印度终末期肾病患者中血液透析与腹膜透析患者的结局及生活质量比较
Comparison of Outcomes and Quality of Life between Hemodialysis and Peritoneal Dialysis Patients in Indian ESRD Population.
作者信息
Makkar Vikas, Kumar Manish, Mahajan Rajesh, Khaira N S
机构信息
Associate Professor, Department of Nephrology, Dayanand Medical College and Hospital , Ludhiana, India .
Ex-Resident, Department of Medicine, Dayanand Medical College and Hospital , Ludhiana, India .
出版信息
J Clin Diagn Res. 2015 Mar;9(3):OC28-31. doi: 10.7860/JCDR/2015/11472.5709. Epub 2015 Mar 1.
BACKGROUND
Hemodialysis (HD) and peritoneal dialysis (PD) are important renal replacement treatments in end stage renal disease (ESRD). There is paucity of data comparing outcomes and quality of life (QOL) between the two modalities in Indian scenario.
MATERIALS AND METHODS
We followed 60 End stage renal disease patients (30 CAPD and 30 Maintenance hemodialysis) for a period of one year. Patients were analysed and compared for complications, physical quality of life and psychological well being with a two part self reported questionnaire at baseline and subsequently at six and twelve months. For the physical component appropriate sections of the McMaster Health Index Questionnaire (MHIQ) and for psychological component Psychological General Well-Being Index (PGWB) developed by Dupey was applied.
RESULTS
The number of males and females in both groups were comparable (p-value > 0.05).The prevalence of diabetes mellitus, coronary artery disease, obesity and ischaemic heart disease was comparable in both groups (p-value>0.05). Significantly higher mortality was observed in patients undergoing HD (20% vs 0 %, p-value <0.05) at the end of study. At the end of study, 16.6% of patients undergoing HD were found to be anti HCV positive as compared to 3.33% in CAPD. Six episodes of CAPD peritonitis were observed (0.2 episodes per catheter year). Significantly higher number of CAPD patients had negative responses between 2-4 at baseline and subsequently on follow ups in Part A of QOL questionnaire(86.7 vs 23.3 % at baseline, 80 vs 26.7% at 6 months, 80 vs16.7 % at 12 months; p <0.05 ). Mean score in Part B of questionnaire was significantly higher in CAPD patients at baseline and at all follow ups (66.7±11 vs 50.1±17 at baseline, 66.7±12.1 vs 53.32±16.3 at 6 months, 65.3±9.5 vs 48.8±16.7 at 12 months , p <0.05) .
CONCLUSION
CAPD patients have significantly better quality of life in physical as well as psychological aspects and have significantly lower mortality when compared with hemodialysis patients.
背景
血液透析（HD）和腹膜透析（PD）是终末期肾病（ESRD）重要的肾脏替代治疗方法。在印度的情况下，比较这两种治疗方式的疗效和生活质量（QOL）的数据较少。
材料与方法
我们对60例终末期肾病患者（30例持续性非卧床腹膜透析患者和30例维持性血液透析患者）进行了为期一年的随访。在基线时以及随后的6个月和12个月时，使用两部分的自我报告问卷对患者的并发症、身体生活质量和心理健康状况进行分析和比较。对于身体部分，应用麦克马斯特健康指数问卷（MHIQ）的适当部分；对于心理部分，应用由杜佩伊编制的心理总体幸福感指数（PGWB）。
结果
两组中男性和女性的数量相当（p值>0.05）。两组中糖尿病、冠状动脉疾病、肥胖症和缺血性心脏病的患病率相当（p值>0.05）。在研究结束时，接受血液透析的患者死亡率显著更高（20%对0%，p值<0.05）。在研究结束时，发现接受血液透析的患者中有16.6%抗丙型肝炎病毒呈阳性，而持续性非卧床腹膜透析患者中这一比例为3.33%。观察到6例持续性非卧床腹膜透析腹膜炎病例（每根导管每年0.2例）。在生活质量问卷A部分的基线及随后随访中，持续性非卧床腹膜透析患者中负面回答的数量显著更多（基线时为86.7%对23.3%，6个月时为80%对26.7%，12个月时为80%对16.7%；p<0.05）。在问卷B部分，持续性非卧床腹膜透析患者在基线及所有随访时的平均得分显著更高（基线时为66.7±11对50.1±17,6个月时为66.7±12.1对53.32±16.3,12个月时为65.3±9.
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