Chan Ramony, Brooks Robert, Erlich Jonathan, Gallagher Martin, Snelling Paul, Chow Josephine, Suranyi Michael
Consultation Liaison Psychiatry, Liverpool Hospital, Locked Bag 7103, Liverpool, BC, NSW, 1871, Australia,
Qual Life Res. 2014 Mar;23(2):677-86. doi: 10.1007/s11136-013-0499-1. Epub 2013 Aug 13.
The aims of this study were to: (1) validate the proximal-distal (PD) model in predialysis and early dialysis and (2) examine the role of hemoglobin on quality of life (QoL) in these patient groups.
Cross-sectional observational studies of 475 participants recruited from four major university teaching hospitals were conducted. The multi-sample structural equation modeling with latent composite techniques was employed to test the PD model. Seven factors were measured, including QoL, positive affect, depression, physical functioning, kidney disease symptoms, comorbidity and hemoglobin.
The results showed that both the equality-constrained and equality-unconstrained PD models were supported by fit statistics. The chi square difference test of the two models was non-significant, indicating that the PD model was consistent across groups. The alternative models were rejected by fit statistics, suggesting that hemoglobin does not impact on psychological states but QoL.
This study validates the PD model across the end-stage renal disease (ESRD) patient groups and shows a hierarchical causal relationship between clinical factors, physical functioning, psychological states and QoL, with hemoglobin as an exception. This model provides an empirical framework for integrating and studying a range of clinical factors and health outcomes in ESRD.
本研究的目的是：（1）在透析前和早期透析阶段验证近端-远端（PD）模型，以及（2）研究血红蛋白在这些患者群体的生活质量（QoL）中的作用。
对从四家主要大学教学医院招募的475名参与者进行横断面观察研究。采用具有潜在复合技术的多样本结构方程模型来检验PD模型。测量了七个因素，包括生活质量、积极情绪、抑郁、身体功能、肾病症状、合并症和血红蛋白。
结果表明，拟合统计支持平等约束和非平等约束的PD模型。两个模型的卡方差异检验无显著性，表明PD模型在各组间具有一致性。替代模型被拟合统计拒绝，表明血红蛋白不影响心理状态，但影响生活质量。
本研究在终末期肾病（ESRD）患者群体中验证了PD模型，并显示了临床因素、身体功能、心理状态和生活质量之间的层次因果关系，但血红蛋白除外。该模型为整合和研究ESRD中的一系列临床因素和健康结果提供了一个实证框架。
