Broers Natascha J H, Usvyat Len A, Kooman Jeroen P, van der Sande Frank M, Lacson Eduardo, Kotanko Peter, Maddux Franklin W
Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands.
Nephron. 2015;130(2):105-12. doi: 10.1159/000430814. Epub 2015 May 29.
BACKGROUND/AIM: Physical component summary (PCS) and mental component summary (MCS) scores are associated with hospitalization and mortality in patients with end-stage renal disease. Most studies in these patients are cross-sectional in nature. This study aimed to assess the dynamics of health-related quality of life (HRQOL) over time, as well as determinants of changes in HRQOL. Also, the relation between changes in HRQOL with respect to both hospitalization and mortality was assessed.
A cross-sectional analysis was performed in 77,848 hemodialysis (HD) patients whereas changes in HRQOL were assessed in 8,339 patients over a 1-year time period. HRQOL measurements were assessed with Kidney Disease Quality of Life-36 questionnaires. Also, relevant biomarkers (albumin, creatinine, hemoglobin, sodium) and equilibrated normalized protein catabolic rate (enPCR) were measured.
HRQOL were found to be decreased in HD patients. Nutritional indices like creatinine (r = 0.23; p < 0.0001) and serum albumin (r = 0.21; p < 0.0001) positively correlated with PCS scores. An increase in levels of albumin, creatinine, hemoglobin, enPCR and serum sodium over time are significantly (p < 0.0001) associated with positive changes in PCS scores. Changes in PCS scores were found to be predictive for hospitalization and mortality. The correlates of predictors for MCS scores were less strong compared to that of PCS scores. The strongest positive predictors of MCS scores were age (r = 0.08; p < 0.0001), albumin (r = 0.05; p < 0.0001) and sodium (r = 0.05; p < 0.0001).
Nutritional factors are strongly associated with changes in HRQOL, especially with regard to PCS scores (change over time in HRQOL was an independent predictor of hospitalization and mortality). Increased scores of HRQOL over time are positively associated with survival.
背景/目的：身体状况总结（PCS）和精神状况总结（MCS）评分与终末期肾病患者的住院率和死亡率相关。这些患者的大多数研究本质上是横断面研究。本研究旨在评估健康相关生活质量（HRQOL）随时间的动态变化，以及HRQOL变化的决定因素。此外，还评估了HRQOL变化与住院率和死亡率之间的关系。
对77848例血液透析（HD）患者进行横断面分析，而在8339例患者中评估了1年时间内HRQOL的变化。使用肾病生活质量-36问卷评估HRQOL测量值。此外，还测量了相关生物标志物（白蛋白、肌酐、血红蛋白、钠）和平衡归一化蛋白分解代谢率（enPCR）。
发现HD患者的HRQOL下降。肌酐（r = 0.23；p < 0.0001）和血清白蛋白（r = 0.21；p < 0.0001）等营养指标与PCS评分呈正相关。随着时间的推移，白蛋白、肌酐、血红蛋白、enPCR和血清钠水平的升高与PCS评分的积极变化显著相关（p < 0.0001）。发现PCS评分的变化可预测住院率和死亡率。与PCS评分相比，MCS评分预测因素的相关性较弱。MCS评分最强的正预测因素是年龄（r = 0.08；p < 0.0001）、白蛋白（r = 0.05；p < 0.0001）和钠（r = 0.05；p < 0.0001）。
营养因素与HRQOL的变化密切相关，尤其是在PCS评分方面（HRQOL随时间的变化是住院率和死亡率的独立预测因素）。HRQOL随时间得分的增加与生存率呈正相关。
