de Goeij Moniek C M, Ocak Gurbey, Rotmans Joris I, Eijgenraam Jan-Willem, Dekker Friedo W, Halbesma Nynke
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
PLoS One. 2014 Apr 3;9(4):e93069. doi: 10.1371/journal.pone.0093069. eCollection 2014.
Concerns are present on the limited value of renal function alone in defining the optimal moment to start dialysis. Disease-related symptoms and health-related quality of life (HRQOL) may have additional clinical value in defining this moment, but little is known about how these parameters change during pre-dialysis care. The aims of our study were to describe the course of symptoms and HRQOL during pre-dialysis care and to investigate their association with poor health outcomes.
In the prospective PREPARE-2 cohort, incident patients starting specialized pre-dialysis care were included when referred to one of the 25 participating Dutch outpatient clinics (2004-2011). In the present analysis, 436 patients with data available on symptoms and HRQOL were included. Clinical data, symptoms (revised illness perception questionnaire), and HRQOL (short form-36 questionnaire; physical and mental summary score) were collected every 6-month interval. A time-dependent Cox proportional hazard model was used to associate symptoms and HRQOL with the combined poor health outcome (i.e. starting dialysis, receiving a kidney transplant, and death).
All symptoms increased, especially fatigue and loss of strength, and both the physical and mental summary score decreased over time, with the most pronounced change during the last 6-12 months of follow-up. Furthermore, each additional symptom (adjusted HR 1.04 (95% CI, 1.00-1.09)) and each 3-point lower physical and mental summary score (adjusted HR 1.04 (1.02-1.06) and 1.04 (1.02-1.06) respectively) were associated with a higher risk of reaching the combined poor health outcome within the subsequent 6 months.
The number of symptoms increased and both the physical and mental HRQOL score decreased during pre-dialysis care and these changes were associated with starting dialysis, receiving a kidney transplant, and death. These results may indicate that symptoms and HRQOL are good markers for the medical condition and disease stage of pre-dialysis patients.
人们担心仅依靠肾功能来确定开始透析的最佳时机价值有限。疾病相关症状和健康相关生活质量（HRQOL）在确定这一时机方面可能具有额外的临床价值，但对于这些参数在透析前护理期间如何变化知之甚少。我们研究的目的是描述透析前护理期间症状和HRQOL的变化过程，并调查它们与不良健康结局的关联。
在前瞻性PREPARE - 2队列中，当转诊至25家参与研究的荷兰门诊诊所之一（2004 - 2011年）时，纳入开始接受专门透析前护理的初诊患者。在本次分析中，纳入了436例有症状和HRQOL数据的患者。每6个月收集一次临床数据、症状（修订后的疾病认知问卷）和HRQOL（简短健康调查问卷；身体和心理总结评分）。使用时间依赖性Cox比例风险模型将症状和HRQOL与综合不良健康结局（即开始透析、接受肾移植和死亡）相关联。
所有症状均增加，尤其是疲劳和体力下降，并且身体和心理总结评分均随时间下降，在随访的最后6 - 12个月变化最为明显。此外，每增加一种症状（调整后风险比1.04（95%置信区间，1.00 - 1.09））以及身体和心理总结评分每降低3分（分别调整后风险比1.04（1.02 - 1.06）和1.04（1.02 - 1.06））与随后6个月内达到综合不良健康结局的较高风险相关。
在透析前护理期间，症状数量增加，身体和心理HRQOL评分均下降，并与开始透析、接受肾移植和死亡相关。这些结果可能表明症状和HRQOL是透析前患者病情和疾病阶段的良好指标。
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