Ortiz Fernanda, Aronen Pasi, Koskinen Petri K, Malmström Raija K, Finne Patrik, Honkanen Eero O, Sintonen Harri, Roine Risto P
Division of Nephrology, Department of Internal Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Transpl Int. 2014 Nov;27(11):1143-51. doi: 10.1111/tri.12394. Epub 2014 Aug 28.
The influence of dialysis modalities on HRQoL before and after kidney transplantation (KT) and the role of adherence to medication on HRQoL have not been fully studied. Sixty four dialysis patients who answered the 15D HRQoL survey during dialysis were surveyed again after KT. Adherence and employment were also investigated. The mean 15D score was highest among home hemodialysis patients (HHD) and lowest among in-center hemodialysis patients (icHD). After KT, the mean 15D score improved significantly in 78.6% of peritoneal dialysis patients (PD), 47.6% of HHD, and 53.8% of icHD. Then, mean 15D score remained unchanged in 28.6% of HHD and in 23.1% of icHD patients. A deterioration in the 15D score occurred in 14.3% of PD, 23.1% of icHD, and 23.8% of HHD patients, and this was influenced by the number of pills (P = 0.04). Adherence to medication was the lowest in PD, timing being the most challenging task showing a connection to higher creatinine concentration (never forgot 1.41 mg/dl vs. forgot 2.08 mg/dl P = 0.05). Employed patients had a higher mean 15D score. The icHD and PD patients benefited the most from KT and HHD the least. Low pill burden and employment were linked to a better HRQoL.
透析方式对肾移植（KT）前后健康相关生活质量（HRQoL）的影响以及药物依从性对HRQoL的作用尚未得到充分研究。64名在透析期间回答了15D HRQoL调查问卷的透析患者在KT后再次接受调查。同时还调查了依从性和就业情况。家庭血液透析患者（HHD）的平均15D评分最高，中心血液透析患者（icHD）的平均15D评分最低。KT后，78.6%的腹膜透析患者（PD）、47.6%的HHD患者和53.8%的icHD患者的平均15D评分显著改善。然后，28.6%的HHD患者和23.1%的icHD患者的平均15D评分保持不变。14.3%的PD患者、23.1%的icHD患者和23.8%的HHD患者的15D评分出现恶化，这受到药片数量的影响（P = 0.04）。PD患者的药物依从性最低，按时服药是最具挑战性的任务，且与较高的肌酐浓度有关（从未忘记服药者肌酐浓度为1.41mg/dl，忘记服药者为2.08mg/dl，P = 0.05）。就业患者的平均15D评分较高。icHD和PD患者从KT中获益最大，HHD患者获益最小。低药片负担和就业与更好的HRQoL相关。
