Amro Amin, Waldum Bård, von der Lippe Nanna, Brekke Fredrik Barth, Dammen Toril, Miaskowski Christine, Os Ingrid
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Nephrology Ullevål, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
J Pain Symptom Manage. 2015 Jan;49(1):27-35. doi: 10.1016/j.jpainsymman.2014.04.005. Epub 2014 May 22.
Patients with end-stage renal disease on dialysis have reduced survival rates compared with the general population. Symptoms are frequent in dialysis patients, and a symptom cluster is defined as two or more related co-occurring symptoms.
The aim of this study was to explore the associations between symptom clusters and mortality in dialysis patients.
In a prospective observational cohort study of dialysis patients (n = 301), Kidney Disease and Quality of Life Short Form and Beck Depression Inventory questionnaires were administered. To generate symptom clusters, principal component analysis with varimax rotation was used on 11 kidney-specific self-reported physical symptoms. A Beck Depression Inventory score of 16 or greater was defined as clinically significant depressive symptoms. Physical and mental component summary scores were generated from Short Form-36. Multivariate Cox regression analysis was used for the survival analysis, Kaplan-Meier curves and log-rank statistics were applied to compare survival rates between the groups.
Three different symptom clusters were identified; one included loading of several uremic symptoms. In multivariate analyses and after adjustment for health-related quality of life and depressive symptoms, the worst perceived quartile of the "uremic" symptom cluster independently predicted all-cause mortality (hazard ratio 2.47, 95% CI 1.44-4.22, P = 0.001) compared with the other quartiles during a follow-up period that ranged from four to 52 months. The two other symptom clusters ("neuromuscular" and "skin") or the individual symptoms did not predict mortality.
Clustering of uremic symptoms predicted mortality. Assessing co-occurring symptoms rather than single symptoms may help to identify dialysis patients at high risk for mortality.
与普通人群相比，接受透析的终末期肾病患者生存率较低。透析患者症状频发，症状群被定义为两种或更多相关的同时出现的症状。
本研究旨在探讨透析患者症状群与死亡率之间的关联。
在一项对透析患者（n = 301）的前瞻性观察队列研究中，使用了肾脏疾病与生活质量简表及贝克抑郁量表问卷。为了生成症状群，对11种肾脏特异性自我报告的身体症状进行了主成分分析并采用方差最大化旋转。贝克抑郁量表得分16分及以上被定义为具有临床意义的抑郁症状。从简明健康状况调查问卷-36中生成身体和心理成分汇总得分。采用多变量Cox回归分析进行生存分析，应用Kaplan-Meier曲线和对数秩统计量比较各组之间的生存率。
识别出三种不同的症状群；其中一个包含几种尿毒症症状。在多变量分析以及对健康相关生活质量和抑郁症状进行调整后，在为期4至52个月的随访期间，与其他四分位数相比，“尿毒症”症状群中自我感觉最差的四分位数独立预测全因死亡率（风险比2.47，95%可信区间1.44 - 4.22，P = 0.001）。另外两个症状群（“神经肌肉”和“皮肤”）或单个症状均不能预测死亡率。
尿毒症症状群可预测死亡率。评估同时出现的症状而非单一症状可能有助于识别死亡风险高的透析患者。
