Lim Haikel A, Yu Zhenli, Kang Augustine W C, Foo Marjorie W Y, Griva Konstadina
Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Department of Psychology, National University of Singapore, Block AS4, #02-07, 9 Arts Link, Singapore, 117570, Singapore.
Int J Behav Med. 2016 Aug;23(4):507-14. doi: 10.1007/s12529-015-9521-z.
Quality of life (QOL) impairments are common in patients undergoing dialysis, and have been strongly associated with significant clinical outcomes like mortality and morbidity. Despite this, little is known about the course of QOL over time, especially for patients on peritoneal dialysis (PD).
This prospective study was set to explore course and determinants of QOL over 12 months in PD patients.
A total of 115 PD patients completed the SF-12 and Kidney Disease Quality of Life Short Form (KDQOL-SF) at baseline and 12 months later. Intra-individual changes in physical (physical component summary, PCS), mental (mental component summary, MCS), and Kidney Disease Component Summary scores (KDCS) were identified based on the minimally important clinical difference threshold. Clinical information was extracted from medical records.
Of the patients, 74-80 % reported physical QOL impairments, as compared to 29-33 % who reported mental/emotional QOL impairments. PCS and MCS scores remained stable across 12 months. Significant deterioration was noted in the domains of patient satisfaction, staff encouragement, and social support, while there were significant increases in the perceived effects of kidney disease. Intra-individual trajectory analyses indicated that one in three patients reported deteriorating QOL. No sociodemographic or clinical variables were found to be associated with course of outcomes.
Although PD offers the convenience of home-based care, it is associated with persisting QOL impairments and diminishing QOL over time, especially in domains related to quality of care and support. This highlights the need for improving or maintaining standards of care and support for PD patients as they become increasingly established on their regimes.
生活质量（QOL）受损在接受透析的患者中很常见，并且与死亡率和发病率等重大临床结局密切相关。尽管如此，人们对生活质量随时间的变化过程知之甚少，尤其是对于腹膜透析（PD）患者。
这项前瞻性研究旨在探讨PD患者12个月内生活质量的变化过程及其决定因素。
共有115名PD患者在基线时和12个月后完成了SF-12和肾脏病生活质量简表（KDQOL-SF）。根据最小重要临床差异阈值确定身体（身体成分总结，PCS）、心理（心理成分总结，MCS）和肾脏病成分总结评分（KDCS）的个体内变化。从医疗记录中提取临床信息。
在这些患者中，74%-80%报告有身体生活质量受损，相比之下，29%-33%报告有心理/情绪生活质量受损。PCS和MCS评分在12个月内保持稳定。在患者满意度、工作人员鼓励和社会支持方面出现了显著恶化，而在肾脏病的感知影响方面有显著增加。个体内轨迹分析表明，三分之一的患者报告生活质量恶化。未发现社会人口统计学或临床变量与结局过程相关。
尽管PD提供了居家护理的便利，但它与持续的生活质量受损以及随着时间推移生活质量下降有关，特别是在与护理和支持质量相关的领域。这凸显了随着PD患者越来越适应其治疗方案，需要改善或维持对他们的护理和支持标准。
