Saad Marc M, El Douaihy Youssef, Boumitri Christine, Rondla Chetana, Moussaly Elias, Daoud Magda, El Sayegh Suzanne E
Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA.
Nephrology, Emory University Hospital, Atlanta, GA, USA.
Int J Nephrol Renovasc Dis. 2015 Sep 3;8:119-23. doi: 10.2147/IJNRD.S84929. eCollection 2015.
Assessment of quality of life (QOL) of end-stage renal disease (ESRD) patients (physical, mental, and social well-being) has become an essential tool to develop better plans of care. Objective of this study is to determine which demographic and biochemical parameters correlate with the QOL scores in patients with ESRD on hemodialysis (HD) using Kidney Disease QOL-36 surveys (KDQOL).
A retrospective chart review of all ESRD patients who underwent HD at an outpatient center. The five components of the KDQOL were the primary end points of this study (burden of kidney disease, symptoms and problems, effects of kidney disease on daily life, mental component survey, and physical component survey). Scores were grouped into three categories (below average, average, and above average). In addition to demographics (age, sex, and race), the independent variables such as weight gain, number of years on dialysis, urea reduction ratio, calcium, phosphorus, parathyroid hormone, albumin, and hemoglobin in the serum were collected. Chi-square analysis for dependent variables and the nominal independent variables was used, and analysis of variance analysis was used for continuous independent variables. Ordinal regression using PLUM (polytomous universal model) method was used to weigh out possible effects of confounders.
The cohort size was 111 patients. Mean age was 61.8 (±15.5) years; there were more males than females (64.9% vs 35.1%), the mean time-on-dialysis at the time of the study was 4.3 (4.8) years. Approximately two-thirds of the responses on all five domains of the questionnaire ranked average when compared to the national numbers. The remainders were split between above average (20.6%) and below average (13.4%). In our cohort, no relationships were statistically significant between the five dependent variables of interest and the independent variables by chi-square- and t-test analyses. This was further confirmed by regression analysis. Of note, sex carried the strongest statistical significance (with a P-value of 0.16) as a predictor of "the burden of kidney disease on daily life" in ordinal regression.
Prior studies have shown variables such as serum phosphate level, intradialytic weight gain, and dialysis adequacy are associated with lower KDQOL scores; however, this was not evident in our analysis likely due to smaller sample size. Larger size studies are required to better understand the predictors of QOL in ESRD patients on HD.
评估终末期肾病（ESRD）患者的生活质量（QOL，包括身体、心理和社会幸福感）已成为制定更好护理计划的重要工具。本研究的目的是使用肾病生活质量36项调查问卷（KDQOL）来确定哪些人口统计学和生化参数与接受血液透析（HD）的ESRD患者的QOL评分相关。
对在门诊中心接受HD治疗的所有ESRD患者进行回顾性病历审查。KDQOL的五个组成部分是本研究的主要终点（肾病负担、症状和问题、肾病对日常生活的影响、心理成分调查和身体成分调查）。评分分为三类（低于平均水平、平均水平和高于平均水平）。除了人口统计学数据（年龄、性别和种族）外，还收集了血清中的体重增加、透析年限、尿素清除率、钙、磷、甲状旁腺激素、白蛋白和血红蛋白等自变量。对因变量和名义自变量进行卡方分析，对连续自变量进行方差分析。使用PLUM（多分类通用模型）方法进行有序回归，以衡量混杂因素的可能影响。
队列规模为111名患者。平均年龄为61.8（±15.5）岁；男性多于女性（64.9%对35.1%），研究时的平均透析时间为4.3（4.8）年。与全国数据相比，问卷所有五个领域中约三分之二的回答排名为平均水平。其余回答在高于平均水平（20.6%）和低于平均水平（13.4%）之间分布。在我们的队列中，通过卡方检验和t检验分析，五个感兴趣的因变量与自变量之间没有统计学上的显著关系。回归分析进一步证实了这一点。值得注意的是，在有序回归中，性别作为“肾病对日常生活的负担”的预测因素具有最强的统计学意义（P值为0.16）。
先前的研究表明，血清磷酸盐水平、透析期间体重增加和透析充分性等变量与较低的KDQOL评分相关；然而，由于样本量较小，这在我们的分析中并不明显。需要更大规模的研究来更好地了解接受HD治疗的ESRD患者生活质量的预测因素。
