Center for Drug and Food Clinical Evaluation, Osaka City University Hospital, Osaka, Japan.
J Ren Nutr. 2013 Sep;23(5):340-7. doi: 10.1053/j.jrn.2012.12.008. Epub 2013 Feb 27.
In the present study, we assessed the associations among fatigue, quality of life (QOL), clinical parameters, and body mass index (BMI) with autonomic function in end-stage renal disease (ESRD) patients undergoing hemodialysis as well as fatigue-free healthy subjects.
This was a case-control study. This study compared autonomic function in ESRD patients (n = 192) to that of healthy subjects (n = 282) and evaluated its association with fatigue, QOL, and clinical parameters such as glucose, albumin, cholesterol, and BMI. Fatigue was evaluated by a recently established fatigue questionnaire and performance status, and QOL was evaluated with the kidney disease QOL questionnaire. With regards to autonomic function, spontaneous beat-to-beat variations were measured, according to time- (standard deviation of all normal a-wave intervals [CVa-a%]) and frequency domains (low frequency [LF] power, high frequency [HF] power, and LF/HF ratio) with acceleration plethysmography.
CVa-a%, LF power, HF power, and LF/HF ratio were significantly lower in ESRD patients than healthy subjects. There were significant inverse correlations between these factors and age in healthy subjects, but not in ESRD patients. Although the fatigue score was not associated with any autonomic parameters, ESRD patients with impaired performance status exhibited a significantly lower LF/HF ratio. Moreover, in ESRD patients, the LF/HF ratio was significantly and positively associated with several components of QOL, including physical functioning and role emotional, independent of other clinical parameters and BMI.
Impaired autonomic function is significantly associated with fatigue and impaired QOL in dialysis patients.
本研究旨在评估终末期肾病（ESRD）血液透析患者与无疲劳的健康受试者之间的疲劳、生活质量（QOL）、临床参数和体重指数（BMI）与自主神经功能之间的关系。
这是一项病例对照研究。本研究比较了 ESRD 患者（n=192）和健康受试者（n=282）的自主神经功能，并评估了其与疲劳、QOL 和临床参数（如血糖、白蛋白、胆固醇和 BMI）的关系。疲劳采用新建立的疲劳问卷和表现状态进行评估，QOL 采用肾脏病生活质量问卷进行评估。在自主神经功能方面，采用加速度体积描记法测量根据时间（所有正常 a 波间隔的标准差 [CVa-a%]）和频率域（低频 [LF] 功率、高频 [HF] 功率和 LF/HF 比）的自主神经功能。
ESRD 患者的 CVa-a%、LF 功率、HF 功率和 LF/HF 比值明显低于健康受试者。在健康受试者中，这些因素与年龄呈显著负相关，但在 ESRD 患者中并非如此。尽管疲劳评分与任何自主神经参数均无相关性，但表现状态受损的 ESRD 患者的 LF/HF 比值明显较低。此外，在 ESRD 患者中，LF/HF 比值与包括身体机能和角色情感在内的多个 QOL 成分呈显著正相关，独立于其他临床参数和 BMI。
自主神经功能受损与透析患者的疲劳和 QOL 受损显著相关。
