531-6. doi: 10.3747/pdi.2010.00250. Epub 2012 Sep 1.
Decline in physical function is commonly observed in patients with kidney failure on dialysis. Whether lung congestion, a predictable consequence of cardiomyopathy and fluid overload, may contribute to the low physical functioning of these patients has not been investigated.
In 51 peritoneal dialysis (PD) patients, we investigated the cross-sectional association between the physical functioning scale of the Kidney Disease Quality of Life Short Form (KDQOL-SF: Rand Corporation, Santa Monica, CA, USA) and an ultrasonographic measure of lung water recently validated in dialysis patients. The relationship between physical functioning and lung water was also analyzed taking into account the severity of dyspnea measured using the New York Heart Association (NYHA) classification currently used to grade the severity of heart failure.
Evidence of moderate-to-severe lung congestion was evident in 20 patients, and this alteration was asymptomatic (that is, NHYHA class I) in 11 patients (55%). On univariate analysis, physical functioning was inversely associated with lung water (r = -0.48, p < 0.001), age (r = -0.44, p = 0.001), previous cardiovascular events (r = -0.46, p = 0.001), and fibrinogen (r = -0.34, p = 0.02). Physical functioning was directly associated with blood pressure, the strongest association being with diastolic blood pressure (r = 0.38, p = 0.006). The NYHA class correlated inversely with physical functioning (r = -0.51, p < 0.001). In multiple regression analysis, only lung water and fibrinogen remained independent correlates of physical functioning. The NYHA class failed to maintain its independent association.
This cross-sectional study supports the hypothesis that symptomatic and asymptomatic lung congestion is a relevant factor in the poor physical functioning of patients on PD.
透析患者常出现身体功能下降。目前尚未研究充血性心力衰竭和液体超负荷的必然结果——肺充血是否会导致这些患者的身体功能降低。
在 51 名腹膜透析（PD）患者中，我们研究了肾脏病生活质量简表（KDQOL-SF：兰德公司，美国加利福尼亚州圣莫尼卡）身体功能量表与最近在透析患者中验证的超声肺水测量值之间的横断面关联。还考虑了使用目前用于分级心力衰竭严重程度的纽约心脏协会（NYHA）分类法测量的呼吸困难严重程度，分析了身体功能与肺水之间的关系。
20 名患者存在中重度肺充血的证据，其中 11 名（55%）患者无症状（即 NYHA Ⅰ级）。单因素分析显示，身体功能与肺水呈负相关（r=-0.48，p<0.001），与年龄（r=-0.44，p=0.001）、既往心血管事件（r=-0.46，p=0.001）和纤维蛋白原（r=-0.34，p=0.02）呈负相关。身体功能与血压呈正相关，与舒张压的相关性最强（r=0.38，p=0.006）。NYHA 分级与身体功能呈负相关（r=-0.51，p<0.001）。多元回归分析显示，只有肺水和纤维蛋白原仍然是身体功能的独立相关因素。NYHA 分级未能保持其独立相关性。
这项横断面研究支持这样一种假设，即有症状和无症状的肺充血是 PD 患者身体功能较差的一个相关因素。
