Cohen Scott D, Kimmel Paul L
Division of Renal Diseases and Hypertension, George Washington University, Washington, District of Columbia.
Semin Dial. 2013 Nov-Dec;26(6):697-701. doi: 10.1111/sdi.12124. Epub 2013 Sep 19.
The perceived quality of life (QOL) and mental health of dialysis patients can have a significant impact on clinical outcomes in the end-stage renal disease (ESRD) population. There is growing interest in increasing dialysis frequency, dose and duration to achieve more adequate dialysis clearance, particularly of middle molecules. Over the past decade, there has been an interest in earlier initiation of dialysis; however, the results of the IDEAL study call this practice into question, and showed no difference in QOL scores between the early-start and later start dialysis patients. There are inconsistent results regarding the impact of increased dialysis frequency and dose on patients' perceived health-related QOL (HRQOL). Some studies of daily nocturnal dialysis patients show a positive impact on QOL, while others show no significant difference. The disparate outcomes may be partly related to differences in the demographic characteristics of the study populations and the specific questionnaires used to measure HRQOL. Additional research is necessary to determine whether changes in dialysis frequency, timing, and dose can positively or negatively impact patients' perceptions of their QOL and mental health.
透析患者的生活质量（QOL）感知和心理健康会对终末期肾病（ESRD）人群的临床结局产生重大影响。人们越来越关注增加透析频率、剂量和时长，以实现更充分的透析清除，尤其是对中分子物质的清除。在过去十年里，人们对更早开始透析产生了兴趣；然而，IDEAL研究的结果对此做法提出了质疑，该研究表明早期开始透析和晚期开始透析的患者在生活质量评分上没有差异。关于增加透析频率和剂量对患者健康相关生活质量（HRQOL）感知的影响，结果并不一致。一些针对每日夜间透析患者的研究显示对生活质量有积极影响，而其他研究则显示无显著差异。这些不同的结果可能部分与研究人群的人口统计学特征差异以及用于测量HRQOL的具体问卷有关。需要进行更多研究来确定透析频率、时机和剂量的变化是否会对患者对其生活质量和心理健康的感知产生正面或负面影响。
