Kang Gun Woo, Lee In Hee, Ahn Ki Sung, Lee Jonghun, Ji Yunmi, Woo Jungmin
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea.
Hemodial Int. 2015 Jul;19(3):439-46. doi: 10.1111/hdi.12271. Epub 2015 Feb 3.
Many patients with end-stage renal disease have significant impairment in health-related quality of life (HRQoL). Most previous studies have focused on clinical factors; however, quality of life can also be affected by psychosocial factors. The aim of this study was to identify the possible predictors of HRQoL among clinical and psychosocial factors in hemodialysis (HD) patients. The study included 101 patients who were undergoing HD. Psychosocial factors were evaluated using the Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Montreal Cognitive Assessment, and Pittsburgh Sleep Quality Index. We also assessed laboratory and clinical factors, including albumin, Kt/V as a marker of dialysis adequacy, normalized protein catabolic rate, and duration of HD. The Euro Quality of Life Questionnaire 5-Dimensional Classification (EQ-5D) was used to evaluate HRQoL. The mean EQ-5D index score was 0.704 ± 0.199. The following variables showed a significant association with the EQ-5D index: age (P < 0.001), depression (P < 0.001), anxiety (P < 0.001), support from friends (P < 0.001), cognitive function (P < 0.001), duration of HD (P = 0.034), triglyceride (P = 0.031), total iron-binding capacity (P = 0.036), and phosphorus (P = 0.037). Multiple regression analysis showed that age (95% confidence interval [CI] -0.008 to -0.002), anxiety (95% CI -0.025 to -0.009), and support from friends (95% CI 0.004 to 0.018) were independent predictors of impaired HRQoL. This study explored determinants of impaired HRQoL in HD patients. We found that impaired HRQoL was independently associated with age, anxiety, and support from friends. We should consider psychosocial as well as clinical factors when evaluating ways to improve HRQoL in HD patients.
许多终末期肾病患者的健康相关生活质量（HRQoL）存在显著损害。以往大多数研究都集中在临床因素上；然而，生活质量也会受到心理社会因素的影响。本研究的目的是确定血液透析（HD）患者临床和心理社会因素中HRQoL的可能预测因素。该研究纳入了101名正在接受HD治疗的患者。使用医院焦虑抑郁量表、感知社会支持多维量表、蒙特利尔认知评估量表和匹兹堡睡眠质量指数对心理社会因素进行评估。我们还评估了实验室和临床因素，包括白蛋白、作为透析充分性标志物的Kt/V、标准化蛋白分解代谢率和HD治疗时间。使用欧洲生活质量问卷5维度分类法（EQ-5D）评估HRQoL。EQ-5D指数的平均得分是0.704±0.199。以下变量与EQ-5D指数显示出显著相关性：年龄（P<0.001）、抑郁（P<0.001）、焦虑（P<0.001）、来自朋友的支持（P<0.001）、认知功能（P<0.001）、HD治疗时间（P = 0.034）、甘油三酯（P = 0.031）、总铁结合力（P = 0.036）和磷（P = 0.037）。多元回归分析表明，年龄（95%置信区间[CI] -0.008至-0.002）、焦虑（95%CI -0.025至-0.009）和来自朋友的支持（95%CI 0.004至0.018）是HRQoL受损的独立预测因素。本研究探讨了HD患者HRQoL受损的决定因素。我们发现HRQoL受损与年龄、焦虑和来自朋友的支持独立相关。在评估改善HD患者HRQoL的方法时，我们应同时考虑心理社会因素和临床因素。
